No abstract available.
Breast Neoplasms* ; Breast*

BACKGROUND: Intimal tear or dissection is a serious complication after coronary angioplasty,sometimes which may develop an acute ischemic event. We evaluate the factor that may predict the development of dissection after angioplasty. METHODS: To identify the factors that development of dissection after angioplasty, the data of 52 patients identified as having dissection with or without immediate vessel closure were examined. Follow-up coronary angiogram was obtained in 22 out of 58 lesions at mean 5.6 month after angioplasty. RESULTS: Intimal dissection developed 58 lesion(31%) out of 177 lesions in 122 patients after PTCA. Ischemic complications, defined as ischemic chest pain, myocardial infarction, the need for coronary bypass surgery occured in 5 patients(9.6%) out of 52 patients with dissections. Significant correlates of a development of dissection were the lesion morphology of type C(P<0.01), more tight diameter stenosis before PTCA(P<0.01), and right coronary artery(P<0.02), especially in the proximal portion (P<0.05). There were no significant correlations of clinical pictures, whether complex or simple angioplasty and PTCA in single vessel disease or in multivessel disease. Morphologic feature of dissection was type A(radiolucency) in 22(38%), B(filling defect)in 14(24%), C(extra-luminal "cap")in 8(14%), D(spiral dissection)in 5(9%), E(filling defect with delayded antegrade flow)in 7(12%) and F(total occlusion) in 2(3%). Twenty-two(38%) dissection out of 58 were obtained follow-up angiogram at mean 5.6 month. Angiographic restenosis occured in 9(41%) lesions, which included more type A dissections (7/9,78%) compared to lesions with dissection healing (3/13, 23%)(P<0.001) at follow-up. Thirteen lesions with dissection healing at follow-up included more B and C dissection(B;54%,C;15%)and E dissection in 1. Furthermoremore restenosis occurred more prevalent in the infarct-related artery(P<0.001) and left anterior decending coronary artery lesion(P<0.01). There was somewhat higher diameter residual stenosis after angioplasty (32+/-11% vs 26+/-10%) in the lesions with restenosis, but there was no statistical significance. CONCLUSION: Intimal dissection after angioplasty occurred in 58(31%) leisions out of 122(177leisions) consecutive patients underwent PTCA developments if intimal dissection after PTCA significantly correlated with the lesions if type C, more tight diameter stenois before PTCA and right coronary artery. At mean 5.6months follow-up,angiographic restenosis occured in 41% of dissections, which had more included type A(radiolucency)dissections, infarct-related artery and left anterior descending coronary artery leision.
Angioplasty* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Vessels ; Follow-Up Studies* ; Humans ; Myocardial Infarction

BACKGROUND: Large series of patients with symptomatic mitral stenosis have undergone percutaneous mitral balloon valvuloplasty(PMV) with use of the Inoue or double balloon technique. But to date the result of the two procedure have not been compared with a single series prospectively. METHODS: In order to assess the immediate hemodynamic results and the longterm efficacy of two different PMV technique, a prospective, randomized trial of PMV was performed using the Inoue balloon(Toray, I group) in 59 patients and the double balloons(a pair of Mansfield balloon. D group) in 61 patients with moderate to severe mitral stenosis. Before valvuloplasty, the patients series were comparable with regard to average age. gender, most clinical and echocardiographic variables. All the patients(120 patients, M/F 38/82, mean age 41+/-11 year) were preselected with good echoscore> or =9. RESULTS: The success rate was 83% in the I group and 89% in the D group when the success defined as mitral valve area(MVA)> or =1.5cm2 with 25% gain in MVA and mitral regurgitation> or =2+ at the end of procedure. The magnitude of increase of mitral valve area and decrease of mitral gradient, left atrial pressure and pulmonary arterial pressure were not significantly different in the Inoue and double balloon series(1.0+/-0.4 and 1.1+/-0.4cm2 for mitral vale area, 10.2+/-6.6 and 11.7+/-6.4mmHg for mitral gradient, 10.5+/-6,4 and 12.9 +/-7,3mmHg for left atrial pressure, and 8.7+/-7.3 and 10.1+/-9.4 mmHg for pulmonary artrial pressure respectively). Immediatly after dilation, the long diameter changes of the mitral orifice was more prominent in the D group(from 1.0+/-0.2 to 2.6+/-0.4cm p<0.01) than those in I series(from 1.1+/-0.4 to 2.3+/-0.3cm) Moreover, the magnitude of increase in the EF slop was significantly larger in the D group(31.9+/-17.0 vs 21.8+/-14.2mm/sec, p<0.001). The duration of total procedure(56+/-20 vs 84+/-24 min, p<0.002) and the fluoroscopic time (15+/-6 vs 25+/-11min, p<0.002) was significantly shorter in group I. The incidence of left to right shunt at the atrial level(Qp/Qs>1.5) was 3.4% in group I and 4.9% in group D. Severe mitral regurgitation> or =3+ occurred in 2 patients in each I(3.4%) and D(3.3%) group respectively. At follow-up, the mitral valve area was significantly decreased(1.6 in group I vs 1.8cm2 in group D, P<0.001 vs immediate after MVA) at 6 months and well maintained at 1 year follow-up in both groups. Until 6 months after valvuloplasty, the long diameter of orifice was greater in group D, however the difference was not apparent at 1 year follow-up. CONCLUSION: The Inoue and double balloon techniques obtained equivalent results of the success rate and the frequently of complications. However, the Inoue balloon technique reduced significantly fluoroscope time and total procedure duration. Double balloon technique afforded a longer longitudinal splitting of the commissure immediatly and 6 months after valvuloplasty. However the differences was not apparent at 1 year follow-up. Increased MVA was well maintained at 1 year in both groups. The severity of the newly developed mitral regurgitation immediately after valvuloplasty reduced significantly in 53% of the Inoue and 43% in the double balloon group at 6 months follow-up. In the view point of similiar immediate and late results of the two methods, the stepwise dilation with Doppler echocardiographic monitoring during the Inoue procedure appeared to be cumbersome.
Arterial Pressure ; Atrial Pressure ; Balloon Valvuloplasty* ; Echocardiography ; Follow-Up Studies* ; Hemodynamics ; Humans ; Incidence ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Prospective Studies

