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简介：Massivehemoptysisisoneofthemostdreadedofallrespiratoryemergenciesandcanhaveavarietyofunderlyingcauses.Itismostlycausedbybleedingfrombronchialcirculation.Bronchialarteryembolizationisnowconsideredtobethetreatmentofchoiceforacutemassivehemoptysis.Bronchialarteryembolization(BAE)isasafeandeffectivenonsurgicaltreatmentforpatientswithmassivehemoptysis.However,nonbronchialsystemicarteriescanbeasignificantsourceofmassivehemoptysisandacauseofrecurrenceaftersuccessfulBAE.Soknowledgeofthebronchialarteryanatomy,togetherwithanunderstandingofthepathophysiologicfeaturesofmassivehemoptysis,areessentialforplanningandperformingBAEinaffectedpatients.Inaddition,interventionalradiologistsshouldbefamiliarwiththetechniques,results,efficacy,safetyandpossiblecomplicationsofBAEandwiththecharacteristicsofthevariousembolicagents.Bronchialarterialcatheterisationinhumanviaapercutaneousapproachhasbeenpracticedfor32years(1973)intheworldand20years(1986)inChina,initiallyfordirectchemotherapytreatmentforbronchialmalignanciesandthenfortheembolizationofpatientswithmassivehaemoptysis.Areviewofclinicalexperiencetoevaluatetechnique,embolicmaterials,outcomeandcomplicationsofBAEispresented.

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简介：DearEditor,Wearewritingthislettertoreportanunexpectedrarecaseofcentralretinalarteryocclusion(CRAO)happenedafterstent-assistedcoilingforinternalcarotidartery(ICA)aneurysminafemalepatient.CRAOisadevastatingocularemergencywithpoorvisualprognosisandnouniversalacceptedtreatmentatpresent.CRAOisusuallyassociatedwitharterialhypertension,diabetesmellitus,renaldisease.

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简介：IntroductionandPatientDescription,Assessmentofpatientswithanginapectorisisachallengefortheclinicalcardiologist.Myocardialischemiaandanginapectoriscanbecausedbyvariousmechanisms,suchascoronaryatherosclerosis,vasospasm,orcoronarymicrovasculardysfunction[1].Moreover,thesemechanismsmayoverlapinagivenpatient,makingitdifficulttodeterminethecauseofangina.Wereportherethecaseofa57-year-oldfemalepatientwithahistoryofanginapectoristhatstarted3monthspreviously.Hersymptomsoccurredpredominantlyatrestbutalsowitheffort.Thepatientwasanactivesmokerwhosmokedabout15cigarettesperday(~20packyears).Moreover,shehadhypertensiontreatedwithenalapril.HerLDLlevelwas75mg/dlwithoutanycholesterol-loweringtherapy.Shewassentfordiagnosticcoronaryangiographyforsuspectedstenosingcoronaryarterydisease.

简介：Thescopeofinterventionalcardiologyhasrapidlyexpandedoverthelastseveraldecades.Inafieldwhereproceduraltreatmentoptionsforavarietyofcomplexcardiovascularconditionshavegrownexponentially,theimportanceofproceduralsafetycontinuestocometotheforefront.Thisismostevidentinthemovementtowardradialaccessastheinitialapproachforoperatorsinthecardiaccatheterizationlaboratory.Astheevidencegrowsforthesuperiorityofradialaccessoverfemoralaccesswithregardtoreducingbleedingeventsandimprovingclinicaloutcomes,wediscussthemodernapproachtoobtainingaccess,andhighlightbestpractices.

简介：Thispaperpresentsthedevelopmentofthebloodflowsimulationintwodimensionsovertherealgeometryofthefemoralartery.TheNavier-Stokesequationsaresolvedusingthefiniteelementmethod,toobtainthedistributionsofthebloodpressureandflowvelocityinmultipleinstantsoftimeanddifferentplacesofthefemoralarteryandthusdeterminethecurrentconditionofthebloodvessels.Thevelocityfieldshowsalaminarbehavior,where,thevelocityishigherinthecenterofthearteryanddecreasesasthebloodflowapproachesarterywalls.Inspiteofallarteryandbloodflowpropertiesnotbeingconsidered,thevaluesofpressureandvelocityobtainedarewithinthenormalranges.Finallythemodelisusedtoverifyifthereexistirregularitiesinthebloodflowinbothhealthysubjectsandsickpatients.

