Using KAIS 0.15 Tesla magnetic resonance imaging system, ECG gated magnetic resonance image (MRI) of cardiovascular system was obtained in 8 normal volunteers and 10 patients with various cardiovascular diseases diagnosed at Seoul National University Hospital. The findings of cardiovascular MRI were analysed and the results were as follows ; 1) ECG gated MRI revealed datailed normal anatomy of heart including both atrioventricles and great vessels in axial, sagittal and coronary sections with natural contrast of moving blood without contrast media. 2) Dynamic changes of both ventricular walls in systolic and diastolic phase were revealed in sequential axial MRI, and increased signals were detected in left ventricle and descending aorta due to slow flow in end diastole. 3) Left ventricular aneurysm and myocardial thinning were shown in 2 cases of myocardial infarction. Enlarged left atrium was noted in 1 cases of mitral stenosis. Segmental analysis was possible in 3 cases of corrected transposition of great vessels. 4) Enlarged lumen, intimal flap and irregular luminal narrowing were detected in each of ascending aortic aneurysm, dissecting aneurysm and Takayasu's arteritis respectively. Pericardial effusion due to lymphoma revealed low signal encircling heart in contrast with neighboring mediastinal structures and cardiac wall. 5) MRI is a new promising modality in the diagnosis of cardiovascular system, which has potentiality to give a hemodynamic information in addition to the anatomical detalis.
Aneurysm ; Aneurysm, Dissecting ; Aorta, Thoracic ; Aortic Aneurysm ; Cardiovascular Diseases ; Cardiovascular System* ; Contrast Media ; Diagnosis ; Diastole ; Electrocardiography ; Healthy Volunteers ; Heart ; Heart Atria ; Heart Ventricles ; Hemodynamics ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Mitral Valve Stenosis ; Myocardial Infarction ; Pericardial Effusion ; Phenobarbital ; Seoul ; Takayasu Arteritis ; Transposition of Great Vessels

Aneurysm, Dissecting ; Aortic Aneurysm ; Cerebral Hemorrhage ; Humans ; Myocardial Infarction ; Syndrome

BACKGROUND: Coronary angiography have become important and integral components in the investigation of patients with cardiovascular disease. Technical improvement combined with an increased need of coronary angiography, and efforts to decrease the length of inpatient hospital stay have prompted the development of outpatient coronary angiography. In this study, we compared the procedure-related complications and costs of inpatient and outpatient coronary angiography when performed at the same institution. In addition, we attempted the coronary angiography as outpatient setting in patients with unstable angina, old age, and anticoagulation therapy, who have been regarded as contraindication for outpatient procedure. METHODS: Diagnostic coronary angiography was performed in 199 cases as inpatient setting, and 225 cases as outpatient setting at Korea University Guro Hospital From January through July 1996. There was no significant difference in sex, age, risk factor, blood pressure, cholesterol level, and ejection fraction. We did not give the heparin during the procedure and, use the Judkins' method in all patients. After the procedure, pressure dressing was done with compressor device for 15 minutes, then sandbag was applied on the puncture site. In outpatient, they took bed rest for 6 hours in one-day care room. RESULTS: 1) In the inpatient group, there were 6 cases(3.0%) of catheterization-related complication, and there were 7 cases(3.1%) of complication in the outpatient group. There was no major complication in both groups, such as death, myocardial infarction, stroke, and perforation of heart and great vessels. In the inpatient group, 2 cases of arrhythmia, 3 cases of hematoma at puncture site, and 1 case of femoral artery pseudoaneuryrsm occurred. In the outpatient group, 2 cases of arrhythmia, 1 case of hematoma at puncture site, 2 cases of skin rash, 1 case of acute febrile reaction, and 1 case of femoral artery dissecting aneurysm developed. There was no significant difference in the rate of complications between two groups(p=0.947). 2) In the outpatient group, there were 28 cases of unstable angina, 6 cases of old age more than 75 years, and 5 cases of anticoagulant has been taken. No catheterization-related complication occurred in those groups. 3) The costs and duration of hospital stay in the inpatient group were won480,230+/-86,800 and 50.3+/-12.3 hours and those in the outpatient group were won276,870+/-32,050 and 8.3+/-1.2 hours. There was significant difference between two groups in the costs and duration of hospital stay(p<0.01, p<0.01). CONCLUSIONS: Outpatient coronary angiography could be done safely with low complication rate, and could reduce the costs and hospital stay. For high risk group such as unstable angina, old age, and anticoagulation therapy, there was no complication in this study, but more experiences and available data should be accumulated to be accepted as a general guideline.
Aneurysm, Dissecting ; Angina, Unstable ; Arrhythmias, Cardiac ; Bandages ; Bed Rest ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Coronary Angiography* ; Exanthema ; Femoral Artery ; Heart ; Hematoma ; Heparin ; Humans ; Inpatients ; Korea ; Length of Stay ; Myocardial Infarction ; Outpatients* ; Punctures ; Risk Factors ; Stroke

