Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

Congenital atresia of the left main coronary artery in an infant

Congenital atresia of the left main coronary artery is a rare occurrence, and surgical revascularizationbypass graft is required. We here report a rare case of congenital coronary anomaly in an infant. A 10-month-old male infant was admitted to the hospital with heart failure symptoms. Echocardiographic examinations revealed mitral valve regurgitation and ischemic changes of the anterolateral papillary muscle and chordae. Coronary angiography showed atresia of the left main coronary artery with a severe hypoplastic left anterior descending artery and a circumflex coronary artery. Unfortunately, sudden cardiac arrest occurred after catheterization and the infant did not recover despite of immediate cardiopulmonary resuscitation. Further studies are needed to find a newer diagnostic method to detect coronary anomaly in an infant, and coronary angiography, if necessary, has to be performed very carefully.     

黄淮白山羊心脏冠状动脉形态特征研究

目的:观察黄淮白山羊心脏冠状动脉的形态学特征,为其研究提供基础资料.方法:选择成年健康黄淮白山羊10头,采用颈静脉放血方式处死,其中6只心脏取不同管径大小的冠状动脉,多聚甲醛溶液固定,经水洗、脱水、二甲苯透明,石蜡包埋以HE、Masson三色及Verhoeff VG染色等步骤,观察冠状动脉的基本组织结构特点;另4只心脏标本经左、右冠状动脉口分别加压注入丁腈苯乙烯(ABS)丙酮溶液,经凝固成型后于70%浓盐酸溶液中腐蚀,观察冠状动脉的分支与分布.结果:黄淮白山羊的心脏左、右冠状动脉均起自于主动脉窦,行走于肺动脉与左心耳之间的左冠状动脉较粗大.黄淮白山羊弹性冠状动脉中弹性纤维含量丰富,外膜层有散在分布的块状平滑肌;肌性冠状动脉内外弹性膜结构清晰,中膜层主要由发达的平滑肌构成,含少量弹性纤维;微冠状动脉由一层内皮细胞构成.结论:黄淮白山羊冠状动脉属于左优势型,可分为弹性冠状动脉、肌性冠状动脉和微动脉三种类型.     

Improved myocardial perfusion and cardiac function by controlled-release basic fibroblast growth factor using fibrin glue in a canine infarct model

Objective: Angiogenic therapy is emerging as a potential strategy for the treatment of ischemic heart disease but is limited by a relatively short half-life of growth factors.Fibrin glue (FG) provides a reservoir for controlledrelease of growth factors.The aim of this study was to evaluate the effects of basic fibroblast growth factor (bFGF) incorporating FG on angiogenesis and cardiac performance in a canine infarct model.Methods: Acute myocardial infarction was induced by ligation of the left anterior descending coronary artery (LAD).Group I (n=6) underwent ligation of LAD alone.In Group II,transmural channels were created in the infarct area (n=6).In Group III,nontransmural channels were created to locate FG cylinders containing bFGF (n=6).Eight weeks after operation,myocardial perfusion was assessed by single photon emission computed tomography,cardiac function by echocardiography,and vascular development by immunohistochemical staining.Results: Total vascular density and the number of large vessels (internal diameter ≥50 μm) were dramatically higher in Group III than in Groups I and II at eight weeks.Only the controlled-release group exhibited an improvement in regional myocardial perfusion associated with lower defect score.Animals in Group III presented improved cardiac regional systolic and diastolic functions as well as global systolic function in comparison with the other two groups.Conclusions: Enhanced and sustained angiogenic response can be achieved by controlled-release bFGF incorporating FG within transmyocardial laser channels,thus enabling improvement in myocardial perfusion and cardiac function.     

Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery bypass grafting with radial arteries on long-term patency and mortality.     

A pilot study on diagnosis of coronary artery disease using computed tomography first-pass myocardial perfusion imaging at rest

Background  

Although computed tomography coronary angiography (CTCA) can identify coronary stenosis, little data exists on the ability of multislice computed tomography (MSCT) to detect myocardial perfusion defects at rest.     

Case Report： Adrenal myelolipoma within myxoid cortical adenoma associated with Conn＇s syndrome

The coexistence of myelolipoma within adrenal cortical adenoma is extremely rare, for both tumors present usually as separate entities. There are only 16 such cases reported worldwide. To the best of our knowledge, the case we reported here is the first one of myxoid adrenal cortical adenoma associated with myelolipoma reported. A 32-year-old Chinese woman with 4-year history of hypertension was presented in our study. Computed tomography (CT) of the abdomen showed a large heterogeneously-enhancing mass (4.5cm in diameter) in the left suprarenal region. Clinical history and laboratory results suggest a metabolic disorder as Conn's syndrome. The patient underwent a left adrenalectomy, and a histopathological study confirmed the mass to be a myxoid adrenal cortical adenoma containing myelolipoma. The patient was postoperatively well and discharged uneventfully. In the present case report, we also discuss the etiology of simultaneous myelolipoma and adrenal adenoma associated with Conn's syndrome, and the methods of the diagnosis and differential diagnosis.     

Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta

The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.     

Gadobutrol at different injection rates for dynamic supra-aortic imaging by contrast-enhanced magnetic resonance angiography

The aim of this study was to compare differences in imaging quality at different injection rates of gadobutrol(Gadovist? 1.0M) for dynamic supra-aortic imaging by contrast-enhanced magnetic resonance angiography(CEM RA). In 6 healthy volunteers,dynamic CEM RA examinations were performed twice at a 7 d interval with a gadobutrol dose of 0.1 mmol given to 1 kg body mass. For the two examinations,the contrast medium was injected at rates of 1.5 mL/s and 2.0 mL/s,followed by 20 mL normal saline injected at the same rate. Using a GE Signa 3.0T M R apparatus and the time-resolved imaging of contrast kinetics(TRICKS) technique,scanning was performed continuously for 15 phases at a time resolution of about 2.4 s. Vascular reconstruction was undertaken by multiplane reconstruction and maximum intensity projection techniques. Two radiologists experienced in CEM RA diagnosis subjectively evaluated the contrast effect,vascular detail,and pseudo-shadow of all images,and graded them via a 5-point scale. With the two drug injection rates,the image quality,peak signal-to-noise ratio(SNR) and contrast-to-noise ratio(CNR) were compared for imaging of the infra-aortic arch,brachiocephalic trunk,subclavian artery(left/right),common carotid artery(left/right),internal carotid artery(left/right),and external carotid artery(left/right). Characteristics of the time-signal-intensity(T-S-I) curves were also analyzed at the two injection rates. All studies were performed successfully,without any complications. There was good image quality with both gadobutrol injection rates of 1.5 mL/s and 2.0 mL/s,and subjective scores for image quality,SNR and CNR were not significantly different between the two rates(P 0.05). The time-to-peak(TTP) from the hand dorsal vein injection site to the carotid artery ranged from 16.0 s to 27.1 s(mean 21.7 s ±3.4 s) in the 6 subjects,and was also not significantly different between the two drug injection rates(P 0.05). We conclude that dynamic CEM RA examination of the supra-aortic arch with gadobutrol injection at a rate of 1.5 mL/s was feasible,and satisfactorily reflected vascular shape and dynamic blood flow information.     

Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention

Objective: Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. Methods: Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1 813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. Results: Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1−P)=exp(−2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. Conclusions: The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.     

Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy

Objective： To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods： We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair （anterior mitral leaflet plication）; 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall＇s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge, Results： One patient died of post-operative heart failure. The mean follow-up time was 4.3 years, There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association （NYHA） Classes Ⅰ-Ⅱ due to associated valvular lesions, Conclusion： Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion （SAM） of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.     

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents

In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm×8 cm×10 cm hematoma in the left psoas muscle. After aggressive supportive therapy [the administration of packed red blood cell transfusion, carbazochrome sodium sulfonate injection, and continuous venovenous hemofiltration (CVVH)], the patient’s vital signs stabilized and her hemoglobin increased to 86 g/L. Repeat CT showed that the hematoma had been partially absorbed after two weeks. Eventually, the patient was discharged with stable vital signs. Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage, particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents.     

动态心电图ST-T变化与冠状动脉造影对比分析

目的：探讨动态心电图ST-T变化在冠心病诊断中的价值,为提高该病的诊断率提供参考。方法：对2008年1月至2009年8月在我院心血管内一科进行诊治的可疑冠心病患者共计128例,首先进行动态心电图检测,然后对其进行冠状动脉造影,对检测结果进行比较分析。结果：应用动态心电图共检出ST段呈水平型或下斜型压低患者52例,阳性率为40.63%。而冠状动脉造影结果显示,共有49例患者为冠心病,单支病变24例,双支病变18例,三支病变7例。动态心电图灵敏度为89.80%（44/49）;特异度为89.87%（71/79）,准确指数为79.67%。结论：动态心电图在检测可疑冠心病患者心肌缺血方面具有很好的灵敏度、特异度和准确度,可以作为诊断冠心病患者的可靠指标。     

