2009年 · 第122卷第06期

In China, the prevalence of type 2 diabetes mellitus is increasing due to the aging of the population, increased frequency of obesity, and suboptimal nutritional habits1The current number of diabetic patients in China is around 40 million. Patients with diabetes even without prior cardiovascular disease have the same event rates as individuals without diabetes but with nrior myocardial infarction.2

Cardiac resynchronization therapy (CRT) improves left ventricular function, symptom status, quality of life and reduces hospitalization and mortality in patients with New York Heart Association (NYHA) Class Ⅲ or IV heart failure and intraventricular conduction delay despite optimal medical management.1 B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-pro BNP) levels correlate with the severity of heart failure and predict prognosis of heart failure patients.2

Pathology and postmortem studies have reported that the most important mechanism of acute coronary syndrome (ACS) is the rupture of a vulnerable plaque and subsequent thrombus formation. Such events commonly arise from the non-flow limiting atherosclerotic lesions which are prone to rupture. Thin-cap fibroatheromas (TCFA) are the most common type of vulnerable plaque. As the widely used technique for the detection of coronary arterial diseases, coronary angiography has intrinsic limitations since it only portrays the contrast agent-filled contour of the lumen and provides little information on the vessel wall and even less the characteristics of the plaques。

Abstract：Background Drug-eluting stents (DES) have revolutionized the field of interventional cardiology by dramatically improving clinical and angiographic outcomes. Patients with diabetes mellitus (DM) are associated with an increased risk of adverse clinical outcomes after a percutaneous coronary intervention (PCI). Available information on the efficacy and safety of DES and bare metal stent (BMS) in diabetic patients remains scarce.Methods From April 2004 to October 2006, 1565 patients with diabetes, who successfully underwent elective stenting at Fu Wai Hospital in Beijing, China, were enrolled in this study. All enrolled patients were assigned to a drug eluting stent group and a bare metal stent group. We obtained follow-up data: death, myocardial infarction (MI), thrombus, target lesion revascularization (TLR), and target vessel revascularization (TVR) at 30 days and 12 and 24 months, as defined by the Academic Research Consortium (ARC). We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox's proportional-hazards models adjusted with the propensity score were used to assess the relative risks of all the outcome measures at 24 months.Results At 24 months, all ARC defined stent thrombosis in the two groups were similar; at 30 days, a more definite thrombosis was found in the BES group (0.08% vs 0.81%, P=0.016). Patients treated with DES showed a significant lower risk of TLR (3.88% vs 10.89%; hazard ratio (HR) 0.159 (95% CI: 0.151-0.444), P<0.001), TVR (5.48% vs 11.69%; HR 0.383 (95% CI: 0.232-0.633), P <0.001), and any revascularization (12.47% vs 18.55%; HR 0.555 (95% CI: 0.370-0.831), P=0.0004) at 24 months. No significant difference was apparent in terms of all-cause mortality, MI, and all-cause mortality/MI.Conclusions In contemporary society's large, diabetic population, the use of DES is associated with long-term significant reductions in the risks of TLR, TVR, and any revascularization. There is no significant difference in all-cause mortality, MI, and thrombosis between DES and BMS in the patients with diabetes at 24-month follow-up。

Abstract：Background Unheralded sudden death and acute myocardial infarction are common manifestations of coronary atherosclerosis. Such events are related to thrombotic occlusion at the site of non-flow limiting atheroscterotic plaques in epicardial coronary arteries. This study aimed to assess plaque characterization of nonculprit lesions in patients with acute coronary syndrome (ACS) compared with those with stable angina pectoris (SAP) determined by analysis of intravascular ultrasound (IVUS) radiofrequency (RF) data.Methods In 81 patients, nonculprit vessels with <50% diameter stenosis and nontarget segment of culprit vessels with <50% diameter stenosis were studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software.Results Mean lipid core percentage was significantly higher in patients with ACS than in those with SAP ((25.78±6.30)% vs (9.11±4.90)%, P <0.001). In addition, patients with SAP showed more fibrotic vessels ((59.66±16.87)% vs (49.07±10.20)%, P <0.001). There was no significant difference in either mean calcium ((4.37±2.40)% vs (5.12±3.00)%, P=0.225) or fibrolipid ((24.94±9.40)% vs (25.82±13.60)%, P=0.731) percentages in nonculprit vessels, but the mean calcium percentage was significantly higher in nontarget lesions of culprit vessels ((5.51±3.29)% vs (3.57±2.10)%, P=0.003). In addition, there was a positive correlation between lipid core and remodeling index (RI) (r=0.847, P<0.001) and a negative correlation between fibrous tissue and RI (r=-0.946, P<0.001).Conclusions In this study, in both nonculprit vessels and nontarget lesion of culprit vessels, plaque characterization of nonculprit lesions determined by spectral analysis of IVUS RF data was significantly different in patients with ACS. The percentage of lipid core was significantly higher in patients with ACS than in those with SAP. Conversely, SAP patients showed more fibrotic content. In vivo plaque composition and morphological changes were related to remodeling of the coronary artery tree。

