简介：TheadoptionoftransradialaccessintheUnitedStatesandinternationallyhasbeengrowingoverthepastfewyears.Inthepopulationofpatientspresentingwithacutecoronarysyndromes,particularlyST-elevationmyocardialinfarction,transradialaccesshasthebenefitoffewervascularandbleedingcomplicationsandlowermortalityratesovertransfemoralaccess.Wewillexaminethecurrentevidencesupportingtransradialaccessforseveralpatientpopulations,includingthosepatientspresentingwithacutecoronarysyndromes.Wewillreviewtheliteratureregardingthelearningcurvefortransradialaccesswithnewoperators,aswellasexperiencedtransfemoraloperatorsnewtotransradialaccess.Finally,wewillinvestigatetheroleoftransradialaccessinsame-daydischargeforstablepatientsundergoingpercutaneouscoronaryintervention.

简介：Arrhythmogenicrightventriculardysplasia/cardiomyopathy(ARVD/C)ischaracterizedbyfibro-fattyreplacementoftherightventricle.However,thefeasibilityandsignificanceofmyocardialfibrosisdetec-tedbydelayedenhancement(DE)using3.0Tmagneticresonanceimaging(MRI)in.ARVD/Cisseldomlystudied.MethodsTwenty-sevenconsecutivepatientswereprospectivelyevaluatedforARVD/C.Magneticreso-nanceimagingwasperformedona3.0Tscanner.Tenminutesafterintravenousadministrationof0.2mmol/kgofgadodiamide,DE-MRIwasobtained.DiagnosisofARVD/CwasbasedupontheTaskForcecriteriaandin-cludedMRIfindings.ResultsSeventeen(59%)of27patientsmettheTaskForcecriteriaforARVD/C.Rightven-tricleDEwasfoundinall(100%)ARVD/Cpatientscomparedwithnone(0%)ofthe10patientswithoutARVD/C(P<0.001).AdditionalleftventricularDEwasfoundin8/17ARVD/Cpatientswhilewithoutleftventricularmor-phologicalandfunctionalabnormalitiesdetectedbyechocardiographyorMRI.ConclusionsDEusing3.0TMRIcouldeffectivelydetectmyocardialfibrosisintherightandleftventricularmyocardiuminARVD/Cpatients.DetectionofmyocardialfibrosismayhaveanimportantclinicalsignificanceinARVD/Cdiagnosis.Histologicalleftventriclein-volvementmaybeeasilymissedbyechocardiography.

简介：心肌缺血再灌注损伤（myocardialischemiareperfusioninjury,MIRI）是指心肌组织缺血后再恢复灌注,缺血心肌的损害不仅没有好转反而出现反常增加的现象[1].MIRI是临床医生面临的一大难题[2-4].由于心外科手术需要无血、相对静止的环境,在体外循环、心脏停跳下进行,而体外循环心脏停跳下手术则需要阻断心脏供血,注入停跳液促使心脏停跳,心脏上操作完成后再恢复心脏血供,促使心脏复跳,因此体外循环下心脏停跳过程就是一个缺血再灌注损伤的过程.在经历体外循环后的心脏病患者术后恢复过程及远期疗效很大程度与缺血再灌注损伤相关,所以MIRI的研究具有重要的意义.但MIRI损伤的病理生理机制是复杂的,到目前为止都还不完全清楚,亦缺乏有效的治疗策略[5].