BACKGROUND: We studied clinical and angiographic findings of 16 Korean patients who had isolated laft coronary ostial steonsis and compared them with those of the patients with non-ostial left main stenosis. The aim of this study is to find the characteristics of the patients with isolated left voronary ostial stenosis. METHODS: Medical records and coronary angiograms were reviewed. We divided the patients with left main stenosis into four groups by lesion location and associated lesion. Clinical and angiographic findings of each group were compared. RESULTS: Twenty four patients(0.15%) had left coronary ostial stenosis and among them sixteen patients(0.1) had an isolated lesion. Their mean age was 48 years and 62% were female. Only 6 patients had coronary risk factors. Two patients were diagnosed as having Takayasu's srteritis. At treadmill exercise test, 7 out of 11 patients lhowed positive results at stage I. Eight patients had undergone surgical treatment. Comoared with the patients who had non-ostial left main stenosis, left ostial group showed lower mean age, female preponderance and lower incidence of coronary risk factors. There was no difference in the results of treadmill exercise test and hemodynamic parameters. CONCLUSION: Isolated left coronary ostial stenosis in Korea also predominantly occured in young female patients who had less risk factors as previous reports. But the incidence of this lesion and nonatherosclerotic origin seemed to be higher. And most of the patients with the left coronary ostial stenosis had isolated ostial stenosis.
Constriction, Pathologic* ; Exercise Test ; Female ; Hemodynamics ; Humans ; Incidence ; Korea* ; Medical Records ; Risk Factors

BACKGROUND: We studied clinical and angiographic findings of 16 Korean patients who had isolated laft coronary ostial steonsis and compared them with those of the patients with non-ostial left main stenosis. The aim of this study is to find the characteristics of the patients with isolated left voronary ostial stenosis. METHODS: Medical records and coronary angiograms were reviewed. We divided the patients with left main stenosis into four groups by lesion location and associated lesion. Clinical and angiographic findings of each group were compared. RESULTS: Twenty four patients(0.15%) had left coronary ostial stenosis and among them sixteen patients(0.1) had an isolated lesion. Their mean age was 48 years and 62% were female. Only 6 patients had coronary risk factors. Two patients were diagnosed as having Takayasu's srteritis. At treadmill exercise test, 7 out of 11 patients lhowed positive results at stage I. Eight patients had undergone surgical treatment. Comoared with the patients who had non-ostial left main stenosis, left ostial group showed lower mean age, female preponderance and lower incidence of coronary risk factors. There was no difference in the results of treadmill exercise test and hemodynamic parameters. CONCLUSION: Isolated left coronary ostial stenosis in Korea also predominantly occured in young female patients who had less risk factors as previous reports. But the incidence of this lesion and nonatherosclerotic origin seemed to be higher. And most of the patients with the left coronary ostial stenosis had isolated ostial stenosis.
Constriction, Pathologic* ; Exercise Test ; Female ; Hemodynamics ; Humans ; Incidence ; Korea* ; Medical Records ; Risk Factors

BACKGROUND: Dobutamine echocardiography has been shown to be a valuable tool for determining myocardial viability in both acute and chronic coronary artery disease with left ventricular dysfunction. The purpose of the our study was to identify the role of dobutamine echocardiography in the prediction of improvement of regional left ventricular (LV) dysfunction after revascularization of chronic coronary artery disease. METHODS: Twenty-three patients (mean age 61.2+/-9.0 years;20 men) with chronic LV dysfunction underwent dobuta-mine echocardiography (dobutamine:baseline, 5, 10, 20 microgram/Kg/min) before coronary revascularization (coronary artery bypass graft surgery 16, percutaneous coronary angioplasty 7). The mean LV ejection fraction was 42.9+/-8.8% with ranging from 26% to 58%. Follow-up echocardiography was performed at 2 to 21 months (mean 9.0+/-6.2 months) after revascularization. RESULTS: During dobutamine echocardiography, there was no major complication. Improvement of the dysfunctional myocardium was observed in 12 of 23 patients in dobutamine echocardiography. Among them, 10 patients showed functonal recovery after revascularization. Another 11 patients did not show improvement of dysfunctional myocardium in dobutamine echocardiography, however 3 of them showed functional recovery after revascularization. One hundred fifteen dysfunctional segments were found in 368 segments of 23 patients, and improvement of wall motion abnormality was observed in 46 of 115 segments in dobutamine echocardiography. Among them, 31 segments showed functional recovery after revascularization. Another 69 segments did not show wall motion improvement in dobutamine echocardiography. But among them, 13 segments showed functional recovery after revas-cularization. The sensitivity and specificity of dobutamine echocardiography for the prediction of postoperative improvement of segmental wall motion were 70% and 79%, respectively. The positive and negative predictive value of dobutamine echocardiography were 67% and 81%, respectively. CONCLUSION: In patients with chronic LV dysfunction, dobutamine echocardiography can be used as a predictor of the improvement of dysfunctional segments after revascularization.
Angioplasty ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography* ; Follow-Up Studies ; Humans ; Myocardium ; Sensitivity and Specificity ; Transplants ; Ventricular Dysfunction, Left*