Abstract：Background Lesions at coronary bifurcations always are a big challenge for interventionists even with the advent of drug eluting stents (DES). Even as more clinical trials are published, operators still can not confirm that one strategy is more efficient than another. Selection of patients and short term follow-up contribute to the difficulty in comparing strategies.Methods From April 2004 to April 2008, 505 consecutive Chinese patients underwent DES implantation for true bifurcation lesions; including 258 using crush strategy (213 male, (56.7±10.8) years old) and 247 using no crush strategy (206 male, (58.1±10.1 ) years old) were analyzed.Results The follow-up period ranged from 237 to 1223 days, average (537±340) days for the crush group and (538±351) days for the no crush group. There was no significant difference of major adverse cardiac events (MACE) rate between the two groups (10.1% vs 12.1%; P=0.481), nor in cardiac death, nonfatal myocardial infarction (MI) or in the target vessel revascularization (TVR) (0.4% vs 1.6%; P=0.207, 2.7% vs 2.8; P=1.000 and 7.0% MS 7.7%; P=0.865). The stent thrombosis rate was similar in the two groups (1.6% vs 2.0%; P=0.409), late and very late stent thrombosis in both groups were very low (0.4% vs 0.4%; P=1.000). Seven-month angiographic follow-up showed no significant difference of the restenosis rate between the two groups (11.0% vs 13.5%; P=0.786). During the follow-up, cardiac death, nonfatal MI, TVR and ST free survival rate showed no significant difference between the two groups. The only variant identified as a predictor of MACE was percutaneous coronary intervention (PCI) in the first two years, which accounted for 47% of patients of all cases in four years.Conclusion Crush technique showed similar long-term clinical effect compared with other two DES techniques for coronary bifurcation lesions, the surgeons' skills are very important for reducing clinical events。

Abstract：Background Large discrepancy of the incidence of myocardial bridging (MB) has been reported either among the postmortem studies or among the studies with coronary angiogram. This study was to investigate the prevalence of MB in large number of coronary angiograms and the angiographic characteristics of MB.Methods A total of 5525 consecutive patients who underwent first diagnostic coronary angiography from January 2003 to March 2006 in Zhongshan Hospital were enrolled in this study. MB was diagnosed when the angiographical "milking effect", defined as the systolic compression and complete or partly release of the compression in diastole, was seen in the epicardial coronary arteries. Angiography was routinely repeated after intracoronary injection of 200 ug nitroglycerin. The systolic compression and length of MB were compared before and after the administration of nitroglycerin and also before and after stent implantation in patients with significant stenosis in segment proximal to the MB.Results Among 5525 patients, MBs were found in a total of 888 patients angiographically with the prevalence of 16.1%. Atherosclerotic lesions were found more often in the segment proximal to the MB with 344/854 (40.3%) patients than in the segment distal to the MB with 47/854 (5.5%) (P<0.01). The systolic compression ((43.3±13.7)% at baseline vs (54.2±14.0)% after nitroglycerine) and the average length ((20.9±7.5) mm at baseline vs (22.7±8.0) mm after nitroglycerine) of the MB segment were increased after intracoronary injection of nitroglycerin (both P <0.01). Stent implantation was performed in 88 patients with significant stenosis in the segment proximal to the MB. The systolic compression and the length of the MB segment were increased after stenting compared with those before stenting (systolic compression, (49.4±14.6)% at baseline vs (57.3±12.3)% after stenting, and length of MB, (19.5±6.1) mm at baseline vs (21.8±6.3) mm after stenting, P<0.01).Conclusions MB was a frequent finding in coronary angiogram with an incidence of 16.1%. Intracoronary administration of nitroglycerin and stent implantation in the segment proximal to the MB could enhance the systolic compression and the length of the MB angiographically。