BACKGROUND: The value of coronary reperfusion resulting from Thrombolysis and/or coronary angioplasty in patients with evolving myocardial infarction has been rigorously evaluated and improved left venticular function and short-term survival rates have been demonstrated consistently in controlled studies. Benefits from delayed coronary angioplasty at 7-10 days after onset of acute myocardial infarction (AMI) without thrombolysis remains unclear. In order to assess the effect of delayed reperfusion in infarct-related artery(IRA), we analyzed the restenosis rate of IRA after successful coronary angioplasty and the change of left ventricular function at late follow-up angiogram. METHOD: Coronary angioplasty in 69 lesions of 55 patients(M/F:48/7, mean age 53 years) with acute myocardial infarction(AMI) were performed at 7-10 days after onset of AMI and follow-up coronary angiogram (25 lesions of 20 pts) with left ventriculogram were obtained at means 5.1 months(range 4-6 months) after angioplasty. Restenosis rate of dilated infaret-related arteries and the changes of left ventricular function after angioplasty were evaluated. RESULTS: The overall procedural success rate of delayed elective coronary angioplasty in patients with AMI was 86% with a higher success rate in subtotally occluded vessel(98%) than in the occluded IRA(64%). Complications included acute closure after large dissection in 1(1.6%) and on -hospital mortality due to cardiogenic shock in 1(1.8%). Angiographically restenosis rate of IRA was 65% at mean 5.1 months follow-up, which was relatively higher than that after non-IRA angioplasty in AMI(25%) and in patients with angina(24%). Left ventricular ejection fraction improved significantly from 47.2+/-12.7% to 58.8+/-8.6%(P<0.05) at follow-up. Patients who had a patent IRA at follow-up had a restenotic IRA at follow-up had no statistically significant improvement in EF(table 3). Patients with a left anterior descending artery(LAD) lesion had lower mean immediate EFs than patients with right coronary artery lesion, however the degree of improvement in EF at follow-up was more significant in patients with LAD lesion. CONCLUSIONS: Delayed elective angioplasty of IRA at 7-10 days after onset of AMI was relatively safe and had comparable procedural success rate. Higher restenosis rate(65%) of IRA at follow-up appeared to be related, at least on part, to the endothelial dysfunction after ischemic-reperfusion injury and clinically unstable status. Left ventricular function improved significantly after angioplasty at follow-up. Recovery of left ventricular function might be reated to whether or not the IRA had an angiographically restenosis at follow-up.
Angioplasty* ; Arteries ; Coronary Vessels ; Follow-Up Studies* ; Humans ; Mortality ; Myocardial Infarction* ; Myocardial Reperfusion ; Reperfusion ; Shock, Cardiogenic ; Stroke Volume ; Survival Rate ; Ventricular Function, Left

A 38 year old woman presented with two week history of cough, progressive dyspnea, orthopnea and pedal edema. She had previously been in excellent health with the exception of surgery five years ago for tumor of the right thigh. The histopatihologic diagnosis was chondrosarcoma. Her clinical course was characterized by rapid aggrevation of dyspnea and eddema unresponsive to conventional managements for congestiove heart failure. Transesophageal echocardiogram showed dleft atrial mass growing from pulmonic vein. To our knowledge, cardiac metastasis from chondrosarcoma is rare and we report this is the first case of chondrosarcoma metastatic to the heart in Korea.
Adult ; Chondrosarcoma* ; Cough ; Diagnosis ; Dyspnea ; Edema ; Female ; Heart Failure ; Heart* ; Humans ; Korea ; Neoplasm Metastasis ; Thigh ; Veins

