ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PRE-AND POST-PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Transesophageal echocardiogram (TEE) was performed in 33 consecutive patients with both rheumatic mitral stenosis and chronic atrial fibrillation to evaluate tfae usefulness of this technique for the detection of left atrial thrombi, mitral regurgitation before percutaneous balloon mitral valvuloplasty and iatrogenic atrial septal defect after the procedure. TEE correctly identified thrombi in 10 (30%) patients and significant mitral regurgitation in 5 patients who underwent surgical intervention. The remaining 18 patients underwent percutaneous balloon mitral valvuloplasty without evidence of systemic embolic event and obtained adequate outcome. Transesophageal color doppler echocardiography demostrated left-o-ight shunting flow through atrial septum in 5 of 7(71%) patients 3 days after the procedure and repeated TEE in 2 of these 5 patients showed no shunting after 6 months. In conclusion, TEE plays a definite role in the selection of patients for balloon mitral valvuloplasty and assessment of iatrogenic atrial septal defect.

A risk prediction score model for predicting occurrence of post-PCI vasovagal reflex syndrome： a single center study in Chinese population

Background The vasovagal reflex syndrome （VVRS） is common in the patiems undergoing percutaneous coronary intervemion （PCI） However, prediction and prevention of the risk for the VVRS have not been completely fulfilled. This study was conducted to develop a Risk Prediction Score Model to identify the determinants of VVRS in a large Chinese population cohort receiving PCI. Methods From the hos- pital electronic medical database, we idemified 3550 patients who received PCI （78.0% males, mean age 60 years） in Chinese PLA General Hospital from January 1, 2000 to August 30, 2016. The multivariate analysis and receiver operating characteristic 01OC） analysis were performed. Results The adverse events of VVRS in the patients were significantly increased after PCI procedure than before the operation （all P 〈 0.001）. The rate of VVRS [95% confidence interval （CI）] in patients receiving PCI was 4.5% （4.1%-5.6%）. Compared to the patients suffering no VVRS, incidence of VVRS involved the following factors, namely female gender, primary PCI, hypertension, over two stems im- plantation in the left anterior descending （LAD）, and the femoral puncture site. The multivariate analysis suggested that they were independ- ent risk factors for predicting the incidence of VVRS （all P 〈 0.001）. We developed a risk prediction score model for VVRS. ROC analysis showed that the risk prediction score model was effectively predictive of the incidence of VVRS in patients receiving PCI （c-statistic 0.76, 95% CI： 0.72-0.79, P 〈 0.001）. There were decreased evems of VVRS in the patients receiving PCI whose diastolic blood pressure dropped by more than 30 mmHg and heart rate reduced by 10 times per minute （AUC： 0.84, 95% CI： 0.81-0.87, P 〈 0.001）. Conclusion The risk prediction score is quite efficient in predicting the incidence of VVRS in patients receiving PCI. In which, the following factors may be in- volved, the femoral puncture site, female gender, hypertension, primary PCI, and over 2 stents implanted in LAD.

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention:A Systematic Review and Meta-Analysis

Objective:To evaluate the effectiveness and safety of oral Chinese herbal medicines(CHMs)on post-percutaneous coronary intervention(PCI)patients with depressive disorder in coronary heart disease(CHD).Methods:A literature search was conducted through databases including PubMed,Cochrane Library,Chinese National Knowledge Infrastructure Databases(CNKI),Chinese Biomedical Literature Database(SinoMed),Chongqing VIP Chinese Science and Technology Periodical Database(VIP)and Wanfang Database up to August 2018.Randomized controlled trials(RCTs)comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included.Data extraction,analyses and quality assessment were performed according to the Cochrane standards.RevMan 5.3 software was used to synthesize the results.Results:A total of 16 RCTs enrolling 1,443 participants were included in this systematic review.When compared with antidepressants alone,CHMs showed similar benefits with less side effects[risk ratio=0.54,95%confidence interval(CI)0.43 to 0.69,582 patients];meanwhile,the combination therapy may have more advantages than antidepressants alone[mean difference(MD)=–1.03,95%CI–1.81 to–0.25,267 patients).When identified with placebo,CHMs seem to have more advantages in relieving depressive symptoms(MD=–19.00,95%CI–20.02 to–17.98,189 patients).However,when compared with basic treatment of postPCI,CHMs showed different results in two trials.In terms of post-PCI related clinical symptoms,CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms.However,the heterogeneity in this review was generally high,it may be caused by different interventions used in each trial and the low quality of the trials.Conclusions:In total,CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms.However,because of small sample size and potential bias of most trials,this result should be interpreted with caution.More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.