Using KAIS 0.15 Telsla resistive magnetic imaging system, ECG gated magnetic resonance (MR) image of variouscardiovascular disease was obtained in 10 patients. The findings of MR image of the cardiovascular disesase wereanlaysed and the results were as follows: 1. In 6 cases of acquired and congenital cardiac disease, there were 2cases of myocardial infarction, 1 case of mitral stenosis and 3 cases of corrected transpossition of greatvessels. The others were 3 cases of aortic disease and 1 case of pericardial effusion with lymphoma. 2. Myocardialthinning left ventricular aneurysm were detected in MR images of myocardial infarction. The left atrium was welldelineated and enlarged in the case of mitral stenosis. And segmental analysis was possible in the cases ofcorrected transposition since all cardiac structures were well delineated anatomically. 3. In aortic disease, thefindings of MR image were enlarged lumen, compressed cardic chambers in ascending aortic aneurysm, intimal flap,enhanced false lumen in dissecting aneurysm and irregular narrowing of aorta with arterial obstruction inTakayasu's arteritis. 4. Pericardial effusion revealed a conspicuous contrast with neighboring meidastinal fat andcardiac wall due to it low signal encircling cardiac wall. 5. ECG gated MR image is an accurate non-invasive imaging modality for the diagnosis of cardiovascular disease and better results of its clinical application areexpected in the futher development in the imaging system and more clinical experiences.
Aneurysm ; Aneurysm, Dissecting ; Aorta ; Aortic Aneurysm ; Aortic Diseases ; Arteritis ; Cardiovascular Diseases ; Diagnosis ; Electrocardiography ; Heart Atria ; Heart Diseases ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Mitral Valve Stenosis ; Myocardial Infarction ; Pericardial Effusion

Acute Disease ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm, Thoracic ; complications ; Female ; Humans ; Myocardial Infarction ; etiology

Adult ; Aneurysm, Dissecting ; complications ; pathology ; Anterior Wall Myocardial Infarction ; etiology ; Aortic Aneurysm, Thoracic ; complications ; Humans ; Male

Flow reversal and thromboexclusion constitute a valuable alternative for aortic surgeons to have within their technical armamentarium for the treatment of aortic aneurysmal disease. Although not usually a preferred treatment for general aortic pathologies, this technique can be considered as a treatment option in select situations, such as mycotic aneurysm, a hostile surgical field, and a poor condition of the patient. Here, we present a case of extra-anatomic bypass and thromboexclusion for recurrent aortic aneurysm after previous extra-anatomic bypass and thromboexclusion surgery.
Aneurysm, Infected ; Aortic Aneurysm ; Humans ; Pathology ; Surgeons