The coronary arteriovenous fistula (CAVF) is a rare congenital anomaly but constitutes the most common hemodynamically significant coronary artery anomaly. Transcatheter embolization is as an effective alternative to surgery even though procedure may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. To our knowledge, the association of CAVF with Turner syndrome was not reported. We report a case of successful coil embolization of CAVF using a complex, helical-fibered platinum coil in patient with Turner phenotype with 46,XX.
Arteriovenous Fistula* ; Coronary Vessels ; Embolization, Therapeutic* ; Humans ; Phenotype* ; Platinum ; Pulmonary Artery ; Turner Syndrome

BACKGROUND: The purpose of this study is to evaluate the immediate survival, complication and follow-up results of aortic dissection and to analyze the risk factors that determine the prognosis after aortic dissection. METHODS: 29 patients(M : 12, Age : 59.0+/-11 yrs) with aortic dissection were reviewed retrospectively. Any dissection involving the ascending aorta was classified as proximal dissection and the dissection was considered to be acute if time from clinical onset of the dissection to admission was less than 2 weeks. The immediate survival rate and follow-up results of aortic dissection was compared by type, onset and mode of treatment. RESULTS: 1) The studied patient were 29(Acute onset : 24, Proximal type : 14) and 17 patients(Proximal type : 14) were surgically treated. 2) Five of 10 patients with proximal dissection and 4 of 12 patients with distal dissection, who were managed by medical treatment, died, and 1 of 4 patients with proximal dissection and none of 3 patients with distal dissection, who were managed by surgical treatment, died at hospital. There was no significant statistical difference in mortality according to type, onset and mode of treatment. 3) Nine of 14 patients with proximal dissection and 8 of 15 patients with distal dissection had one or more complications. 4) The cause of death could be established in 10 patients. The most frequent cause of death was aortic rupture including cardiac tamponade(4 of 6 patients for proximal dissection, 2 of 3 patients for distal dissection). 5) The most of death, 8 of 10 deaths occurred within 2 weeks of onset of disease. there was a good life expectancy for the discharged patient regardless of type, onset and mode of treatment. CONCLUSION: These data showed that there was equivalent outcomes in patients with aortic dissection regardless of type, onset and mode of treatment. But these data would not be applied to general population with aortic dissection because of limited number of the study.
Aorta ; Aortic Rupture ; Cause of Death ; Follow-Up Studies* ; Humans ; Life Expectancy ; Mortality ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Rate

BACKGROUND: A clinical trial was done to evaluate the antihypertensive efficacy and side effects of amlodipine, a new long-acting calcium antagonist, in patients with mild to moderate essential hypertension. METHODS AND RESULTS: 1) The study patients consisted of 18 men and 12 women, and the mean age was 49 years. Amlodipine monotherapy (5-10mg) was continued for 12 weeks. 2) Blood pressure dropped significantly in 4 weeks and in 8 weeks, and well maintained throughout the study period. The mean-pressure drop was 32.9/20.8mmHg after 12 weeks. 3) Heart rate did not change significantly with amlodipine therapy. 4) Optimal dose for effective pressure-drop was 10mg in 57% of patients. Overall good antihypertensive effect was achieved in 83% of patients. 5) All of the laboratory parameters including blood chemistry, glucose, lipid and electrolytes did not change significantly after 12 weeks. 6) Side effects were mild in nature(gastrointestinal discomfort in 3, dry mouth in 1, weakness in 1, dizziness in 1 and headache in 1 patient). CONCLUSION: Amlodipine monotherapy with 5 to 10mg once a day regimen is effective and well tolerated in the patients with mild to moderate essential hypertension.
Amlodipine ; Blood Pressure ; Calcium ; Chemistry ; Dizziness ; Electrolytes ; Female ; Glucose ; Headache ; Heart Rate ; Humans ; Hypertension* ; Male ; Mouth

