Objective To investigate the efficacy of infusion Diltiazem for patients with refractory angina pectoris. Methods　10 patients with refractory angina pectoris received continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) for 48 hours after cessation of intravenous nitroglycerin and oral β-blokers. Results　With the single therapy of Diltiazem, 7 patients (70%) got satisfied results: 5 were free from and 2 were relieved of symptom; With the combination therapy of Diltiazem and intravenous nitroglycerin 60～120 μg/min after failed with Diltiazem alone, 3 (30%) patietns got satisfied results: 1 was free from and 2 were relieved of symptom. There is no severe side effects, including hypotension, bradycardia, cardiac function deterioration. Acute myocardial infarction, death and emergency interventional therapy did not occurred in all the 10 patients during the therapy period. Coronary angiography were performed in 8 patients within 1 week after the patients were stabled, 5 patients received PTCA and stent implantation and 3 patients received CABG. Conclusions　Continuous intravenous Diltiazem 40～150 μg/min (2.4～9 mg/h) or combination with intravenous nitroglycerin 60～120 μg/min is an efficient and safe therapy for patients with refractory angina pectoris.

Objective　To evaluate the treatment of in-stent restenosis with rotational atherectomy and balloon angioplasty. Methods　The rotational atherectomy and 4～6 atm low pressure balloon angioplasty was performed in 3 patients with in-stent restenosis and follow up after treatment. Results　All cases were succeeded. The bradycardia occurred in one patient was quickly disappeared without treatment, two other patients were found no effect on heart rate, hemodynamic performance, global LV function, or regional wall motion. No complications, angina, death or other coronary event occurred during the follow up for 6～12 months. Two of them was performed coronary angiography after 6 months and showed the diameter of target vessel was less than 30% as compared with that on coronary angiography which performed immedately after operation. Conclusion　The management of in-stent restenosis in target vessels using a combination of rotational atherectomy and balloon angioplasty is safe and efficient.

Objective　The aim of our study was to examine the utility of a mutielectrode basket catheter (MBC) in the mapping and Ablation of atrial tachycardias (ATs). Methods and Results　This study of ATs was conducted in 15 patients. The MBC recording and pacing capabilities, mapping performance and ablation with MBC was evaluated. Stable endocardial electrograms were recorded in 88±4% of electrodes. 64±5% electrode pairs could be used to stimulate the heart. Earliest endocardial activation was recorded from MBC and standard catheters were 41±9 and 45.9±8 m before the onset of P-wave,respectively (P=0.21). Ablation successed in 7 patients (87.5%). Conclusion　The MBC allows comprehensive and reliable endocardial mapping during ATs, which facilitates successful ablation in the patients with ATs.

Objective To study the effect of ulinastatin on no reflow or slow flow in the infarct related artery in patient with acute ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary interventional therapy (PCI).Methods 180 STEMI patients were divided into the control group (n=100) and the ulinastatin treatment group (n=80).The control group received conventional PCI treatment and the treatment group received conventional PCI treatment plus ulinastatin. The level of serum inflammatory factors IL-6,IL-10,superoxide converting enzyme,the infarct related coronary artery reperfusion TIMI flow grade (TFG) and myocardial perfusion grade (TMPG),the results of postoperative cardiac ultrasound examination and clinical outcomes were compared between the two groups.Results Compared with the control group,the level of IL-6 was decreased,while the levels of IL-10 and superoxide converting enzyme were increased significantly in the ulinastatin treatment group(P<0.05).The TFG and TMPG of the infarct related vessels were increased significantly in the ulinastatin treatment group. The left ventricular end diastolic diameter[(54.6 ± 5.2 mm vs. (50.4±4.6) mm,P=0.046)]and left ventricular ejection fraction [(58.4±10.2) % vs. (62.2±9.8) % P=0.048] showed statistical difference between the two groups.Compared to the control,the major cardiovascular event rate of the treatment group during hospitalization (1% vs. 5%, P=0.038), after one month (1.2% vs. 3%,P=0.046) and 6 months (3% vs 12%,P=0.018) were all significantly lower .There was no significant difference in mortality between the 2 groups.Conclusion Ulinastatin may lower the incidence of no flow and slow flow after emergency PCI,improve heart function and the lower the rates of MACE.

