A Pilot Study about the First Cases of Coronary Angioplasty in Democratic Republic of Congo/Kinshasa: Patient Profile

Background: The objective of this pilot study was to describe clinical profile, electric, echocardiographic and angiographic caracteristics with procedural outcome of congolease patients undergoing coronarography in the first and only one cardiac catheterization center opened in Kinshasa. Methods: An analytical cross-sectional study was carried out over a period from October 2019 (date of establishment of the first coronary angiography unit in DR Congo) to March 2021. We proceeded to a serial sampling of the consecutive cases of all the patients who have an angiographic exploration of coronary arteries. Clinical, ECG and cardiac ultrasound data were collected in all patients. The indications for the coronary angiography examination were set by differents cardiologists on the basis of repolarization troubles in the electrocardiogram, cinetic troubles in echocardiography, positive stress test and chest pain in patients with cardiovascular risq factors. Results: The serie (47 patients) was predominantly male with a sex ratio M/W of 2.6. The average age was 59.8 ± 10.5 years. Arterial hypertension (HBP) was the main risk factor (89.4%);followed by diabetes mellitus (14.9%). Chest pain was the main functional sign with an atypical character in 44.7%. The ECG showed ST segment depression (17%) and T wave inversion (17%), the anterior region being the most affected. Hypokinesia was the most common echocardiographic abnormality (34%), followed by akinesia (10.6%). The anteroseptal and apical territories were affected in 12.8%. Dilated myocardiopathy (DMC) was significantly predominant in the male sex (29.4% vs 7.7%;p = 0.011). With radial puncture as the main approach, coronary angiography was pathological in 44% revealing mono-truncal lesions. The left coronary network was the most affected: the middle inter ventricular artery (12.8%), the proximal interventricular artery (10.6%) and the proximal circonflex artery (10.6%). In multivariate logistic regression analysis, age (for age > 50 years for men and >60 years for women), arterial hypertension and dilated cardiomyopathy emerged as independent determinants of pathological coronary angiography. Transluminal angioplasty was performed in 27.7% of patients. The bypass indication was retained in 4.3% of cases and medical treatment in 68%. Conclusion: Coronary angiography was used to diagnose lesions responsible for ischemic heart disease and to treat 27.7% of patients locally. The young age of patients and limited financial resources encourage the strengthening of preventive measures against cardio vascular risq factors.

Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS

COMPLEX PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutancous transluminal coronary angioplasty was pcrfonned in 70patients with high risk characteristics from Jan.1998 toDcc.1997 These factors include age】70(10patients),unstableangina(35patients),ejection fraction【40%(7 patients),multivesseldisease(50patients).There were 96 lesions(79 vessels)dilated,amongthem type Alesion 15,type B lesion 52,type C lesion 29.Autoperfusion balloon was used in 7 patients, coronary stcnl wasimplantcd in 50 paticnts.One patient undcrgoing directional coronaryathrectomy(DCA).The clinical success rate was 91.5% and lesionsuccess rate was 89.6%.Average predilation stenosis was 89.5+8.2%and average postdilation stenosis was 16.9+6.2%.Two patients diedfrom abrupt vessel closureno acule myocardial infarction andemergency coronary bypass operation.The considerations in selectionand management of these high risk patients were discussed. The resultsshowed that PTCA can be performed safely in the complex cases.

Effect of Carvedilol on the Coronary Vascular Endothelial Function after Percutaneous Transluminal Coronary Angioplasty

Objectives To understand the effect of carvedilol on the coronary vascular endothelial function of the patients with coronary heart disease after percutaneous transluminal coronary angioplasty (PTCA). Methods 51cases, having one or more than two branches narrow ( ≥ 70% ) , were diagnosed by coronary angiography. These patients were divided randomly into carvedilol group (n = 28) and control group ( n = 23) who did not take carvedilol. Endothelin (ET) and nitro dioxide (NO) levels of peripheral blood were measured before and after PTCA, before and after two weeks by taking earvedilol. Results Compared with the ET and NO levels before PTCA, ET were markedly increased and NO were decreased after PTCA (p <0. 05) ; compared with the ET and NO levels before taking carvedilol, ET were decreased and NO were increased after two week (p <0.05 ) , but the ET and NO levels of the control group did not change in the period of two weeks observation (p > 0.05). Conclusions Carvedilol may improve the coronary vascular endothelial function after PTCA.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ITS SUCCESS RATE AND AFFECTING FACTORS

