Objective To discuss the causes and the therapeutic strategy of acute cardiac tamponade(ACT)occurring as a complication of transcatheter aortic valve replacement(TAVR)so as to improve the success rate of the surgery and to make a further understanding of this complication.Methods The general clinical data,surgical procedures,and postoperative follow-up results of five patients,who received TAVR at the Affiliated Northern Jiangsu People's Hospital of Yangzhou University of China and developed ACT from March 2018 to September 2024,were retrospectively analyzed.Results After developing ACT,all the 5 patients received pericardiocentesis together with other adjuvant therapies including blood volume expansion with infusion,vasopressors,heparin neutralization,and blood transfusion.However,due to no obvious reduction in drainage volume and unstable hemodynamics all the 5 patients had eventually to receive open-chest surgery to identify the source of bleeding and to make hemostasis.Surgical exploration revealed that the perforation or rupture of cardiac structures caused by the temporary pacemaker lead or a super-stiff guide wire during the procedure was the main cause of ACT.Finally,after active treatment four patients recovered and discharged,and one patient died.The discharged patients were followed up for 3-12 months,and no procedure-related complications such as acute coronary artery occlusion,severe arrhythmia,exacerbation of heart failure symptoms,valve displacement,or stroke occurred.Conclusion As a severe complication occurring during the TAVR procedure,ACT requires to get a rapid diagnosis and management.Improvement of surgical techniques and operative methods,comprehensive preoperative assessment,and close intraoperative monitoring are crucial points for the prevention of ACT.

Objective:To explore the predictive value of Epinephrine (EPI) level for Major adverse cardiovascular events (MACE) in patients with ST segment elevation myocardial infarction (STEMI) after emergency Percutaneous coronary intervention (PCI).Methods:A total of 107 patients with STEMI after emergency PCI in Northern Jiangsu People's Hospital of Jiangsu Province from September 2020 to November 2021 were selected. Baseline data, biochemical test data and coronary angiography data were collected. EPI level was measured by enzyme-linked immunosorbent assay. The following analysis was planned: ① Patients were divided into MACE group and non-MACE group, and various indicators of the two groups were compared; ② According to Receiver operating characteristic curve (ROC), the best cut-off values of EPI level which predict the occurrence of MACE were calculated respectively. Patients were respectively divided into high EPI level group and low EPI level group according to the best cut-off values, and the occurrence of MACE between the groups was compared respectively.③ Survival analysis (Kaplan-Meier method and log-rank test) was used to investigate the relationship between EPI level and MACE in patients with STEMI after emergency PCI. ④COX proportional hazard regression model was used to investigate the risk factors for MACE in patients with STEMI after emergency PCI.Results:①According to the inclusion and exclusion criteria, 107 patients with STEMI after emergency PCI were selected for the study, of which 19 patients had MACE and 88 patients did not have MACE. Compared with the non-MACE group, the patients in the MACE group were older, the proportion of Killip Ⅱ and above, NT-proBNP and EPI were higher, while FT3 was lower, and the differences were statistically significant ( P<0.05). The Gensini score of MACE group was significantly higher than that of non-MACE group ( P<0.01). ② According to ROC analysis, the Area under the curve (AUC) of EPI level for predicting MACE in patients with STEMI after emergency PCI was 0.699 (95% CI: 0.579-0.819, P=0.007), the best cut-off value of EPI level was 528.54, the sensitivity was 78.9%, and the specificity was 56.8%. The incidence of MACE in the high EPI level group was significantly higher than that in the low EPI group ( P=0.005).③ Kaplan-Meier survival curve showed that the higher the EPI level value, the higher the risk of MACE (log-rank test P=0.004). ④Multivariate COX regression analysis showed that age ( P=0.042), FT3 ( P<0.001), EPI level ( P<0.001) and Gensini score ( P=0.004) were independent risk factors for MACE. Conclusions:①EPI level significantly correlates with the occurrence of MACE in patients with STEMI after emergency PCI. EPI level has predictive value for MACE in patients with STEMI after emergency PCI. The higher the EPI value, the higher the risk of MACE. ②Multivariate COX regression analysis show that EPI level is independent risk factor for MACE in patients with STEMI after emergency PCI.