BACKGROUND AND OBJECTIVES: Unstable angina is an inhomogenous syndrome. A substantial percentage of patients, ranging from 12 to 30% in most series, develops acute myocardial infarction or dies suddenly soon after their hospitalization, while the remainder have a benign prognosis without adverse coronary events. Unstable angina is a complex condition such as angina at rest, crescendo angina, new onset angina and postinfarction angina. These variable clinical presentations suggest that unstable angina have a heterogenous pathogenesis and prognosis. We divided unstable angina into 5 groups and studied the relationship between clinical presentations and coronary angiographic morphology. METHODS: One hundred sixty six patients were selected from the patients who were diagnosed as an unstable angina between January 1989 and March 1991, at Hallym University Hospital. Angiography was performed in patient with typical angina symptoms and transient ECG changes of myocardial ischemia. Coronary angiogram was done as usual method. Calcification of coronary artery as well as the presence of collateral circulation were recorded. Ergonovine test was performed in patients with near normal or normal angiogram. Coronary lesions were morphologically classified as follows; type A is simple lesion such as symmetric, concentric narrowing and smooth border. and type B is complex lesion such as asymmetric, eccentric, ulcerated narrowing and irregular border. RESULTS: These groups were classified as follows; Group I(represented the patients with angina at rest but typical Prinzmetal angina was excluded) 30 patients, Group II(represented the patients with crescendo angina) 24 patients, Group III(represented the patients with new onset angina) 62 patients, Group IVA(represented the patients with early postinfarction angina within 2 weeks after AMI) 34 patients, Group IVB(represented the patients with delayed postinfarction angina) 16 patients, There were no significant differences in age and sex among the 5 groups. Locations of involved vessel were similar among the five groups, and left anterior descending artery was most frequently(mean 60%) involved. Single vessel disease was frequently observed in new onset angina and early postinfarction angina(Group III*, IVa** 48%, 65% VS Group II, IVB 25%, 19% respectively, *p<0.05, **p<0.005) whereas multivessel disease was frequent in crescendo angina and delayed postinfarction angina(Group II, IVB 51%, 76% VS Group II, IVA 16%, 27% respectively, p<0.005). More than two third of patients with unstable angina had complex B lesion of coronary artery (77%), but in new onset angina simple A lesion was frequently observed (Group III 45% VS Group I, IVA, IVB 16%, 10%, 13% respectively, p<0.05). The frequency of calcification increased in early postinfarction angina(Group IVA 18% VS Group III 3%, p<0.05). The frequency of coronary collateral circulation increased in cresendo angina, early postinfarction and delayed postinfarcion angina(Group II*, IVA*, IVB** 38%, 35%, 50% VS Group III 10% respectively, *p<0.005.**p<0.0001). Incidence of coronary vasospasm was higher in resting angina than the others(Group I*, III 30%, 19% VS Group II, IVA 4%, 6% respectively, *p<0.02). The coronary vasospasm was frequently observed in an insignificant lesion(insignificant lesion/total vasopasm: 12/24(50%)). Early postinfarction angina had frequent intracoronary thrombus in infact-related artery(incidence of thrombus : Group IVA*, IVB 21%, 13% VS Group I, II, III 3%, 4%, 5% respectively, *p<0.05). CONCLUSION: This study suggests that patients with unstable angina pectoris may be heterogeneous groups. Coronary angiography must be performed in patients with unstable angina, in order to classify the clinical correlates with each possible angiogrphic finding that could affect treatment modality and outcome of cardiac events.
Angina Pectoris, Variant ; Angina, Unstable* ; Angiography ; Arteries ; Collateral Circulation ; Coronary Angiography ; Coronary Vasospasm ; Coronary Vessels ; Electrocardiography ; Ergonovine ; Hospitalization ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Ischemia ; Prognosis ; Thrombosis ; Ulcer

OBJECTIVETo investigate the potential association between monocyte chemotactic protein 1(MCP-1)in plasma and acute aortic dissection(AAD).

METHODSA total of 110 patients with Stanford type A AAD who had received emergent surgical treatment in Xiangya hospital from September 2011 to September 2014 were enrolled in as the study group;meanwhile,110 patients with simple hypertension who had received treatment in department of cardiology were chosen as the control group. The plasma level of MCP-1 was measured and then compared between these two groups.

RESULTSThe plasma level of MCP-1 in the study group was(257.79±86.52)pg/ml,which was significantly higher than that in control group [(136.57±48.84)pg/ml](P<0.001).

CONCLUSIONThere may be a correlation between plasma MCP-1 level and AAD.

Aneurysm, Dissecting ; therapy ; Aortic Aneurysm ; therapy ; Humans