Abstract：Background Current guidelines support primary percutaneous coronary intervention (primary PCI) as the first treatment of choice (as opposed to thrombolytic therapy) for patients with acute ST-segment elevation myocardial infarction (STEMI) especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI.Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory (rapid group), and 275 patients were admitted to the coronary care unit (CCU) or cardiac ward first, and then transferred to the catheterization laboratory (non-rapid group). Primary endpoint was door-to-balloon (D28) time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events (MACE) including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein Ⅱb/Ⅲa receptor inhibitors before angiography (84.0% and 77.1, P=0.042) and had TIMI 3 flow in the culprit vessel at initial angiogram (17.1% and 9.2%, P=0.007) in the non-rapid group. The D2B time was shortened ((108±44) minutes and (138±31) minutes, P <0.0001), and number of patients with D2B time <90 minutes was greater (22.6% and 10.9%, P <0.0001) in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality (4.1% and 5.8%) and cumulative MACE rate (7.0% and 9.8%) did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death-and MACE-free survival rates were improved in the rapid group (94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively).Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours。

Abstract：Background There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation.Methods Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.Results Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4±2.5) months vs (1.7±0.8) months, P<0.001). Average follow-up periods were (4.7±0.89) and (3.2±1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P=0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P <0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P <0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P <0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P <0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396-0.656, P <0.001). Left ventricular ejection fraction <50% and elderly (>65 years) were identified as independent predictors of long-term MACE during follow-up.Conclusion This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of FVR and MACE, as well as the need of re-admission and bypass surgery。

Abstract：Background A growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.Methods From September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).Results Baseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P=0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P=0.74). Aspirated thrombi were categorized as small thrombi (<3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (>7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P=0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P=0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.Conclusions Both Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome。

Abstract：Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common lilac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic intima, or of obstruction of the coronary orifice.Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period。

Abstract：Background The incidence of no reflow phenomenon limits the clinical outcomes of percutaneous coronary intervention (PCI). This randomized controlled study was designed to evaluate the immediate protective effects of intensive stalin pretreatment on myocardial perfusion and myocardial ischemic injury during PCI.Methods Altogether 228 patients with acute coronary syndrome (ACS) were randomly assigned to standard stalin group (SS group, n=115) and intensive statin group (IS group, n=113). Patients in the SS group received 20 mg simvastatin and patients in the IS group received 80 mg simvastatin for 7 days before PCI. Thrombolysis in myocardial infarction (TIMI) flow grade (TFG), corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMPG) of the intervened vessel were recorded before and after stent deployment. Creatine kinase (CK) isoenzyme MB, troponin I and plasma level of high sensitive-C reactive protein (hs-CRP), P-selectin and intercellular adhesion molecule (ICAM) were measured before and 24 hours after the procedure.Results The TFG after stent deployment was significantly improved with less TIMI 0-1 and more TIMI 3 blood flow in the IS group than in the SS group (all P<0.05). Patients with no reflow phenomenon were less in the IS group (P<0.001). The CTFC was lower in the IS group than in the SS group (P<0.001). TMPG was also improved in the IS group than in the SS group (P=0.001). Although PCI caused a significant increase in CK-MB 24 hours after the procedure, the elevated CK-MB value was lower in the IS group than in the SS group (18.74±8.41 vs 21.78±10.64, P=0.018). Similar changes were also found in troponin I (0.99±1.07 in the IS group vs 1.47±1.54 in the SS group, P=0.006). CK-MB elevation occurred in 27.8% (32/115) of the patients in the SS group vs 15.9% (18/113) in the IS group (P=0.030). Myocardial necrosis was detected in 4.4% (5/115) of the patients in the SS group, whereas 0.9% (1/113) in the IS group (P=0.341). But no myocardial infarction was found. Similarly, the patients with increased level of troponin I were much more in the SS group (36.5%, 42/115) than in the IS group (19.5%, 22/113) (P=0.04). Among them, myocardial necrosis was detected in 13.0% (15/115) of the patients in the SS group, while 4.4% (5/113) in the IS group (P=0.021). Myocardial infarction was found in 4.4% (5/115) of the patients in the SS group and 0.9% (1/113) in the IS group (P=0.213).Conclusions Intensive statin pretreatment for 7 days before PCI can further improve myocardial blood perrusion, protect the myocardium from ischemic injury. These effects are associated with the lowered levels of hs-CRP, P-selectin and ICAM。

Abstract：Background Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods We performed 18 intravascular ultrasound assessments preintervention during the primary PCI for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion extemal elastic membrane (EEM), lumen, and plaque plus media (P&M) area. Positive remodeling was defined as lesion/mean reference EEM >1.0. Culprit lesions were identified by a combination of electrocardiogram (ECG) and coronary angiography.Results There was an average of 1.44 infarct-related artery (IRA) plaques per patient. The incidences of thrombus and plaque ruptures were 28% (5) and 33% (6), respectively. Hypoechoic plaque was observed in 72% (13) of AMI patients. Calcified lesions could be found in 33% (6) of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling.Conclusions Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling。

