Atrial Fibrillation ; complications ; drug therapy ; Coronary Artery Disease ; complications ; drug therapy ; Fibrinolytic Agents ; therapeutic use ; Humans

Objective To determine the diagnostic and therapeutic approach of cute cardiac perforation and tamponade complicating percutaneous balloon mitral valvuloplasty. Methods and Results Percutaneous balloon mitral valvuloplasty was performed in 772 patients with rheumatic mitral stenosis from May 1992 to Dec. 2001, 9 were diagnosed cardiac perforation, 2 which developed pericardial tamponade which was successfully controlled by contrast and X ray guided pericardiocentesis using a subxiphoid approach. Conclusions Only a minority of cardiac perforation resulted from PBMV developed pericardial tamponade. The latter could be controlled safely and effectively by contrast and X ray guided pericardiocentesis using a subxiphoid approach.The diagnosis of pericardial tamponade during or after PBMV relies on a strong clinical suspicion, and contrast and X ray guided pericardiocentesis should be carried out without echocardiography for patients in unstable state.

European Society of Hypertension/European Society of Cardiology jointly published new guidelines on diagnosis and treatment of hypertension in 2007.It reflected the the latest developments on comprehensive assessment,treatment modalities and strategies,as well as therapeutic approach for special populations.In addition,the new guidelines updated evaluation.It also stressed the importance of an early,faster and more stringent treatment and aggressive combination therapy.More impartantly,it requested prevention and treatment earlier.It is of great importance for the guidelines to guide the current diagnosis and treatment of hypertension.

Objective To evaluate the prevalence and the predictors of clopidogrel therapy after DES implantation,and to determine the impact of discontinuation of clopidogrel therapy on the occurrence of late stent thrombosis(ST)and very late stent thrombosis.Methods Between July 2003 and June 2005,2 930 consecutive patients treated with PCI and DES implantation in Anzhen hospital were involved in the study,and among them,13 patients died within 3 dys after PCI.A total of 2 704 patients out of the 2 917 patients were followed up successfully for at least 2 years,or mortality.All of the clinical,angiographic and intervention treatment character were recorded.ST was adjudicated by the definition of ARC Dublin.Patients were grouped by the duration of clopidogrel therapy to 4 groups(group 1,12 months).The duration of clopidogrel therapy and the predictors of the premature discontinuation of clopidogrel were evaluated,and the rate of late ST(1 month to 12 months)and very late ST(after 12 months)in the 4 groups were analysised.Results There were 82(3.0%)patients in group 1,333(12.3%)patients in group 2,1 590(58.8%)patients in group 3,and 699(25.9%)patients in group 4.In contrast with group 4,the mean level of total cholesterol were higher,mean LVEF value were lower,more patients were diabetes,less patients were STEMI,and the mean number of DES implantation was less in group 1-3.In group 1 and group 2,most of the discontinuation of clopidogrel therapy(95.1%,85.9% respectively)were directed by patients themselves;and in group 3,71.1% of the patients discortinued clopidogrel therapy on the doctor's order.There was no significant differences among the 3 groups on discontinuation of clopidogrel for bleeding or other operations.By Cox regression,diabetes(OR=1.542,95% CI=1.184-2.008,P=0.001)and number and DES implantation(OR=0.790,95% CI=0.709-0.880,P

Objective To investigate the safety and efficacy of circumferential pulmonary vein linear ablation guided by 3-D mapping system in patients with atrial fibrillation.Methods From April 2003 to March 2006,410 consecutive patients with atrial fibrillation underwent circumferential pulmonary vein linear ablation guided by 3-D mapping system(CARTO system or EnSite NavX TM system).Success was defined as symptomatic atrial tachyarrhythmia free after 3 months washout period.Results 96%of the 410 patients attained the ablation endpoint.After a mean of (12.4?6.8)months' follow-up,clinical success achieved in 77.3% of the patients with paroxysmal atrial fibrillation and 69.4% of the patients with persistent/permanent atrial fibrillation after first-time ablation procedure.The successs rate of the persistent/permanent atrial fibrillation was significantly lower than that of paroxysmal atrial fibrillation.Forty-one of the 103 patients with recurrent atrial fibrillation underwent ablation again.Thirty-one of the 41 patients(75.6%)were atrial tachyarrhythmia free during the follow-up.Severe complications included 4 cases of pericardial tamponade(0.97%)and 3 cases of stroke(0.73%).Pericardial tamponades were relieved by pericardiocentesis.The patients with stroke recovered well without any lingering effects.There was no death case.Conclusion Circumferential pulmonary vein linear ablation guided by 3-D mapping system is an effective therapy for atrial fibrillation patients with an acceptable safety.

Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)in patients with coronary artery disease and diabetes mellitus.Methods The DESIRE(drug-eluting stent impact on revascularization)is a single-center registry comparing coronary revascularization in our institution before and after the introduction of drug-eluting stents.Between July 2001 and June 2002,July 2003 and June 2004,1040 patients were referred for revascularization(PCI or CABG)during hospitalization.Clinical,angiographic,revascularization data clinical condition in hospital and the follow-up results were collected for retrospective analysis.In the present study,patients with diabetes were selected and divided into PCI and CABG groups.The primary endpoint is in-hospital and follow-up major adverse cardiovascular and cerebral events(MACCE).Results Compared with the CABG group,the PCI group had lower in-hospital MACCE rates(P0.05),but the PCI group had higher rates of repeat revascularization than that of the CABG group(P0.05).Conclusion Although PCI has lower in-hospital MACCE rates in diabetic patients,the follow-up MACCE rates of PCI and CABG are comparable,and PCI has even higher rates of repeat revascularization than CABG.With the increasing use of drug eluting stents,PCI might have better performance.

By using the OEC 9600 mobile digital imaging system, 14 coronary stents were successfully implanted in all 13 cases of coronary heart disease. After the procedure,immediate satisfactory angiographic results were obtained without residual stenosis, and chest pain was relieved or disappeared in all cases. No major complications occurred except for groin hematoma in one case,these results suggest that intracoro-nary stenting is a safe and effective management for coronary heart disease.

Objective To explore the feasibility and safety of primary coronary stenting in the patients with coronary heart disease Methods From march 1997 to august 1999, 80 cases with 90 of lesions were selected for primary coronary stenting without the predilation procedure Their efficacy and success rate were analysed Results We smoothly pushed 85 stents into the lesion in the 80 patients, the success rate of primary coronary stenting was 94% with shorter duration of the procedure and lower cost In 3 lesions the stent did not cross the lesion and was successfully retrieved in the guiding catheter, in 1 cases the stent was lost in the systemic circulation with no further complications Conclusions Primary coronary stenting without predilation was safe and feasible in selected patients

Objective To determine the impact of body mass index(BMI)on clinical outcomes in patients underwent coronary revascularization.Methods The DESIRE-plus(Drug-Eluting Stent Impact on Revascularization-plus)was a single-center registry study of coronary revascularization in our institution between 1 July 2004 and 30 September 2005.We analyzed patients with complete data of BMI from the DESIRE-plus trial,grouped by BMI(low BMI group:BMI

Objective To investigate the clinical and electrophysiological characters of atrial fibrillation(AF) originated from superior vena cava(SVC).Methods Patients with SVC-originated AF admitted into our centre during the past 2 years were retrospectively investigated,and their clinical and electrophysiological characters were systematically analyzed.Results The AF in 16 patients(M/F=12/4 cases,mean age of 53.4?10.6 years old,paroxysmal/persistent AF=11/5 cases) were confirmed to be originated from SVC,who contributed to 2.9%(16/545) of total cases underwent AF ablation during the same period.Among the 16 cases,2 patients were diagnosed as SVC-originated AF by surface ECG,and isolation of SVC terminated AF in these 2 patients.In the remaining 14 patients with non-classic surface ECG,AF or organized atrial tachycardia(Ata) still sustained after initial left atrial(LA) ablation.The sustainable AF and Ata were found to be driven by fast activations within SVC,and were terminated by isolation of SVC.The average applications and procedure time for isolating SVC were 6?2 times and 10?3 minutes respectively.The average muscle connections between SVC and LA were 3?1.After a mean period of 6-month-follow-up,only one patient recurred with organized Ata.Except femoral hematoma in one patient,no other complications were found.Conclusion In addition to pulmonary vein and LA,SVC could be the orgin of AF.Therefore,for patient with sustainable AF or organized Ata after initial LA ablation,SVC origin should be put under consideration.