Free fatty acids, as important energy metabolism substrates for the heart, play an important role in various cardiovascular diseases; ω-3 PUFA, as an important branch of free fatty acids, has been confirmed by more and more researches to be closely related to cardiovascular diseases. Heart failure, as a common cardiovascular problem, seriously affects people's quality of life. Studies have shown that ω-3 PUFA plays a significant role in the development of heart failure. In this paper, we try to review the metabolism, pathogenesis and therapeutic significance of ω-3 PUFA in heart failure.

Objective To investigate the distribution differences of cytochrome P4502C19(CYP2C19)gene polymorphisms and its impact on antiplatelet therapy in patients with coronary arter-y disease undergoing percutaneous coronary intervention(PCI)in Yangzhou region.Methods A to-tal of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to De-cember 2022 in Yangzhou region were retrospectively selected as study objects.The age of the pa-tients ranged from 37 to 93 years,with 152 males and 63 females.Polymerase chain reaction-sequen-cing was used to detect the CYP2C19 genotypes in the patients.The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed.Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively,the patients were divided into fast-metabo-lizing clopidogrel group,medium-slow metabolizing clopidogrel group,fast-metabolizing ticagrelor group,medium-slow metabolizing ticagrelor group.After 6 months of follow-up,the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.Results The CYP2C19 genotypes of 215 patients were distributed as follows:81 cases of CYP2C19*1/*1 genotype,93 cases of CYP2C19*1/*2,10 cases of CYP2C19*1/*3,25 cases of CYP2C19*2/*2,6 cases of CYP2C19*2/*3.CYP2C19 metabolite types were fast metabolizers in 81 cases(37.67％),intermediate metabolizers in 103 cases(47.91％)and slow metabolizers in 31 cases(14.42％).The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67％,intermediate metabolizers accounted for 47.91％,and poor metabolizers accounted for 14.42％.There was no significant difference in the distribution of CYP2C19 genotype between different genders(x2=0.346,P=0.987).There was no significant difference in the distribution of metabolic type between different genders(x2=0.342,P=0.843).There was no significant differ-ence in the distribution frequency of metabolic type among different age groups(x2=1.098,P=0.895).The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopi-dogrel group and the fast-metabolizing ticagrelor group was 16.67％and 14.29％,respectively,no significant difference was observed(P＞0.05).The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group,and the difference was statistically significant(P＜0.05).There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P＞0.05).Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou re-gion,there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups.The intermediate and fast metabolizers are more prevalent.It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.

Atrial fibrillation(AF)is one of common arrhythmia,which is associated with lower quality of life,decreased heart function,and reduced survival rate.Currently,the treatment of AF focuses on improving symptoms,reducing the incidence of complications and mortality,as well as de-creasing emergency department visit or hospitalization related to AF.Percutaneous left atrial append-age closure(LAAC)can reduce the risk of stroke in non-valvular atrial fibrillation(NVAF)patients,and is an effective alternative to oral anticoagulant therapy.This study reported the successful thera-peutic process of LAAC in a patient with persistent AF and coexisting coronary heart disease,and the preoperative transesophageal echocardiography(TEE)showed a complex multi-lobed left atrial append-age,so the LAmbre occluder with small umbrella and large cover design was selected for treatment.

