Contrast media is equivalent to a “lamp”
In routine coronary intervention , the contrast agent is equivalent to a “light”, the doctor can inject the contrast agent at any time to display the direction of the blood vessel and the position of the catheter and guide wire, and can also accurately locate the position of the stent, which is easy to operate. However, for patients with contrast medium allergy and renal insufficiency, the use of contrast medium is severely limited. Without the guidance of contrast agent, how to operate has always been a difficult problem for interventional physicians.
In recent years, the use of intravascular ultrasound image-guided contrast agent-free interventional therapy technology is in the ascendant internationally. Interventional therapy for patients with contrast medium allergy or renal insufficiency has great clinical significance. But this technology is extremely demanding on the intervention team. The surgeon must have a deep understanding of coronary anatomy and intravascular ultrasound images, and rely on skilled operation experience and intravascular ultrasound image positioning to complete the operation. At present, only a few heart centers in China have carried out such operations.
Actively exploring to benefit patients
Deputy Chief Physician Wang Jian, Deputy Chief Physician Luo Zhi, Deputy Chief Physician Luo Zhi, Department of Cardiology, Beijing Geriatrics Hospital With the intervention experience and technology accumulated over the years, he has led the Cardiology Department to carry out routine coronary intervention with zero contrast agent or a very small amount of contrast agent, bringing more good news to the common people, especially patients with contrast agent allergy or renal insufficiency.
Case Sharing
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Mr. Wang, 48, from Langfang, Hebei Province, suffered from chest tightness during physical labor a year ago Breath holding, activity tolerance was significantly decreased, and he went to many local hospitals for diagnosis of heart failure, coronary heart disease, old anterior inferior myocardial infarction, cardiomegaly, and cardiac function class III (NYHA classification); UCG: left atrial large, LVEDD64mm, EF 30%, the range of motion of the inferior posterior wall of the left ventricle was reduced, mirror dextrocardia; CAG: ulcer plaque at the end of the left main trunk; LAD proximal tubular stenosis 90%, middle segment 100% occlusion, D1 proximal tubular stenosis 90%, LCX proximal segment 80% diffuse stenosis, 70% limited distal stenosis, proximal RCA plaques, 90% diffuse stenosis in the middle, 90% diffuse stenosis in the distal segment, and 80% tubular stenosis in the proximal segment of the PDA, which can provide collateral circulation to the LAD.
Mr. Wang is in critical condition and the dextrocardia makes the operation more difficult. The local hospital recommends bypassing the patient. .
Figure｜Devocardiac
Consider the patient At the prime of his life, he is the mainstay of the family. Cardiac surgery is traumatic and the service life of venous grafts is short. His family refused CABG (coronary artery bypass surgery) and hoped for PCI intervention. After that, he went to many hospitals in Beijing for treatment, and finally the patients and their families came here. to our hospital.
Figure｜Preoperative
Mr. Wang was admitted to the hospital for examination Serum creatinine 137.9umol/L, eGFR50.74ml/min, BNP365pg/ml, UCG: LVEDD56mm, EF28%, multi-segment wall motion abnormalities. Mirror dextrocardia, large-area myocardial infarction, left main coronary artery + three-vessel disease, severe heart failure, and cardiac enlargement are already extremely high-risk interventional operations. Surgery is even more difficult.
Figure｜Preoperative
Cardiology team in Under the guidance of Chief Physician Wang Jian and Deputy Chief Physician Luo Zhi, the patient’s condition and surgical risks were carefully evaluated. After many discussions, the final decision was made.Intravascular ultrasound (IVUS) under the guidance of contrast agent-free PCI technology is used to preferentially treat RCA lesions, and left coronary lesions will be selectively intervened after coronary blood supply is improved and cardiorenal function is further improved.
Figure｜Intraoperative
Intraoperative mirror right The location of the center increases the difficulty of the operation, and the right coronary guiding catheter can never reach the right coronary ostium. In desperation, only a very small amount of contrast agent is used to find the right coronary ostium. Director Wang Jian uses his rich experience to send the guide wire to the distal end of the right coronary, and then apply IVUS. Evaluate the lesion, pretreat the lesion, determine the ideal landing point of the diameter and length of the stent, and finally successfully implant the stent, and re-evaluate the expansion and good adherence of the stent to achieve precise treatment.
A total of 30ml of contrast medium was used throughout the operation, and the postoperative monitoring of serum creatinine was 121.2umol/L and BNP324pg/ml , serum creatinine did not change significantly and was in a stable state.
Figure｜Postoperative
Science time:
< strong>Intra Vascular UltraSound (IVUS) technology
Simple and popular In other words, it is an ultrasound examination in the heart blood vessels, and a miniaturized ultrasound probe is sent into the blood vessel lumen through a catheter, so as to obtain a cross-sectional image of the inside of the vessel wall. The degree of sophistication can be called the “eyes of the doctor” in cardiovascular interventional surgery.
By using a miniature ultrasound probe installed on the top of the catheter, the cross-sectional image of the blood vessel can be displayed in real time, and the tube can be clearly displayed The thickness of the wall structure, the size and shape of the lumen, etc., can accurately measure the diameter and cross-sectional area of the vascular lumen, and even identify lesions such as calcification, fibrosis, and lipid pools, and find early vascular lesions that cannot be displayed by coronary angiography. Provide an accurate reference for the selection of suitable stents before insertion, so that the operator can better select the diameter and length of the stent, so that the stent and the blood vessel can be better matched.
After the stent is implanted, the size, position, shape, degree of adherence, symmetry of the stent can also be adjusted. A systematic review of performance and deployment satisfaction was performed to ensure that the stent was adequate and not overexpanded.
none Contrast agent interventional therapy can also be applied to patients with contrast agent allergy. This interventional technique requires that the surgeon must have superb interventional surgery skills, strong spatial judgment ability, skilled operation techniques, and accumulated surgical experience. Surgery was performed on the basis of ultrasound.
Text | Cardiology Jardine
< strong>Beijing Geriatrics Hospital Cardiology Intervention Team
The Department of Cardiology of Beijing Geriatrics Hospital is characterized by elderly heart disease. It is a comprehensive clinical discipline integrating clinical, scientific research, teaching and rehabilitation. It is good at elderly coronary heart disease, heart failure, atrial fibrillation, slow heart rhythm The diagnosis and treatment of common and frequently-occurring diseases such as disorders, and the diagnosis and treatment of complex internal diseases with multiple complications of heart disease.
Coronary angiography and stent implantation are now performed, in the elderly, complex high-risk coronary heart disease (such as: He has accumulated rich experience in interventional treatment of acute myocardial infarction, left main disease, calcified disease, bifurcation disease, chronic total occlusion disease, etc.
Performance of temporary and permanent pacemaker implantation for bradyarrhythmias, tachyarrhythmia Disorders (supraventricular tachycardia, atrial flutter, atrial fibrillation, premature ventricular tachycardia, ventricular tachycardia) cardiac electrophysiological examination and radiofrequency ablation therapy; chemical ablation therapy for hypertrophic cardiomyopathy, cardiac valvular disease interventional therapy, etc.