I. Development of cardiology
The specialist treatment of cardiology at our hospital began with transvenous (urokinase) thrombolysis for acute myocardial infarction.
In 2000, supraventricular tachycardia was terminated by transesophageal unprogrammed stimulation of overdrive inhibition.
In September 2004, temporary pacemaker placement and implantation of a buried pacemaker were introduced.
In 2005, transesophageal cardiac electrophysiology.
In January 2006, DSA selective pulmonary angiography was performed.
In July 2007, the “coronary angiography examination and treatment” was carried out, and the treatment of coronary heart disease in our hospital directly entered the era of drug-eluting stents, which opened the prelude to the interventional treatment of coronary heart disease.
In November 2007, we carried out “transcatheter congenital heart disease intervention” and successfully cured the first patient with congenital heart disease (arteriovenous ductus arteriosus), and in December, we successfully cured the first patient with atrial septal defect.
In January 2008, we continued to complete the blocking of congenital heart (ventricular septal defect), which further broadened the scope of interventional cardiology in our city.
II. Overview
(A) Esophageal method of cardiac electrophysiology
Esophageal cardiac electrophysiology is a non-invasive clinical cardiac electrophysiology technique.
Cremer et al. successfully recorded the cardiac electrical activity through an electrode catheter placed in the esophagus, i.e., esophageal lead ECG.
Monotoyo applied transesophageal atrial pacing to perform a comprehensive cardiac electrophysiological examination and treat a variety of tachyarrhythmias in 2007.
Professor Wenping Jiang of Soochow University School of Medicine in China pioneered the procedure in 1978.
The left atrium is most closely related to the esophagus, and its distance is only 0.5-1.5 cm. The tall P waves recorded in the esophagus are formed by left atrial excitation.
This technique makes full use of this anatomical feature by sending an electrode catheter into the esophagus through the nasal cavity, applying a cardiac electrophysiological stimulator to deliver direct current pulses, indirectly pacing the atria or ventricles through the esophageal electrodes close to the heart, and recording the body surface and esophageal ECG to obtain electrophysiological parameters of various parts of the heart, reveal the mechanism of occurrence of certain arrhythmias, and diagnose and treat certain arrhythmias.
Esophageal method of cardiac electrophysiological examination is used in the following clinical applications
1.To understand the sequence of atrial excitation, to determine the anterograde induction period and conduction characteristics of various parts of the heart.
2.Measure sinus node function, evaluate conduction function and pacing function in the atrioventricular junction.
3.To induce and terminate refractory supraventricular tachycardia or triggered arrhythmias, and to elucidate the formation mechanism and differentiate the types.
4.To understand the electrophysiological characteristics of the bypass and AV node double pathways and multipathways and the multiple arrhythmias caused by them.
5.Replicate and study some common and rare cardiac electrophysiological phenomena, such as cleft phenomenon, cicada phenomenon and dragging phenomenon, etc.
6.Prevention, rescue and treatment of certain slow arrhythmias and tip-twisting ventricular tachycardia.
7.The screening of catheter before radiofrequency ablation and the evaluation of postoperative efficacy.
(B) Cardiac pacing
Healthy heart
The heart beats at a steady and regular rhythm per minute (normal sinus rhythm), and during strenuous exercise, the blood transfusion to the heart can increase to four times the average value in a few seconds. The normal adult heart rate is between 60 and 100 beats per minute, if it exceeds 100 beats it is called tachycardia and below 60 beats it is called bradycardia.
Treatment of bradycardia
Drug treatment
Cardiac pacing therapy
Pharmacological treatment and its limitations
Medication can only be used in emergency or temporary life-saving situations
Medication is not suitable for long-term treatment (it is not long-lasting and not reliable)
Some arrhythmias are not suitable for pharmacological treatment
Cardiac pacing
Implantation of buried pacemakers
Temporary cardiac pacing
Therapeutic emergency cardiac pacing
Prophylactic temporary pacing
Electrophysiological studies
The role of cardiac pacing therapy
Let the pacemaker rebuild a better life with you!
Continuous improvement over half a century.
an almost zero surgical mortality rate.
More than three million patients are paced worldwide.
More than 300,000 new pacemakers are inserted each year.
What is a pacemaker?
A pacemaker is actually composed of two parts
A pulse generator: a small titanium case containing an electrical circuit and a long-lasting battery.