Objective To analyze the correlation between the pressure volume parameters and cardiac function in terms of New York Heart Association(NYHA) classification in patients with pulmonary arterial hypertension. Methods Among 36 patients with pulmonary hypertension admitted in our center between April 2015 to June 2016, right heart catheterization recording right atrial pressure curve,right ventricular pressure curve,pulmonary arterial pressure and oxygen saturation curve in different parts was performal.All patients recived underwent cardiac MRI examination to obtain a single cardiac cycle and the use of Mass software to measure right ventricular volume continuously and right ventricular pressure-volume loop parameters were then obtained. Patients were divided into different groups according to the NYHA functional classification, and the correlation between the parameters of each group and the cardiac function classes a were analyzed. Results Compare to patients with NYHA class Ⅰheart function,patients with NYHA heart function class Ⅱ and class Ⅲ had significantly higher right ventricular end diastolic pressure(P < 0.05)and higher right ventricular systolic pressure (P < 0.01). Spearman correlation analysis showed that cardiac function of NYHA classⅠ,Ⅱ and Ⅲhad position correlation with RVESV,RVEDP and RVESP wheras negative correlation with RVEDV. ROC curve analysis showed that,when the patients were divided into 2 groups as NYHAⅠvs. NYHA class Ⅱ + Ⅲ,NYHA classification for predicting the outcome of the NYHA class Ⅱ + Ⅲ level, pulmonary artery elasticity and right ventricular end systolic pressure had larger area under curves respectively. Conclusions Pressure-volume parameters of right ventricles are more objective indicators for cardiac function assessment for pulmonary hypertension patients and evaluation of disease progression especialy in patients with mild symptoms.

Objective To understand the treatment circumstance of ST-elevation myocardial Infarction (STEMI) patients at public hospitals in Shenzhen.Methods Directed by Public Hospital Administration at Shenzhen Municipality (PHASM) and led by Chest Pain Treatment Quality Control Center at Shenzhen People's Hospital (CPTQCC-SZ),25 public hospitals in Shenzhen, including 15 PCI-capable hospitals and 10 non-PCI-capable hospitals,we investigated on the overall treatment conditions and the STEMI patient treatment situations from October to December 2015 in these hospitals. A regression analysis was performed between a few factors and the success rate of STEMI treatment was reviewed. Results 383 STEMI cases twere registered between October to December 2015 in the 25 public hospitals in Shenzhen,with 324 case treated in PCI-capable hospitals and 59 cases in non-PCI-capable hospitals. There were statistical differences between the PCI-capable hospitals and non-PCI-capable hospital in fields of total number of senior cardiologists (work year ≥ 3 year),total number of beds in general cardiology beds and number of beds in cccu(all P<0.01). There was no difference in the time of obtaining the first ECG at patient arrival between hospitals(P=0.052).Time for laboratory results availability for troporin was significantly shorter in PCI-capable hospital[(25.0±4.2)min vs.(58.0±2.8)min,P=0.002] .Among the PCI-capable hospitals,the mean D-to-B time was 320 minutes, and mean F-to-B time was 380 minutes. In non-PCI-capable hospitals,D-to-N time ranged from 20 to 350 minutes and F-to-N time ranged from 25 to 380 minutes. Conclusions There are gaps among the overall conditions of the public hospitals in Shenzhen. The overall conditions and chest pain treatment conditions of non-PCI-capable hospitals had bigger gaps with PCI-capable hospitals.

Objective To evaluate the clinical safety and efficacy of GuidezillaTM guide extension catheter during complex coronary percutaneous coronary intervention(PCI). Methods A total of 13 patients were included in the studywho presented with complex coronary lesions during PCI. Stents or balloons could not be delivered to these complex lesions with conventional approach and GuidezillaTM guide extension catheters were used. Results Among these 13 patients,there were 7 CTO lesions,7 calcified lesions, 6 tortuous lesions,8 diffuse lesions,8 distal lesions and 8 lesions with pre-existing stents. PCI success rate was 100% .In one patient,GuidezillaTM guide extension catheter was obstructed which were relieved after stent implantation. There was no major adverse cardiac event(MACE) during follow-up.Conclusions The GuidezillaTM guide extension catheter was safe and effective for PCI of complex coronary artery lesions.