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

Objective To investigate the distribution differences of cytochrome P4502C19(CYP2C19)gene polymorphisms and its impact on antiplatelet therapy in patients with coronary arter-y disease undergoing percutaneous coronary intervention(PCI)in Yangzhou region.Methods A to-tal of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to De-cember 2022 in Yangzhou region were retrospectively selected as study objects.The age of the pa-tients ranged from 37 to 93 years,with 152 males and 63 females.Polymerase chain reaction-sequen-cing was used to detect the CYP2C19 genotypes in the patients.The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed.Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively,the patients were divided into fast-metabo-lizing clopidogrel group,medium-slow metabolizing clopidogrel group,fast-metabolizing ticagrelor group,medium-slow metabolizing ticagrelor group.After 6 months of follow-up,the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.Results The CYP2C19 genotypes of 215 patients were distributed as follows:81 cases of CYP2C19*1/*1 genotype,93 cases of CYP2C19*1/*2,10 cases of CYP2C19*1/*3,25 cases of CYP2C19*2/*2,6 cases of CYP2C19*2/*3.CYP2C19 metabolite types were fast metabolizers in 81 cases(37.67％),intermediate metabolizers in 103 cases(47.91％)and slow metabolizers in 31 cases(14.42％).The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67％,intermediate metabolizers accounted for 47.91％,and poor metabolizers accounted for 14.42％.There was no significant difference in the distribution of CYP2C19 genotype between different genders(x2=0.346,P=0.987).There was no significant difference in the distribution of metabolic type between different genders(x2=0.342,P=0.843).There was no significant differ-ence in the distribution frequency of metabolic type among different age groups(x2=1.098,P=0.895).The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopi-dogrel group and the fast-metabolizing ticagrelor group was 16.67％and 14.29％,respectively,no significant difference was observed(P＞0.05).The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group,and the difference was statistically significant(P＜0.05).There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P＞0.05).Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou re-gion,there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups.The intermediate and fast metabolizers are more prevalent.It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.

Atrial fibrillation(AF)is one of common arrhythmia,which is associated with lower quality of life,decreased heart function,and reduced survival rate.Currently,the treatment of AF focuses on improving symptoms,reducing the incidence of complications and mortality,as well as de-creasing emergency department visit or hospitalization related to AF.Percutaneous left atrial append-age closure(LAAC)can reduce the risk of stroke in non-valvular atrial fibrillation(NVAF)patients,and is an effective alternative to oral anticoagulant therapy.This study reported the successful thera-peutic process of LAAC in a patient with persistent AF and coexisting coronary heart disease,and the preoperative transesophageal echocardiography(TEE)showed a complex multi-lobed left atrial append-age,so the LAmbre occluder with small umbrella and large cover design was selected for treatment.

Anomalous aortic origin of a coronary artery is a rare abnormal coronary artery development disease, which affects myocardial blood perfusion in the absence of significant coronary artery stenosis. Such patients have a high risk of sudden death, and their disease progresses rapidly, and their clinical manifestations are easily confused with myocardial diseases. We report a case of a 13-year-old young patient whose diagnosis was confirmed, the condition was stabilized at an early stage, and the abnormal coronary structure was corrected by coronary decapitation through a multidisciplinary combination of cardiology, cardiac surgery, ICU, and imaging. This article focuses on the diagnosis and treatment of these patients.

AIM: To observe the clinical efficacy of antiplatelet therapy with ticagrelor monotherapy after short-term double antibody therapy in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI). METHODS: A total of 172 patients with ACS who had undergone PCI from October 2018 to April 2022 in our hospital and Subei People's Hospital of Jiangsu Province were selected and divided into three groups according to the patients' medication status: 50 patients in group A (tegretol alone group); 62 patients in group B (aspirin enteric coated tablets + tegretol group); and 60 patients in group C (aspirin enteric coated tablets + clopidogrel hydrogen sulfate group). The patients were observed for postoperative recurrent angina pectoris, in-stent restenosis, revascularization, heart failure, and bleeding. RESULTS: There were no significant differences in postoperative recurrent angina, in-stent restenosis, re-hematologic reconstruction, heart failure, and bleeding between the 3 groups. CONCLUSION: There is no increase in ischemic events, heart failure in patients treated with tegretol antiplatelet therapy alone after a short course of dual antibiotics after PCI and it reduces risk of bleeding.