No abstract available.
Arteries* ; Atherectomy*

BACKGROUND AND OBJECTIVES: Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI). The aim of this study was to assess the ability of dobutamine echocardiography (DE) to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. METHODS: Twenty-five patients (male 24, mean age 57+/-9.6) with AMI underwent DE (dobutamine: 0, 5, 10 and 20 microgramm/kg/min) in 4.8+/-2.2 days after infarction. Revascularization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2). A follow-up 2D-echocardiography was performed at 7.1+/-2.3 months after AMI. RESULTS: 1. Improvement of regional wall motion abnormality (RWMA) was observed in 12 patients during DE[DE (+) group]. Thirteen patients showed no improvement of RWMA[DE (-) group]. 2. In follow-up 2D-echocardiography 10 patients showed improvement of RWMA among DE (+) group (positive predictive value= 83.3%). Two patients showed improvement of RWMA among DE (-) group (negative predictive value=84.6%). Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction.
Angioplasty ; Arteries ; Coronary Artery Bypass ; Dobutamine* ; Echocardiography* ; Follow-Up Studies ; Humans ; Infarction ; Myocardial Infarction* ; Myocardium ; Sensitivity and Specificity ; Transplants ; Ventricular Dysfunction, Left

Sinus of Valsalva aneurysms are rare cardiac anomalies and are usually caused by the separation of the aortic wall media from the valve ring tissue. These aneurysms frequently rupture into the low-pressure areas like the right ventricle and right atrium, rarely do they rupture into the left atrium, left ventricle, pericardial sac, or pulmonary artery. Cerebral infarction has been reported as a rare complication of unruptured sinus of Valsalva aneurysm. We experienced very rare two cases of Valsalva aneurysms of right coronary sinus dissecting into the interventricular septum in patients with cerebral infarction. In two cases these aneurysms ruptured into the left ventricle. These aneurysms were excised and the defect was closed with autopericardium. At the end of the surgical repair, coaptation was found to be insufficient and aortic valve replacement was undertaken.
Aneurysm* ; Aortic Valve ; Cerebral Infarction* ; Coronary Sinus ; Heart Atria ; Heart Ventricles ; Humans ; Pulmonary Artery ; Rupture ; Sinus of Valsalva*

BACKGROUND AND OBJECTIVE: Percutaneous transluminal coronary angioplasty of chronic total occlusion has been limited by a relatively low success rate and a high restenosis rate. This study investigated procedural outcome, factors predictive of procedural success and safety of coronary angioplasty for chronic total coronary occlusion. MATERIALS AND METHODS: The study population was composed of 45 lesions attempting PTCA with or without stent implantation for recanalization of chronic total coronary occlusion between January 1997 and July 1999. The clinical and angiographic data of the 45 lesions were reviewed. The results of successful PTCA in 28 lesions were compared with those in 17 lesions whose PTCA was failed. RESULTS: The overall success of balloon angioplasty and stenting was achieved in 28 lesions (62.2%) and did not differ significantly by clinical variables. The most common cause of failure of balloon angioplasty was inability to pass the guide wire across the occlusion( 14 of 23 lesions, 61%). Procedural success was more common in patients with occlusions with a tapered entry configuration(77.2% vs. 47.8%, p=.042), with lesions without side branches(82.3% vs. 50%, p=.03). Multiple logistic regression analysis identified the absence of side branch(p<0.01) and the presence of a tapered entry configuration(p<0.05) as independent predictors of procedural success. One case(2.2%) needed emergency coronary bypass surgery after failure to recanalize the occluded vessel. There was no Q wave acute myocardial infarction, death. CONCLUSIONS: The favorable cases(>60%) of chronic total coronary occlusions can be successfully dilated by balloon angioplasty with or without stent implantation, with a major complication rate of 2.2%. Therefore, with careful patient selection, we need to try the aggressive recanalization for chronic total coronary occlusion.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Coronary Occlusion ; Emergencies ; Humans ; Logistic Models ; Myocardial Infarction ; Patient Selection ; Stents