Objective To summarize the clinical experience and efficacy of interventional therapy for pediatric congenital heart disease(CHD) with the Amplatzer Duct Occluder Ⅱ (ADO-Ⅱ). Methods A total of 24 patients had received intervention of CHD with the ADO-Ⅱ,including 18 patients of patent ductus arteriosus(PDA),2 patients of ventricular septal defect(VSD) of muscular part,and 4 patients of coronary artery fistula.All patients were screened by transthoracic echocardiogram before the operations.preoperative. Transthoracic echocardiography was performed to determine the device position, residual shunt and procedural complications during and after ADO-Ⅱ implantation.Results 16 patients with PAD had suecessful transcatheter closure without residual shunt and other complications during the follow-up.Minimal residual shunt was found in 2 PDA patients immediately after the occlusion which became undetectable on control echocardiography the day after operation.3 coronary artery fistula patients had suecessful transcatheter closure without residual shunts,and minimal residual shunt was found in 1 patient with coronary artery fistula at 1 month follow up.All the 2 of VSD patients had suecessful transcatheter closure without residual shunts. No complication and no atrioventricular conduction block were found in these 2 patients. Conclusions Transcatheter closure using the ADO-Ⅱ is safe and effective for interventional therapy for pediatric congenital heart disease.

Objective To compare the incidence of contrast-induced acute kidney injury(CI-AKI) following iso-osmolar iodixanol or low-osmolar iohexol administration in patients with acute myocardial infarction(AMI)undergoing emergent percutaneous coronary intervention(PCI). Methods The study was a prospectiverandomized controlled study.Consecutive patients with AMI were assigned to either the iodixanol group or the iohexol group randomly after they were categorized in different group according to the infarcted walls(inferior and anterior infarction)indicated by electrocardiogram. The primary end point was the incidence of CI-AKI,which is defined as serum creatinine(sCr)increase>25% or>0.5 mg/dl(44 μmol/L)from baseline witin 72 hours. Results Two hundred ninety-seven patients were enrolled and allocated to the iodixanol group(n=149)or the iohexol group(n=148),and CI-AKI occurred in 22.1% of patients in the iodixanol group and 16.9% of patients in the iohexol group (95% confidence interval –14.2% to 3.8%,P for noninferiority<0.002). The incidence of CI-AKI was higher in the anterior infarction group than in the inferior infarction group(21.4% vs. 11.6%,P<0.01). Conclusions In patients with AMI who underwent emergent PCI,iohexol was not inferior to iodixanol on the incidence of CI-AKI,and it is reasonable to avoid selection bias for assigning patients into inferior and anterior infarction group according to the infarcted walls for the future CI-AKI related clinical study.

Objective To summarize the experience of transcatheter aortic valve implantation (TAVI) in the treatment of severe aortic stenosis (AS) with VENUS-A valve. Methods Retrospectively collected and analyzed the baseline characteristics,preoperative assessment, surgery details,early and mid-term clinical outcome of 10 patients who underwent TAVI. Results From April 2016 to April 2017,10 patients with severe AS were treated with TAVI at the Guangdong General Hospital. The median age was 75 (65,81)years old and 5(5/10)were males. The median Society of Thoracic Surgery score was 5% (2%,11%). TAVI was successful in 10 patients (10/10),and percutaneous coronary intervention was performed in two cases (2/10) at the same time. The median operation time was 190 (150,225) minutes,the ICU monitoring time was 113 (49, 231) hours,and the hospital stay was 12 (6,25) days. After the procedure,the mean aortic-valve gradient reduced to 10(6,21)mmHg(1 mmHg=0.133 kPa). There was minimal or mild marginal periprosthetic leak in five patients(5/10)and moderate leak in one patient(1/10). During the 30 days of follow up,one patient(1/10)die due to perioperative myocardial infarction and ventricular fibrillation. One patient(1/10)was implanted with a permanent pacemaker for severe arrhythmia. Two patients(2/10)occurred vascular complications. The median follow-up was 3(1,15)months. One patient had syncope at 6 months post operation with R-R interval up to 7 seconds and he was implanted with a permanent pacemaker. There was no death,stroke,surgical surgery intervention and rehospitallization due to heart failure during the follow up. Conclusions It is feasible,safe and effective to use VENUS-A valve for TAVI treatment in serve AS.