No abstract available.
Coronary Disease* ; Estrogens* ; Female ; Humans

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by inappropriate myocardial hypertrophy that occurred in the absence of an obvious cause for the hypertrophy and dynamic left ventricular outflow tract obstruction, caused by asymmetrical septal hypertrophy and systolic anterior motion of the anterior mitral leaflet. The pathophysiological abnormality in HOCM is diastolic dysfunction, abnormal stiffness of the left ventricle with resultant impaired ventricular filling and impaired vasodilator reserve (perhaps related to the thickened and narrowed small intramural coronary arteries found in HOCM). During the early course of this progressive disease, treatment consists of negative inotropic drugs. Surgery has been the only therapeutic option in patients with hypertrophic cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. We describe a novel catheter-based technique that may replace surgical myocardial reduction. The technique is interventional infarction of a portion of the interventricular septum by the infusion of alcohol into a selectively catheterized septal artery.
Arteries ; Cardiomyopathy, Hypertrophic* ; Catheters ; Coronary Vessels ; Heart Ventricles ; Humans ; Hypertrophy ; Infarction

There are many various complications associated with coronary artery stenting, in cluding thrombotic and hemorrhagic complications, in-stent restenosis, side branch occlusion, stent embolization. The retention of equipment components is the uncommon, unexpected and often problematic situations that can arise requiring ingenuity, skill, and creativity. We reports on a patient in whom an sleeve marker ring of a stent balloon catheter retained within the lumen of the coronary artery following coronary stenting. The sleeve marker ring was extracted by dilatation and withdrawal of balloon catheter which readvanced over a guidewire positioned in the center of ring.
Catheters ; Coronary Vessels* ; Creativity ; Dilatation ; Humans ; Stents*

An isolated single coronary artery from the left aortic sinus is one of rare congenital coronary anomalies. This anomaly was detected during elective coronary angiogram in a 44 year-old male patient with atypical chest pain. Treadmill exercise test demonstrated 1 mm horizontal depression at stage IV and the test was terminated at the V stage due to chest pain. No myocardial ischemia was demonstrated on myocardial SPECT using 99mTc-tetrofosmin. Coronary angiogram revealed single coronary artery originating from left aortic sinus without any stenotic lesions.
Adult ; Chest Pain ; Coronary Vessels* ; Depression ; Exercise Test ; Humans ; Male ; Myocardial Ischemia ; Sinus of Valsalva* ; Tomography, Emission-Computed, Single-Photon

Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QT interval and increased U wave amplitude. It has been found to be induced by various drugs, electrolyte imbalances, and so on, but the mechanism of torsades de pointes has not been completely documented. Two hypotheses, early afterdepolarization and dispersion of repolarization have been known to be the possible mechanism. Terfenadine and astemizole are the antihistamines, known to be one of the etiologic agents of torsades de pointes, and factors associated with increased risk are significant liver disease, drug overdose, and concomitant administration of imidazole and macrolide antimicrobial drugs. There has been only one case reported that torsades de pointes had been induced by first-generation antihistamine, piprinhydrinate. We experienced a case of 43 year old male patient with torsades de pointes induced by first-generation antihistamine, hydroxyzine and treated successfully with drug cessation, MgSO
Adult ; Astemizole ; Drug Overdose ; Histamine Antagonists ; Humans ; Hydroxyzine* ; Isoproterenol ; Liver Diseases ; Male ; Tachycardia, Ventricular ; Terfenadine ; Torsades de Pointes*

Double-orifice mitral valve is a relatively rare congenital abnormality, usually discovered at autopsy or surgery. In most cases, the double-orifice mitral valve causes no hemodynamic effects, sometimes it is regurgitant, and rarely is stenotic. Appreciation of this echocardiographic abnormality is important because double orifice mitral valve is often associated with other congenital anomalies and this echocardiographic findings may be confused with other cardiac abnormalities. The authors report a case of isolated congenital double-orifice mitral valve in a 42-year-old woman. Data from the literature are reviewed and the echocardiographic images of the malformation are described.
Adult ; Autopsy ; Congenital Abnormalities ; Echocardiography ; Female ; Hemodynamics ; Humans ; Mitral Valve*