From December 1987 to October 1983, percutaneous transluminal coronary angioplasty (PTCA) was performed in 302 patients with 392 diseased vessels and 440 lesions. The success rate was 93.71% in 302 patients, 94.90% in 392 diseased vessels and 95.00% in 440 lesions. The success rate was 98.92% in Type A lesion, 95.71% in Type B lesion, and 86.57% in Type C lesion (A vs B P=NS, A vs C P<0.01). There were 55 lesions with total or subtotal occlusion, the success rate was 89.09% (93.10% in Type B lesion and 84.62% in Type C lesion). As to the diseased vessels, the success rate was 95.65% in LAD, 94.38% in LCX and 93.75% in RCA. The results showed no significant difference. In this series, acute ischemic complications were found in 6.59% (29 / 440). Of these 29 lesions, 23 were treated successfully, 5 developed Q wave myocardial infarction and 1 died.

PERCUTANEOUS TRANSLUMINAL EXCIMER LASER CORONARY ANGIOPLASTY CLINICAL REPORT OF SIX CASES

Six patients with 95% to 100% occluded atheroseleroticlesions underwent percutaneous transluminal excimer lasercoronary angioplasty (PTELCA). Among them, 5 were maleand ! was female; their age ranged from 28 to 66 years. Fourpatients had LAD stenosis and 2 LCX lesions.Acuteangiographic and clinical success was achieved in all patientsbut one, with a success rate Of 83.3%. It was demonstratedthat PTELCA is a safe and effective therapy for selected pa-tients with coronary artery disease.

Clinical Study on The rapeutic Mechanism of Sini Decoction (四逆汤) in Treating Post-Percutane ous Transluminal Coronary Angioplasty Ische mia-Reperfusion In jury in Terms of Syndrome Typing of TCM

Objective: To study the mechanism of Sini Decoction (SND) in prevention and treatment of post-percutaneous transluminal coronary angioplasty (PTCA) ischemia-reperfusion injury with different Syndrome typing of TCM.Methods: Forty patients who received PTCA were randomly divided equally into the SND group and the control group, there were 10 of Excess Syndrome (ES) and 10 of Deficiency Syndrome (DS)in each group.25 ml SND was gi ven daily to the SND group from 3 days before operation to the third day after operation. The blood superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) content of patients were determined before PTCA, and 1 hr, 12 hrs, 24 hrs, 48 hrs and 72 hrs after PTCA. Results: Before PTCA, the cases with DS were characterized by low SOD activity and high MDA content, as compared with the patients with ES, P<0.05. SND could relieve the post-PTCA deprivation of SOD activity and NO content and the elevation of MDA level in both ES and DS patients, the amplitude of elevation of SOD activity in DS patients was higher than that in ES patients (P<0.05). Conclusion: SND has antagonizing effect on post-PTCA ischemia-reperfusion injury, which is more effective in treating patients with DS.

Study on Influence of Sini Decoction (四逆汤) on Quality of Life of Patients after Percutane ous Transluminal Coronary Angioplasty

Objective: To determine the influence of Sini Decoction (SND) on quality of life(QOL) of patients after percutaneous transluminal coronary angioplasty (PTCA). Methods: Randomized case-control clinical trial was conducted to evaluate QOL of 40 post-PTCA patients before and after SND treatment by scoring. Results: The scores in physical symptoms, sense of well-being, degree of depression, index of satisfaction of life and work capacity of the patients after PTCA were improved significantly as compared with before PTCA, P<0.01. Scores of patients who received SND treatment were higher than those untreated with SND in the first three criteria, P<0.05, particularly in relieving palpitation and dyspnea. Conclusion: SND is helpful in improving QOL of patients after PTCA.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient＇s sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group （P= 0.008）. In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