Abstract：Background N-terminal pro β-type natriuretic peptide (NT pro BNP) has been shown to predict the prognosis and could guide the treatment of heart failure. We aimed to investigate the values of NT pro BNP in predicting the clinical response to cardiac resynchronization therapy (CRT).Methods A total of 44 patients with chronic heart failure (34 male and 10 female, mean age of (58±13) years, New York Heart Association (NYHA) class 3.3±0.5, QRS duration (150±14) milliseconds) who underwent successful implantation of a CRT system were enrolled in this study. Pharmacotherapy remained stable during the first 3 months of follow-up. Plasma levels of NT pro BNP were evaluated before and 3 months after implantation. Clinical, echocardiographic and exercise parameters were monitored at each clinical visit after CRT implantation. Receiver operating characteristic analysis and a paired ttest were performed to analyze the data.Results After a mean of (16.3±5.5) months of follow-up, 11 nonresponders were identified. CRT resulted in a significant reduction in NT pro BNP ((1.70±1.28) vs (1.07±0.88) pmol/ml, P <0.001) in responders. Percentage change in NT pro BNP level (△BNP%) was a statistically significant predictor of long term clinical improvement at 3 months of follow-up.Conclusions △BNP% from baseline to 3 months of follow-up is a predictor of long term response to CRT. NT pro BNP may be a simple method for monitoring the effects of CRT。

Coronary angiography presently remains the main method for the diagnosis and instruction of epicardial coronary disease. However, precise characterization of the significance for any given stenosis is limited by the inability to identify intermediate coronary lesions responsible for ischemia.1-3 In clinical practice, in addition to the assessment of the anatomical details of vessel narrowing, a more precise assessment of the impediment to coronary blood flow has become extremely important. At present, several physiological parameters have been introduced to improve discrimination in functional coronary lesion severity during cardiac catheterization。

Coronary stents have been used as standard mechanical devices for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD).1-3 They provide vessel wall scaffolding and prevent early elastic recoil and restenosis, which are major limitations of balloon angioplasty.4,5 Consequently, coronary stenting has a higher successful rate of PCI and improves the clinical outcome of the patients with CAD.6

Standards for treating bifurcation lesions are crucial due to poor outcomes by percutaneous implantation of either bare metal stents or drug-eluting stents, even with several modified double-stent techniques including "T", "V", "Y", "culotte" and "simultaneous kissing stents (SKS)". Understanding the drawbacks in classical crush techniques, we proposed a novel double kissing (DK) crush technique being testified in our previous serial studies.1,2

Litz-Hugh-Curtis syndrome (FHCS) was reported by Curtis after he found a fibrous adhesion between the surface of the liver and peritoneum in patients with gonococcal pelvic inflammation during laparoscopy in 1930, and the first report by Fitz-Hugh as acute gonococcal peritonitis in the right upper quadrant abdomen was published in 1934.1,2 The so-called FHCS is believed to originate from an inflammation in the pelvis which may ascend toward the diaphragmatic surface of the liver along the right paracolic gutters to cause the inflammation of the liver caosule with right upper abdominal pain.3-7

The long head of the biceps tendon (LHBT) pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement.1 Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed.1-5

Mucosa-associated lymphoid tissue (MALT) is a term that describes lymphoid tissue in various sites of the body, such as the gastrointestinal tract, thyroid, breast, lung, salivary glands, eye, and skin. MALT lymphoma of the lung is a subset of primary pulmonary lymphomas which originates from the MALT. Previously reported computed tomographic (CT) features of MALT lymphoma are the presence of consolidation or nodules in the lungs. 1-4

Highly active antiretroviral therapy (HAART) for HIV/AIDS has efficiently controlled the progression of the disease, extended life expectancy and decreased HIV/AIDS related morbidity and mortality since the advent of HIV protease inhibitors in 1996.1 Recent emergence of HIV resistance has severely affected the efficacy of antiretroviral therapy. The prevalence of HIV resistance has been increasing from the usage of AZT。

Myopericytoma belongs to a family of benign tumors that exhibit a myoid/pericvtic line of differentiation.1 The most common anatomical sites for myopericytoma are the skin and superficial soft tissues of the distal extremities.2 With increased clinical recognition, a wider distribution has been described;3-5 however, a pulmonary lesion has never been reported. We now report a case of primary pulmonary myopericytoma and review the literature on this rare entity。

Left ventricular pseudoaneurysm is a rare complication of chest trauma.1 Accurate diagnosis and early surgical intervention is essential for patients with large or expanding left ventricular pseudoaneurysms due to the high propensity of fatal rupture and thromboembolism or arrhythmia。