BACKGROUND: The orthostatic hypotension in response to the assumption of an upright posture is regulated by activation of sympathetic nerves. Role of the vestibular system and neural pathway on orthostatic hypotension were investigated. METHODS: Changes of arterial blood pressure produced by head-up tilting, rotatory stimulation of the vestibular system, or electrical stimulation to the vestibular nerve, vestibular nuclei, and rostral ventrolateral medulla (RVLM) were measured in Sprague-Dawley rats. Also, field potentials were recorded in the vestibular nuclei and RVLM and c-Fos expression was evaluated in the brain stem in order to investigate the vestibulosympathetic pathways. RESULTS: The three phasic blood pressure responses were elicited by head-up tilting: initial fall, early recovery, and late sustained pressure at near control levels, the magnitude of the pressure fall was parallel with the degree of head-up tilting in normal rats. Return position from head-up tilting recovered control level of blood pressure after a brief rapid elevation. However, bilateral labyrinthectomy resulted in exaggerated initial falling and devoid of early recovery phase during postural change. Sinusoidal rotation about off-vertical axis of the vestibular system elicited more elevation of blood pressure than rotation about earth vertical axis. Electrical stimulation of the vestibular nerve, vestibular nucleus, and RVLM produced elevation of blood pressure, which was the most prominent by stimulation of RVLM. Field potentials composed of P, N1, N2 waves in the vestibular nuclei were recorded by stimulation of the vestibular nerve, while weak potentials in RVLM were recorded by stimulation of the vestibular nuclei. An electrical stimulation of the vestibular nuclei expressed c-Fos immunoreactive cells in RVLM. CONCLUSION: These results suggest that the otolith organ of the vestibular system plays a major role in control of orthostatic hypotension, and the pathway of vestibulosympathetic reflex in control of blood pressure involves the vestibular nuclei, RVLM, intermed-iolateral nuclei of the thoracic spinal cord.
Animals ; Arterial Pressure ; Axis, Cervical Vertebra ; Blood Pressure ; Brain Stem ; Electric Stimulation ; Hypotension, Orthostatic* ; Neural Pathways ; Otolithic Membrane ; Posture ; Rats* ; Rats, Sprague-Dawley ; Reflex* ; Spinal Cord ; Vestibular Nerve ; Vestibular Nuclei

BACKGROUND: It has been known that a brief ischemic insult followed by reperfusion ('preconditioning') shows a protective effect on subsequent ischemic insult. The mechanism of this preconditioning was not fully understood, but oxygen free radicals, such as superoxide, hydrogen peroxide, which are released at the time of cardiac ischemia and reperfusion, were thought to have an important role in cardiac damage. We investigated the mechanism of preconditioning by examining the effects of oxidants on contractile function of isolated heart and the expression of cytokines and antioxidative genes. METHODS: Isolated perfused rat hearts were exposed to a 5 minutes ischemia (1 x PC) and to four times of 5 minutes ischemia, each seperated by 10 min (4 x PC). Both 1 x PC and 4 x PC groups were reperfused for 60 minutes. Control experiments were performed by perfusiong the hearts with buffer using the same time frame without ischemia-reperfusion. The effects of oxidants in contractile function of isolated rat heart were observed. The induction of the expression of two cytokines (TNF-alpha and interleukin-1) and two antioxidative enzyme genes (Mn-superoxide dismutase and catalase) were examined in control, 1 x PC and 4 x PC hearts by RT-PCR. RESULTS: In the control group, hydrogen peroxide or t-BHP inhibited contractile function of isolated heart as a dose-dependent manner, and IC50 were 36.3 micrometer or 0.34 mM, respectively. In 4 x PC hearts, inhibitory action of hydrogen peroxide on contractile function was diminished significantly, but the t-BHP action was not. In 4 x PC hearts TNF-alpha, interleukin-1alpha and catalase gene expression was significantly increased compared to both 1 x PC and control values. CONCLUSION: Repeated ischemia and reperfusion caused the induction of inflammatory and catalase genes, which may contribute to relative resistance of hydrogen peroxide in 4 x PC hearts.
Animals ; Catalase ; Cytokines ; Free Radicals ; Gene Expression ; Heart* ; Hydrogen Peroxide ; Inhibitory Concentration 50 ; Interleukin-1alpha ; Ischemia ; Ischemic Preconditioning* ; Oxidants ; Oxygen* ; Rats* ; Reactive Oxygen Species* ; Reperfusion ; Superoxides ; Tumor Necrosis Factor-alpha