The lead: a piece of insulated wire
Characteristics of a pacemaker
Size: like a man’s watch
Weight: 20-30 grams
Housing: titanium
Lifespan: about 10 years
Control: remote control by programmable instrument
Dual-chamber pacing with two leads
One lead placed in the atrium
One lead is placed in the ventricle
More in line with normal physiological conditions
Pacemaker insertion
X-ray fluoroscopy available in the operating room
Basic surgical skills
Local anesthesia
Short operation time, no chest opening, minimal trauma
Short hospital stay
Pacemaker insertion procedure
Local anesthesia
Placement and testing of the pacing lead through the vein
Creation of the capsule, insertion of the pacemaker, burial under the skin
The procedure takes only about 1 hour!
Pacemakers are a very safe and effective treatment
The procedure is simple and risk-free
Only local anesthesia is needed, no chest opening is required, bleeding is minimal, and the operation takes only a short time.
Fast recovery after surgery
Significantly improves the quality of life and does not affect daily life and work
The importance of programmed follow-up of the pacemaker
For pacing therapy, the implantation of a pacemaker is only the beginning, but clinical follow-up and programmatic control should be carried out throughout the life of the pacemaker system.
”Implantation without follow-up is like being born without nurturing”.
Why is follow-up necessary?
To adjust pacemaker parameters to maximize patient benefit
Follow-up interval Frequency of follow-up
Acute phase (8 weeks) —— 1-2 weeks/time
Intermediate —— 6-12 months/time
Near replacement (1 year) —— 1-2 months/time
How to determine battery depletion?
Pacemaker frequency decreases or is greater than or equal to a specific frequency (each manufacturer has a specific setting for this)
The pacemaker’s battery voltage and internal battery resistance drop significantly to or near the manufacturer’s specified replacement value.
The magnet frequency of the pacemaker indicates a specific frequency value that needs to be replaced
Note: Of the above three points, only the first one may be detected and observed by the patient himself, while the remaining two points can only be detected by the physician with the programmable instrument.
(C) Coronary angiography and intervention
Coronary angiography: An interventional diagnostic technique that uses catheters to perform radiological imaging of the coronary artery anatomy.
Purpose: To examine all branches of the coronary artery vascular tree and understand its anatomical details, to provide reliable anatomical and functional information for the diagnosis of coronary artery disease, and to lay a scientific basis for the selection of interventional treatment or coronary artery bypass surgery plan.
Coronary angiography is the “gold standard” for the diagnosis of coronary artery disease.
History of coronary angiography
Wemer Forssmann, a German physician, performed the first cardiac catheterization procedure on himself. He sent the catheter through the left anterior elbow vein, subclavian vein and superior vena cava into the right atrium and took the first cardiac catheterization chest film in medical history, which opened the prelude of interventional cardiology.
Nine right heart catheterizations were performed on himself successively. A concentrated sodium iodide solution was injected into the heart chambers through the catheter and the first right ventriculography film was taken.
International development of interventional cardiology
First successful PTCA: 1977, Gruentzig et al.
First stent implantation: March 1986 Puels et al.
The number of PCI (PTCA/stent) in the United States amounts to more than 500,000 cases per year.
Development of interventional cardiology in China
Right heart catheterization was introduced in the year (Huang Wan, Fang Qi and Chen Haozhu)
the introduction of left heart catheterization in the year
the introduction of selective coronary angiography in Shanghai Zhongshan Hospital and Beijing Fu Wai Hospital in 2001
By the end of 2001, 112 hospitals nationwide had carried out interventions and completed 1,6345 cases of PCI, which is still at a relatively low level.
Development of coronary interventional cardiology in Tianchang People’s Hospital
July 6, 2007: the first case of selective coronary angiography
July 20th, 2007: the first case of direct drug insects and ЪЪ쑗쑗쑗쑗
January 31, 2008: the first case of acute myocardial infarction treated with emergency percutaneous coronary intervention (PCI).
Indications for coronary angiography
Known or suspected coronary artery disease.
Stable angina pectoris.
Unstable angina/non-ST-segment elevation myocardial infarction.
Acute myocardial infarction.
Recurrence after hemodynamic reconstruction.
Non-cardiac surgery.
Cardiac valve disease.