Novel economic treatment for coronary wire perforation:A case report

BACKGROUND Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention(PCI),however if recognized and managed promptly,its adverse consequences can be minimized.Risk factors include the use of advanced PCI technique(such as atherectomy and chronic total occlusion interventions)and treatment of severely calcified lesions.Large vessel perforation is usually treated with implantation of a covered stent,whereas distal and collateral vessel perforations are usually treated with embolization of coils,fat,thrombin,or collagen.We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation.we advocate this method as a simple method of managing distal vessel perforation.CASE SUMMARY A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex.At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation.A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.CONCLUSION The use of a balloon remnant for embolization in coronary perforation presents a simple,efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome.Prevention remains the most important part with meticulous attention to the distal wire position,particularly with hydrophilic wires.

Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.

Multivariate Analysis of Clinical Factors in Restenosis after Coronary Stenting

Ojbective To find the independent predictors for restenosis after coronary stenting. Methods Quantitative angiography was performed on 60 cases (67 successfully dilated lesions) after angio-plasty over 6-months follow-up, and both univariate and multivariate logistic regression analysis were done to i-dentify the correlations of restenosis with clinical factors. Results The total restenosis rate was 31. 3% (21 of 67 lesions), and according to univariate analysis the patients who underwent coronary stenting≥ 3. 5mm had a lower rate of restenosis ( P < 0. 01). Collateral circulation to the obstruction site, high maximal inflation pressure, smoking and the less minimal lumen diameter after PTCA made the rate of restenosis higherower ( P < 0. 05) . Multivariate logistic regression analysis showed that coronary stenting ≥3. 5mm had a low rate of restenosis, but high maximal inflation pressure and smoking made the restenosis rate higher. Conclusion Coronary stent size, maximal inflation pressure and. smoking were independent predictors for restenosis.

CLINICAL APPLICATION OF PERCUTANEOUS BALLOON MITRAL VALVALOPASTY

The operation of PBMV is popular and considecl highlybeacuso of advantages of satisfactory effects andlittle lesion.But there are many difficulties inpractices,such as the balloon can’t be passedthrough the mitral valve eesily.We operated 64patients by the method of big curve in front part ofthe catheter during PBMV and all of the catheterswere passed through the mitral valve in short time,the stenosis valves vere dilated successfully.In myopinion,in order to made a big curve in front partof the catheter,it is vital to change the curve infront part of left ventricular wire according to thesize of left atrium,which can make the catheter havea proper curve to pass the mitral valve.In addition,it is not suitable to puncture the artial ssptum inhigher position,if so,the front part of the catheterin left atrium is parallel or almost parallel to theaitral valve,not in the right angle,so the cathetercan’t be easy to pass through the mitral valve.During the puncturing,the angle of the punctureneedle must be settled properly to reduce thecomplications.We suggest that the degrees of arrowin the puncture needle be set to 45°.60 and 75°separately when the size of left atrium are 4.0cm,5.0cm and 6.0cm.When pueeturing in such degree,thecatheter could be in right angle with the mitralvalve and passed through the valve easily.

Potassium in Prevention of Restenosis after PTCA

Objectives To investigate safety and effectivity of potassium inprevention of restenosis after PTCA. Methods Eighty patients with PTCA were randomized into two groups: Control group ( Group Ⅱ n= 40) with conventional therapy; Treatment group (Group Ⅰ n = 40) with conventional therapy plus oral potassium (Slow - K 1.2 g, q8h, given 3 days before PTCA and continued to the end ofsub - study). Observation indeces of two groups were compared in follow - up. Results Seventy - seven patients were followed -up(39 in group Ⅰ, 38 in group Ⅱ) All blood indices (including fat, sugar, uric acid, cretonne, Na+, Cl-, Ca2+, Mg2+ ) except blood potassium in both groups were similar. Oral potassium could increase blood potassium level about 0. 3 mmol/L in group Ⅰ without causing any side effects. Suspicious angina pectoris and evidence of myocardial ischemia by ETT were developed in group Ⅱ had 14 patients (28. 9 % ) and Group I had 7 patients (17. 9 % ); 6 of 17 patients(35. 3 % ) in groupⅠ and 11 of 21 patients in group Ⅱ (52. 3 % ) appeared restenosis confirmed by coronary arteriography. 10. 2 % in group Ⅰ (4/39) and 23.7 % in group Ⅱ (9/38) needed revascular-izations(PTCA or CABG) . Conclusions Therapy with potassium after PTCA showed that recurrence of myocardial ischemia, restenosis rate by follow - up coronary arteriography and revascularization rate tended to be lower in group Ⅰ than in group Ⅱ.