BACKGROUND: Herpes simplex virus thymidine kinase (HSVtk) phosphorylates the prodrug ganciclovir to a nucleoside analog that inhibits DNA synthesis, causing cell death. Neighbouring nontransfected cells may be affected through a 'bystander effect', thereby amplifying the antiproliferative actions. This study was carried out to determine whether retrovirus-mediated HSVtk gene therapy could reduce intimal hyperplasia and prevent stenosis following balloon injury of the rat carotid artery. METHODS: A replication-defective recombinant retroviral vector containing HSVtk cDNA (LtkSN) was constructed. Cultured primary rat smooth muscle cells (SMCs) infected with this vector (SMC/LtkSN) were transplanted to the balloon injured rat right carotid artery. One week after transplantation, HSVtk gene therapy group was administered a 2-week treatment of ganciclovir (30 mg/kg/d). Three weeks after balloon injury and SMC/LtkSN transplantation, carotid arteriography was performed and carotid arteries were perfusion-fixed for histologic examination. RESULTS: Carotid arteriographic evaluation comparing with the uninjured left carotid artery showed that the mean luminal diameter of HSVtk gene therapy group (n=5, 85+/-3%) was significantly larger than that of balloon injury only group (n=5, 65+/-5%). The neointimal mass of HSVtk gene therapy group was less than that of balloon injury only group. SMC/LtkSN transplantation without ganciclovir treatment group (n=3) showed asymmetric intimal proliferation probably because of gravitational pooling of seeding. There were inflammatory cell infiltrations at the gravity dependent portion of HSVtk gene therapy group. CONCLUSION: Retrovirus-mediated HSVtk gene therapy following balloon injury of the rat carotid artery reduced neointimal expansion and arteriographic stenosis.
Angiography ; Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Cell Death ; Constriction, Pathologic* ; DNA ; DNA, Complementary ; Ganciclovir ; Genetic Therapy* ; Gravitation ; Herpes Simplex* ; Hyperplasia ; Myocytes, Smooth Muscle ; Phenobarbital ; Phosphotransferases* ; Rats* ; Simplexvirus* ; Thymidine Kinase ; Zidovudine

BACKGROUND: Surgical correction of patent ductus arteriosus (PDA) is relatively safe and effective since it does not remain in the category of open-heart-surgery. Although the surgical practice for PDA is performed in almost all hospitals, they contain the problems of anxiety of patients, remained surgical wounds on patients' chests and complications of surgery and general anesthesia. Recently non-surgical methods for the obstruction of PDA have been developed and some of them including buttoned devices are used now. The success rates of these methods approach to 84%. But the problems of embolization, incomplete closure, hemolysis, stenosis of aorta and left pulmonary artery have been reported. We invented new PDA occluder , using stainless steel wire and polyurethane foam. Therefore we investigated the efficacy of occluding blood flow with the new PDA occluder in the vessels of experimental animals. METHOD: Using 304 stainless steel wire which is self-expandable stent, two star-shaped frames were made, each frame forming cone and facing the other's tip. And in the center of the frames polyurethane foam was inserted. 316L stainless steel wire was used to fix the elements described above and some portion of the wire was extracted outside of the frames, shaping hook or round loop with which the occluder could be pulled out in case of misplacement. To create the similar situation to PDA, we made shunts from artery to vein between carotid arteries and jugular veins with surgical bypass grafts or made shunts of direct artery to vein connections without grafts in 4 dogs and 1 pig. Through 8F sheath, we deployed the occluders into the shunts made of 5 grafts or made of 3 arterial ends. Also the occluders were inserted into the femoral artery of dog and iliac artery of pig. After deployment of occluders, angiograms were performed to obscure the efficacy of blocking blood flow and follow-up angiogrms were done in one and two weeks. The animals were sacrificed in one and two weeks to get the tissues including occluders inside. Gross findings were checked about thrombi formation in and around polyurethane foam. RESULTS: The 10 occluders were placed successfully except one site due to misplacement. The occluders successfully blocked the blood flows in all 10 sites within 3 - 60 minutes. Each follow-up angiogram for occluders in one and two weeks revealed good maintenance of blockade in blood flow. Observed gross findings on tissues were packed thrombi formation in the polyurethane foam and membrane formation along the occluder. CONCLUSIONS: This newly developed device revealed good efficacy for occlusion of blood flow including shunts in immediate and follow-up study. Practical method for the delivery of the device and some design modification for proper fitting into the PDA especially for small patients would be required. Longer period of follow-up with more animal experiments for other possible complications including distal embolization would be required also before clinical trial.
Anesthesia, General ; Animal Experimentation ; Animals ; Anxiety ; Aorta ; Arteries ; Carotid Arteries ; Constriction, Pathologic ; Dogs ; Ductus Arteriosus, Patent* ; Femoral Artery ; Follow-Up Studies ; Hemolysis ; Humans ; Iliac Artery ; Jugular Veins ; Membranes ; Polyurethanes ; Pulmonary Artery ; Stainless Steel ; Stents ; Thorax ; Transplants ; Veins ; Wounds and Injuries