简介：Surgicaloptionsdevelopedtotreatcarotidarterystenosishaveevolvedinthelastsixdecades,andstudieshaveshownthesuperiorityofcarotidendarterectomy(CEA)comparedtomedicaltherapy.Similarly,asendovasculartherapyhasevolvedoverthelasttwodecades,studiesreflectingsafety,feasibility,andequivalenceofcarotidarterystenting(CAS)toCEAhavebeenreplicatedinseveralstudiesforintermediatetohighsurgicalriskpatients.However,sinceitsinception,thefieldofCAShasbeenmiredinseveralcontroversiesandhasbeensubjecttointensescrutinyfrommultiplestakeholderswithinthefieldofmedicine.ThisreviewdiscussesspecificissuesconcerningCASthatarerelevantinthecurrentera.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

简介：BackgroundAnomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery(ALCAPA)isararecongenitalanomaly.Itdemonstratedthecombinedeffectsoftheabsenceofanormalcoronaryflowwithacoronarystealandtheprofoundischemiathatcanproduceleftventriculardysfunctionandmitralregurgitation.Wehereintroducethepostoperativemanagementofpatientswithrepairofanomalousoriginoftheleftcoronaryarteryfromthepulmonaryartery,withanemphasisonitsoutcome.MethodsRecordsof31patientswithanomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryreceivingsurgeryfrom1998to2010werereviewedretrospectively,10ofwhichweretreatedwiththemitralvalvesurgicallyatthesametime.Theageofpatientswas4monthsto16years(median,1year)andweightofthosewas5to53kilograms(median,7.8kilograms),allofwhichwerediagnosedofanomalousoriginoftheleftcoronaryarteryfromthepulmonarybyechocardiographyandcardiaccatheterization.Aftersurgery,electrocardiogram,echocardiography,arterialbloodpressure,transcutaneousoxygensaturationandcentralvenouspressureweremonitored.Commonpostoperativecomplicationsinourgroupwereanalysed.Andpreoperativeandpostoperativedataincludingareaofmitralregurgitation,leftventricularsystolicdiameterandleftventriculardistolicdiameterwereobtained.Cardiopulmonarybypasstimeandmechanicalventilationtimeofpostoperativepatientswithnopneumoniawerecomparedwiththosewithpneumonia.Binarylogisticregressionwasappliedfortheanalysisoftheriskfactorsofpostoperativepneumonia.ResultsOf31patients,30survivedaftersurgerywithearlymortalityof3.23%.Onepatientdiedofseverelowcardiacoutputsyndrome.Mechanicalventilationtimewas4hoursto168hourshours(mean,39.68±50.52hours;median,18hours).ICUstaywas16hoursto425hours(mean,111.65±127.03hours;median,44hours).Inourgroup,commonpostoperativecomplicationsweremyocardialischemia(n=12,36.4%),infection(n=