Plaque increase may be an important contributor to late restenosis after percutaneous transluminal coronary balloon angioplasty

There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.

Treatment of in stent coronary restenosis with excimer laser angioplasty

OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P

Clinical and angiographic significance of exercise induced ST-segment elevation in patients without previous myocardial infarction

Objective To study the clinical significance of exercise-induced ST-segment elevation(STE)in patients without previous myocardial infarction(MI). Methods Ten patients without previous MI who developed STE during exercise testing were underwent coronary angiography, left ventriculography and rest electrocardiography, and Bruce protocol were used during exercise test. Results The incidence of exercise induced STE in patients without previous MI was 0.28%(10/3564). One of the 10 patients had only a mild coronary lesion (stenosis < 35%in diameter) in left anterior descending artery, but she developed an acute myocardial infarction 4 weeks after coronary angiography,and the leads of myocardial infarction and the leads of exercise induced STE elevation were same, the others all had severe coronary stenosis(90%～100%). There was a good correlation between leads of ST segment elevation and ischemic related artery. Nine patients received invasive therapy. During a period of 28 months (range 8 to 48 months) of follow up, 2 of them received PTCA again at 11 and 19 months after their discharge, prospectively. Conclusions The findings indicats ST elevation during exercise is a specific marker of severe transmural regional ischemia and should be an indication for coronary angiography. Most patients with exercise induced ST segment elevation have critical organic stenosis of the ischemic-related coronary artery and are candidates for myocardial revascularization. In a few patients, ST segment elevation during exercise may be caused by coronary artery spasm in the absence of significant organic lesions, and they may have a poor prognosis.

Incidence and predictors of radial artery spasm during transradial coronary angiography and intervention

Background Radial artery spasm （RAS） is the most common complication in transradial coronary angiography and intervention. In this study, we designed to investigate the incidence of RAS during transradial procedures in Chinese, find out the independent predictors through multiple regression, and analyze the clinical effect of RAS during follow-up. Methods Patients arranged to receive transradial coronary angiography and intervention were consecutively enrolled. The incidence of RAS was recorded. Univariate analysis was performed to find out the influence factors of RAS, and logistic regression analysis was performed to find out the independent predictors of RAS. The patients were asked to return 1 month later for the assessment of the radial access.Results The incidence of RAS was 7.8% （112/1427） in all the patients received transradial procedure. Univariate analysis indicates that young （P=0.038）, female （P=0.026）, small diameter of radial artery （P 〈0.001）, diabetes （P=0.026）, smoking （P=0.019）, moderate or severe pain during radial artery cannulation （P〈0.001）, unsuccessful access at first attempt （P=0.002）, big sheath （P=0.004）, number of catheters （〉3） （P=0.048）, rapid baseline heart rate （P=0.032） and long operation time （P=0.021） were associated with RAS. Logistic regression showed that female （OR=1.745, 95% CI： 1.148-3.846, P=0.024）, small radial artery diameter （OR=4.028, 95%CI： 1.264-12.196, P=0.008）, diabetes （OR= 2.148, 95%CI： 1.579-7.458, P=0.019） and unsuccessful access at first attempt （OR=1.468, 95%CI： 1.212-2.591, P=0.032） were independent predictors of RAS. Follow-up at （28±7） days after the procedure showed that, compared with non-spasm patients, the RAS patients had higher portion of pain （11.8% vs. 6.2%, P=0.043）. The occurrences of hematoma （7.3% vs. 5.6%, P=0.518） and radial artery occlusion （3.6% vs. 2.6%, P=0.534） were similar. Conclusions The incidence of RAS during transradial coronary procedure was 7.8%. Logistic regression analysis showed that female, small radial artery diameter, diabetes and unsuccessful access at first attempt were the independent predictors of RAS.