2014年 · 第42卷第10期

Li Tieyi, a teacher from Beijing Friendship Hospital of Capital Medical University, is a famous expert in the field of imaging in China. I have heard his name for a long time and have always admired him. However, I really know the high level of medical ethics and medical skills, and I have personal experience this year.

It has been 30 years since the first case of percutaneous coronary intervention (PCI) was carried out in China. Reviewing the origin and looking forward to the future in the year of "establishment" should be beneficial to the further promotion and development of this technology and benefit more patients.

China's first expert consensus on the prevention, diagnosis and treatment of infectious endocarditis (IE) in adults^[1](hereinafter referred to as the Consensus) is published in this issue. The consensus was implemented by the Heart Failure Group organized by the Cardiovascular Disease Branch of Chinese Medical Association.

The development of infectious endocantitis (IE) is a complex process, including the formation of non-bacterial thrombotic endocarditis on the intima of the damaged heart valve; Platelets aggregated at the endothelial lesion of the valve form neoplasms; Bacteria in the blood adhere to and multiply in neoplasms during bacteremia^[1,2]； Interaction between pathogens and valve matrix molecular proteins and platelets.

cardiopulmonary exercise testing (CPET) is a continuous dynamic monitoring, analysis and calculation of ECG, blood pressure, respiration, gas exchange, blood oxygen saturation, etc. of patients from rest to exercise to maximum limit state and recovery period, which is used to quantitatively evaluate the overall functional status of patients, evaluate the diagnosis and treatment of various diseases and exercise rehabilitation, judge the prognosis of critically ill patients, and predict and intervene in possible crisis events. As the most important detection method of human whole function, CPET has been widely developed abroad for more than 50 years, but it is difficult in China. There are two main reasons for this. First, the concept of overall regulation has not been used to explain the lack of regulation of normal respiratory circulation and metabolism^[1,2,3]Systems Theory of Traditional Physiology Medicine^[1,2]One-sided, incorrect or even misunderstanding of gas exchange measurement indexes, such as oxygen consumption and ventilation effectiveness, which need to be completed by multiple systems of human body; Second, the requirements of gas exchange measurement instruments and equipment are high, and the stability is limited, so it is difficult to achieve high-quality quality control. The author combines many years of experience working in the HARBOR-UCLA cardiopulmonary exercise laboratory in the United States^[4]Especially in North America, we created, prepared and operated the first core laboratory of cardiopulmonary exercise testing in the world, managed more than 200 cardiopulmonary exercise laboratories in medical centers, and returned to work in China. Combined with the actual situation in China, we discussed the requirements and quality control of CPET clinical laboratories and equipment.

The patient was a 43-year-old male. He was admitted to hospital for 6 years of recurrent fever 11 years after tricuspid valve neoplasm debridement. In August 2000, he was hospitalized in our hospital due to chills, fever, cough and left chest pain. Transthoracic echocardiography (TTE) showed the formation of tricuspid septal valve neoplasms, and chest CT showed two lung infections (mainly on the right side). Three blood cultures were negative. The diagnosis was "infectious endocarditis". Neoplasm removal, lesion debridement and tricuspid valvuloplasty were performed on 4 Dec 2000 when the body temperature could not be controlled with multiple antibiotics. A grey-white neoplasm with a size of about 4.0 cm ×1.0 cm ×1.0 cm was found at the junction of anterior tricuspid valve and septal valve. Postoperative pathological examination showed that the neoplasm was 2.2 cm ×1.0 cm ×0.3 cm, gray-yellow, dark brown and brittle. Microscopic examination showed a large number of mold spores and microfilaments in inflammatory necrotic tissue and blood clot. No bacteria were found in Gram staining, and the neoplasm was cultured as Candida albicans. The postoperative diagnosis was tricuspid fungal endocarditis. After operation, intravenous fluconazole was used for 2 weeks, followed by oral fluconazole for 2 weeks. One year after operation, TTE revealed that the echo of tricuspid septal valve was enhanced, and no abnormal echo mass was found.

A 42-year-old male was admitted with "persistent chest pain for 2 h". Has a history of smoking for 15 years. Physical examination: blood pressure 145/80 mmHg (1 mmHg =0.133 kPa); The breathing sounds of both lungs were clear, and no dry and wet rales were heard; The boundary of heart turbidity was not large, the heart rate was 90 beats/min, the rhythm was uniform, and no pathological murmur was heard in the auscultation area of each valve. ECG: sinus rhythm, V₁~ V₅Lead ST segment elevation. Echocardiography: segmental anomalies of anterior wall motion. Marker of myocardial necrosis: troponin T (+). Aspirin 300 mg chewed and clopidogrel 600 mg orally administered immediately after admission; Preoperative intravenous bolus injection of tirofiban 10 μ g/kg (bolus injection completed within 3 min), followed by 0.15 μ g · kg^–1• min^–1Continued pumping for 48 h; The intraoperative dosage of unfractionated heparin was 50-70 U/kg. Coronary angiography showed proximal occlusion of the left anterior descending (LAD) (FIG. 1a), visible giant thrombosis image, thrombosis burden score of 5 points, blood flow myocardial infarction thrombolytic test (TIMI) grade 0; No abnormalities were seen in the left circumflex artery (LCX); There was no abnormality in the right coronary artery (RCA), and the blood flow was TIMI grade 3. Interventional therapy was performed using a right radial approach with a 6 F BL3.0 guide catheter to the left coronary artery opening and a Runthrough guidewire to the distal end of the LAD. After repeated thrombus aspiration through the Export thrombus aspiration catheter (FIG. 1b), a huge thrombotic shadow is still visible (Figure 1c）。 The Heartrail Ⅱ 5F sub-catheter (Terumo, Japan) was directly fed into the LAD and the thrombus was aspirated once (Figure 1d), withdraw a large thrombus (Figure 1e）。 Coronary angiography showed disappearance of LAD thrombus, TIMI grade 3 blood flow, 40% proximal LAD stenosis, and no stent (Figure 1f）。

In the early stage of atherosclerosis, monocytes enter the intima of arteries, and then transform into macrophages in the intima, which in turn uptake modified lipoproteins to form foam cells. In addition to lipoprotein uptake, macrophages can also engulf red blood cells, platelets, and disintegrated fragments of necrotic substances in the plaque, and degrade and remove them^[1]。 Recent studies have shown that phagocytosis by mononuclear macrophages has an important influence on the progression and stability of atherosclerotic plaques^[2,3,4]。

With the aging of the population, calcific aortic valve disease (CAVD) has become the most common valve disease in the elderly. For a long time, CAVD has been regarded as an age-related and irreversible degenerative disease in the elderly. However, this concept is being gradually changed. In recent years, with the research on the risk factors, histopathology and molecular genetic mechanism of CAVD, people have a new understanding of its occurrence and development. In this paper, the genetic research of CAVD is reviewed.