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简介：BackgroundHybridcoronaryrevascularization(HCR)isanalternativecoronaryrevascularizationstrategythatcombinesaminimallyinvasive,survivaladvantageoftheleftinternalmammaryartery(LIMA)-leftanteriordescending(LAD)coronaryarterybypasswithless-invasivepercutaneouscoronaryintervention(PCI)tonon-LADcoronarylesionsbyusingdrug-elutingstents.Wereportourexperienceofhybridminimallyinvasiveapproachin15patients.MethodsFromDecember2012toOctober2013,15patientsunderwentrevascularizationoftheleftanteriordescendingarterythroughminimallyinvasivecoronaryarterybypassgrafting(MIDCAB).Allpatientsbyendoscopicassistbeatingheartcoronaryarterybypassgrafting.Sevenpatientswerescheduledforahybridprocedure.Percutaneouscoronaryinterventionofnon-LADwasperformed3to5dayspreoperatively.Demographicdata,perioperativeoutcome,andannualfollow-upwereobtainedfromallthepatients.ResultsIn-hospitalmortalitywas6.67%.Therateofconversiontofullmediansternotomywas13.3%.Ventilationtimewas6.9±5.1h.Bloodlossvolumewas241±67.8mL.ICUstaywas21.3±10.8h.Hospitalpostoperativestaylastedfor7.5±1.3days.PriortoPCIpatientsshowed100%patentLIMA(Tables3and4).Ameanfollow-upwas8.5months.Oneyeargraftpatencyratewas100%(8/8patientsfor254-slicetomography).Twopatientsrequiredreintervention.ConclusionsMinimallyinvasivehybridcoronaryrevascularizationisasafe,feasibleandefficaciousapproachwithgoodresultsandshouldbeperformedinselectedpatientsbysurgeonswithexperienceinminimallyinvasivebypasssurgerypluscollaborationwithcardiologists.elutingstents.

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简介：BackgroundAnomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryisararecongenitalcardiaclesionresultinginmyocardialischemiaeveninfarction,morphologicalimpairmentanddysfunctionofleftventricle,togetherwithmitralregurgitation.Herewewillintroduceourexperienceinthesurgicalrepairofthiskindofcongenitallesionandtheretrospectiveanalysisabouttheimprovementofleftventriculardimensionandmitralregurgitationinearlypostoperativeterm.MethodFromMay1998toJuly2012,38consecutivepatientswithanomalouscoronaryarteryfromthepulmonaryarteryunderwentsurgicalcorrection(33receivedleftcoronaryarteryre-implantation,4leftcoronaryarteryligationorprimaryclosure,1Takeuchiprocedure,and10simultaneousmitralvalveplasty).Leftventriculardimension,mitralregurgitation,andejectionfraction,weremeasuredbycolorDopplerechocardiographypreoperatively,and1monthafterdischarge.ResultsHospitalsurvivalwas94.7%(2in-hospitaldeaths).Tenpaptientswithmorethanmoderatemitralregurgitationreceivedsimultaneousmitralplasty,oneofwhomwasconvertedtomechanicalprostheticvalvereplacement.Mitralvalveannuloplastywasappliedin9casesofcoronaryre-implantationcorrection,3ofwhomalsoreceivedadditionalmitralleafletcleftrepair.Meanwhile8patientsunderwentotherdifferentconcomitantoperations.Echocardiographicresultsforthesurvivals1monthafterdischargeshowedthatleftventricularend-diastolic,endsystolicdimensiondecreasedfrom40.05±5.56mmand28.94±6.21mmto33.07±6.82mm(P<0.01)and23.04±5.87mm(P<0.01)respectively.Theaveragemitralregurgitationgradewasalsoreducedfrom2.36±1.08to1.64±93(P<0.05)inthegroup.AllsurvivalpatientsimprovedclinicallyandNYHAfunctionalclassdecreasedsignificantlyfrom2.37±1.08to2.10±0.54(P<0.05).ConclusionsThesurgicalrepairofanomalousoriginoftheleftcoronaryarteryfromthepulmonaryarteryissafeandeffective,andcange

简介：AbstractUmbilical cord (UC) embolism is a rare, life-threatening complication of pregnancy. The exact cause of this condition is not yet known. Women with more than one UC abnormality are at risk of UC obstruction; this condition can lead to stasis, ischemia, and in some cases, thrombosis. However, many women with UC abnormalities remain undetected and may not be recognized until after birth. Here, we present a case involving the prenatal diagnosis and successful treatment of umbilical artery embolism in the third trimester with good maternal and fetal outcomes. The risk of UC embolism increases when more than one UC abnormality is identified in a single case. Ultrasound examination in the third trimester of pregnancy should be able to verify the existence of two arteries and one vein in the UC. If necessary, these results can be compared with ultrasound imaging acquired during the first trimester of pregnancy.