BACKGROUND: Follow-up angiographic study was performed in patients who underwent successful coronary artery stenting(Palmaz-Schatz) to native coronary arteries, to evaluate the restenosis rate and angiographic features. METHOD: Follow-up angiography was done in 6 months after coronary arteries stenting in 16 of 22 patients(follow-up rate : 73%) regardless of symptom recurrence or the result of exercise treadmill test. RESULTS: 1) Total 26 Palmaz-Schatz stents were implanted in 26 patients with coronary stenosis : primary, elective stenting in 19, bail-out procedure in 4 and restenosis after prior coronary angioplasty(PTCA) in 4 patients. The morphological characteristic of the leisons were type A in 1, type B in 20 and type C in 5. 2) Coronary stenting was successful in all patients and no significant procedure-related cardiac event occurred. Subacute closure in the stent and bleeding complication developed in minority of patients. 3) The overall restenosis rate in six months was 31%. 4) The diameter stenosis of the lesion in the patients without restenosis was 94% before stenting, 6% immediately after stenting and 26% in 6 months. CONCLUSION: Coronary artery stenting is a safe and useful interventional procedure which can be done with low risk even in the complicated leison. The restenosis rate is comparable to conventional PTCA. The long-term outcome of coronary stenting might be more favorable and promising with more selective and strict application of this procedure.
Angiography* ; Constriction, Pathologic ; Coronary Stenosis ; Coronary Vessels* ; Exercise Test ; Follow-Up Studies* ; Hemorrhage ; Humans ; Recurrence ; Stents

BACKGROUND: In patients with mitral stenosis(MS) the predilection of the left atrial appendage(LAA) for thrombus formation has been known, while the characteristics and clinical implications of LAA flow have not been clearly analyzed. This prospective study with transesophageal echocardiography(TEE) was done to compare the LAA flow velocities of normal controls and patients with tight MS, to evaluate the correlation between LAA flow and hemodynamic indices and to observe the effects of successful percutaneous mitral valvuloplasty(PMV) on LAA flow. METHODS: TEE was performed in 12 normal controls and 50 patients with tight MS using a 5.0 MHz biplane transducer(Hewlett Packard SONOS 1000). Left atrial spontaneous echo contrast(SEC) was semiquantified(Grade 0-III) according to the relative extent of swirling echo movement in left atrial cavity : Grade I denotes SEC confined to LAA and swirling movement over the half of left atrial cavity was graded as III. In patients with MS. TEE was performed one day before and after PMV.Hemodynamic data(left atrial pressure, transmitral diastolic pressure gradient, cardiac output and mitral valve area) were obtained just before and after PMV. RESULTS: 1) In normal controls LAA flow recording showed two pairs of LAA ejection(positive) and filling(negative) waves. One pair of LAA ejection(appendage peak positive flow ; APF) and filling flow(appendage peak negative flow ; ANF) occurred 143+/-22msec and 289+/-33msec respectively after the onset of the ECG P wave. In early diastole another small pair of LAA ejection(ACF) and filling(ADF) occurred 550+/-21msec and 671+/-50msec respectively after the onset of ECG QRS wave. Mean absolute velocities of APF and ANF were 54+/-21 and 54+/-22cm/sec respectively, which were significantly higher than those of ACF(16+/-6cm/sec) and ADF(16+/-5cm/sec). 2) In patients with tight MS(mitral valve area of 0.9+/-0.3cm2) mean velocities of APF(20+/-12cm/sec) and ANF(23+/-16cm/sec) were significangly decreased compared with normal controls. There was no significant correlation between hemodynamic indices and absolute velocities of LAA flow. SEC was observed in 62%(31/50) and mean velocities of APF(10+/-8cm/sec) and ANF(12+/-11cm/sec) were significantly lower in patients with SEC than those values(25+/-19, 27+/-21cm/sec) in patients without SEC. There was strong negative correlation between the absolute values of APF and ANF and the grade of SEC(rAPF=-0.75, pAPF=0.00 ; rANF=-0.70, pANF=0.00). 3) After successful PMV(mitral valve area of 2.0+/-0.4cm2), APF increased from 20+/-12cm/sec to 36+/-24cm/sec and statistically significant increase of ANF was also observed(23+/-16cm/sec vs 36+/-22cm/sec, p<0.05). In patients with sinus rhythm, PMV normalized LAA flow(APF=52+/-14cm/sec, ANF=51+/-10cm/sec) while still decreased flow velocities were recorded in patients with atrial fibrillation(APF=15+/-4cm/sec, ANF=16+/-6cm/sec). CONCLUSIONS: Recording of LAA flow with TEE is an indicator of LAA function and risk of thrombus formation and cardiogenic embolism, which may not be obtained with conventional hemodynamic indices. Improvement of LAA flow and normalization of flow velocities in patients with sinus rhythm immediately after successful PMV raises a question of role of PMV in prevention of thromboembolism. Randomized sudies of the long-term effects of PMV in MS will be required before this important question can be answered.
Atrial Appendage* ; Atrial Natriuretic Factor ; Atrial Pressure ; Balloon Valvuloplasty* ; Blood Pressure ; Cardiac Output ; Diastole ; Echocardiography, Transesophageal ; Electrocardiography ; Embolism ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies ; Thromboembolism ; Thrombosis