Puncture routes for coronary angiography
Femoral artery puncture (most commonly used)
Radial artery puncture (gradually increasing)
Interventional era
Swedish physician Ake senning implanted the first fully buried pacemaker, artificial heart pacing that became the only effective method of bradycardia treatment; in September 1977 Gruentzig performed the world’s first percutaneous transluminal coronary angioplasty (PTCA), creating a new era of interventional cardiology; with this as a milestone, mankind’s struggle with cardiovascular disease entered the With this milestone, mankind’s fight against cardiovascular diseases entered the era of intervention.
(IV) Interventional treatment of congenital heart disease
Classification of congenital heart disease
Non-cyanotic type: ASD, VSD, PDA, PS, etc.
Cyanotic type: TOF, TGA, etc.
Current interventional cured congenital heart disease: ASD, VSD, PDA, PS and some pulmonary arteriovenous fistulas, coronary arteriovenous fistulas, etc.
Trends of interventional treatment for congenital heart disease
Interventional treatment of congenital heart disease tends to be at a younger age
Interventional and surgical methods mosaic for complex malformations
Interventional treatment of compound and complex congenital heart malformations
Percutaneous prosthetic valve replacement
Interventional imaging will see revolutionary advances
The staging of
Primary foramen ovale: also known as foramen I type atrial defect, accounting for about 5% of cases, the lower part of the atrial septum is echogenic, as the lower part of the defect is the atrioventricular valve, which is often combined with abnormal atrioventricular valve development.
Secondary foramen ovale: also known as foramen II atrial defect, accounting for about 95% of ASDs. It accounts for 10%-20% of the precordial disease
Central type 76%
Inferior foramen ovale 12
Superior chamber type 3%
Mixed type 9%
Indications for atrial septal defect
Age > 3 years, weight >
Central type (secondary foramen) with left-to-right shunt
Residual defect after surgical procedure
Maximum diameter ≤ 30 mm (foreign), ≤ 36 mm (domestic)
Length of stump on left atrial side from right upper pulmonary vein, mitral valve ≥
The length of the stump on the right atrial side is ≥ from the superior vena cava, inferior vena cava, and coronary sinus
Spacing between multiple atrial septal defects <
Intracardiac malformations that do not require surgical correction, such as ectopic pulmonary venous drainage
Classification of ventricular septal defect
Membranous (perimembranous) ventricular defect: 78%
Funicular ventricular defect: 20%
Myocardial ventricular defect: 2%
Indications for membranous VSD
Age > 3 years, weight >
Membranous with surgical indications
Diameter of the left ventricular surface of the defect 3-12 mm in adults, ≤ in children
If the defect is multiforaminal on the right ventricular side, the large orifice diameter ≥
Distance of the defect margin from the aortic valve >
Distance of the defect margin from the tricuspid valve >1.5 mm, without significant tricuspid valve abnormalities and moderate tricuspid regurgitation
Combined cardiovascular malformations that can be treated interventionally
post-surgical residual leak
Mild to moderate pulmonary hypertension without right-to-left shunt
Ventricular septal defect occlusion device
Arterial duct failure
Patent ductus arteriosus (PDA) is a congenital anomaly between the aorta and pulmonary dynamics, mostly located between the aortic isthmus and the root of the left pulmonary artery, and accounts for about 20% of precordial disease.
Clinical manifestations
The small internal diameter of the unclosed ductus arteriosus may be clinically asymptomatic. The prominent sign is a continuous mechanical murmur that can be heard at the second intercostal space at the left sternal border and at the left subclavian area, which may be accompanied by tremor.
Interventional occlusion-indications and contraindications
Indications: Most PDAs can be blocked by intervention
Contraindications: Very few people with advanced right-to-left shunt are not easy to perform this procedure
Improve discipline construction and implement scientific development
Development plan of cardiovascular department
First, build a team with complete discipline structure and reasonable echelon structure
Change the model of evidence-based medicine and develop interventional cardiology
Third, build academic atmosphere and strengthen communication and collaboration
Our situation has been opened and we have entered the academic realm of cardiovascular specialization, but there is still a considerable gap in the level, and the mission is a long way to go. Medicine is a benevolent art, we strive to improve the academic level and professional skills with the principle of benevolent heart and patient first, and develop scientifically step by step in a planned way to continuously improve the comprehensive strength in order to benefit the people of our city.