Control of pigeons’ keypecking by the left-right arrangement of stimuli

Control of pigeons’ keypecking by conditionalities in the spatial arrangement of two element stimuli (designated A and B) was investigated. In Experiment 1, reinforcement for keypecking was made conditional upon the left-right location of A and B: Reinforcement was available when A was on the left and B was on the right (AB), but not on BA, AA, or BB trials. The pigeons successfully discriminated the rewarded AB configuration, but only after a stage in which a particular element in a particular location (e.g., A on left) primarily controlled pecking. Experiments 2 and 3 systematically replicated these findings and included controls to discount discrimination of the AB compound on the basis of the temporal order (e.g., A followed by B) rather than the spatial configuration of the elements. During a generalization test in Experiment 4, the elements were presented singly either in the left (AX, BX) or right (XA, XB) positions. As would be expected had the animals learned “A on the left, B on the right is rewarded,” responding on AX trials exceeded that on XA trials, and responding on XB trials exceeded that on BX trials.     

Learning whom not to trust across early and middle adolescence: A longitudinal neuroimaging study to trusting behavior involving an uncooperative other

Longitudinal changes in trusting behavior across adolescence and their neural correlates were examined. Neural regions of interest (ROIs) included the medial prefrontal cortex (mPFC), dorsal anterior cingulate cortex (dACC), left anterior insula (AI), bilateral ventral striatum (VS), and right dorsal striatum (DS). Participants (wave 1 age: M = 12.90) played the investor in a Trust Game with an uncooperative trustee three times (1-year interval). Analyses included 77 primarily Dutch participants (33 females). Participants decreased their investments with wave. Furthermore, activity was heightened in mPFC, dACC, and DS during investment and repayment, and in right VS (investment) and AI (repayment). Finally, DS activity during repayment increased with wave. These findings highlight early–middle adolescence as an important period for developing sensitivity to uncooperative behavior.     

Off-pump coronary artery bypass grafting versus on-pumpcoronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

INTRODUCTION Conventional coronary artery bypass graftin(CCABG) with cardiopulmonary bypass (CPB) habeen accepted as an effective and safe treatment fomulti-vessel coronary heat disease. CPB may stilcontribute to the operation field because of threlatively easier technical requirement; but it alscauses a serious systematic inflammatory reactiowhich will lead to dysfunction of important organand higher cost for the patients. Off-pump coronarartery bypass grafting (OPCABG) has r…     

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.     

心率及心电图在冠状动脉造影术时的变化

目的:探讨选择性冠状动脉术时心率和心电图的变化.方法:经常规两种人路途径行冠状动脉造影术,全过程中12导联心电图监测记录,记录选择性冠状动脉术时注射造影剂前后心率、R波、ST段及T波的变化.结果:注射造影剂后均出现心率减慢,R波幅降低(或S波加深),ST段降低或压低,T波幅度下降或倒置加深.结论:冠状动脉有严重病变者,造影剂的量要少于常规量,并且要准备好抢救药品和器械.     

Early association of electrocardiogram alteration with infarct size and cardiac function after myocardial infarction

Objective: Myocardial infarction (MI) is the main cause of heart failure, but the relationship between the extent of MI and cardiac function has not been clearly determined. The present study was undertaken to investigate early changes in the electrocardiogram associated with infarct size and cardiac function after MI. Methods: MI was induced by ligating the left anterior descending coronary artery in rats. Electrocardiograms, echocardiographs and hemodynamic parameters were assessed and myocardial infarct size was measured from mid-transverse sections stained with Masson's trichrome. Results: The sum of pathological Q wave amplitudes was strongly correlated with myocardial infarct size (r = 0.920, P < 0.0001), left ventricular ejection fraction (r = (0.868, P < 0.0001) and left ventricular end diastolic pressure (r = 0.835, P < 0.0004). Furthermore, there was close relationship between MI size and cardiac function as assessed by left ventricular ejection fraction (r = (0.913, P < 0.0001) and left ventricular end diastolic pressure (r = 0.893, P < 0.0001). Conclusion: The sum of pathological Q wave amplitudes after MI can be used to estimate the extent of MI as well as cardiac function.     

西经经度数加工中SNARC效应的反转

采用快速呈现刺激分类范式,以西经经度数为材料进一步探讨数字加工中的SNARC效应.结果发现：（1）在西经经度数加工中左手对大数字反应更快,右手对小数字反应更快,出现反转的SNARC效应.（2）数字在人脑以空间表征的方式表征在心理数字线上.但其表征方向并非完全取决于数字的大小信息,还受制于特定数字携带的位置信息.人们会根据特定数字的具体信息在心理数字线上灵活地表征数字.