BACKGROUND: Coronary stenting is known to reduce the rates of restenosis in focal lesions, but the efficacy of stents for long lesions have not been thoroughly defined. To evaluate the immediate and follow-up results of three different types of stents in lesions longer than 20mm, consecutive series of patients (pts) were reviewed. METHODS: Between February 1996 and January 1997, 123 patients (male 68.3%, mean age 57+/-10 years) with a total of 130 lesions underwent long stent : stenting. Excluding multiple stents and unplanned use for acute closure fifty-three pts (56 lesions) were treated with the Microstent II (M-II):30 pts (31 lesions) received the Less Shortening Wallstent (WA):and 40 pts (43 lesions) were treated by the Gianturco-Roubin II stent (GR-II). RESULTS: With the clinical success defined as <30% residual stenosis without death, CABG, Q-wave MI was achieved in 93% with the M-II, 94% with the WA and 95% with the GR-II. Stent thrombosis occurred 0% in M-II, 1.5% in WA and 2.3% in GR-II. Clinical success and stent thrombosis rates were not different between the three types of stents. Follow-up (FU) quantitative angiography was obtained from 34 pts (64%) in M-II, 25 lesions (83%) in WA and 26 pts (65%) in GR-II after 6 months. Restenosis rate defined as <0A65B>50% diameter stenosis at FU was 26% in M-II, 32% in WA and 38% in GR-II:there was no significant difference between the three stents. Target lesion revascularization (TLR) defined as CABG or target lesion PTCA at FU was 17.6% in M-II, 12% in WA and 23.1% in GR-II. Restenosis rate correlated closely with lesion length (p-value-0.03, Odds ratio-1.096) and small post-stent luminal diameter (p-value-0.002, Odds ratio-0.063) in a mu-ltivariable analysis. CONCLUSION: Coronary stenting for long lesions can be safely performed with acceptable complication rates using any of the three types of stents. Restenosis and late outcome was not related to type of stent.
Angiography ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis

Primary cardiac lymphomas diagnosed antemortem are extremely rare. We present a case of primary cardiac lymphma diagnosed antemortem by transvenous biopsy under transesophageal echocardiographic guidance. The patient who was a 62 years old male presented with facial edema, dyspnea on exertion and syncope. The chest X-ray film showed double contour at right cardiac border and the ECG showed marked sinus bradycardia. Transesophageal echocardiography (TEE), chest computed tomography (CT) and magnetic resonance imaging (MRI) showed intracardiac tumor of right atrium, invasing interatrial septum and inlets of superior and inferior vena cava and lateral wall of right atrium. Abdominopelvic CT and bone scan failed to show any extracardiac location. Transvenous biopsy confirmed the diagnosis of malignant lymphoma (diffuse large cell, B cell type). After chemotherapy was begun, the tumor makedly shrunk and symptoms resolved. Primary cardiac lymphoma is extremely rare and almost uniformly fatal, but this case showed that early diagnosis and intensive che-motherapy might contribute to a better prognosis for patients with malignant lymphoma of the heart.
Bays ; Biopsy* ; Bradycardia ; Diagnosis* ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Edema ; Electrocardiography ; Heart ; Heart Atria ; Humans ; Lymphoma* ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prognosis ; Syncope ; Thorax ; Vena Cava, Inferior ; X-Ray Film

BACKGROUND AND OBJECTIVES: The clinical pattern of infective endocarditis is constantly changing. Diagnosis and treatment of infective endocarditis were developed by recent diagnostic strategy (Duke criteria) and introduction of transesophageal echocardiography. The aim of this study was to compare the clinical character-istics of infective endocarditis in Sejong hospital to the previous report and was to investigate risk factor of heart failure, embolism and death. MATERIAL AND METHODS: All episodes hospitalized of infective endocarditis from January of 1990 to October of 1999 in Sejong hospital were reviewed retrospectively. The total cases of infective endocarditis was 80 cases in 78 patients. RESULTS: The male to female ratio was 1:1.05 (39 male, 41 female). The mean age was 42 years. Rheumatic heart disease was the most common predisposing heart disease in 28.8%, followed by prosthetic valve endocarditis. Streptococci were the most commonly isolated micro-organisms in 18 cases (45.0%), followed by staphylococci in 11 cases. Transesophageal echocardiography has a higher sensitivity than transthoracic echocardiography for detection of vegetation, abscess and paravalvular complication in endocarditis. In patients with echocardiographic vegetation and involvement of aortic valve, there was a statistically significant increase in the risk of heart failure. The factor that was associated with a statistically significant increase in the overall risk of embolization was not exist. Ten patients died (12.5%). Risk factor for death was left ventricular dysfunction. The incidence of death was more higher in patients with abscess and non-streptococcal endocarditis. CONCLUSION: Compared to the 1980's report, we observed increased mean age of patients, the decreasing trend of rheumatic heart disease as a predisposing heart disease and the decreasing incidence of streptococci as causative microorganism. Risk factors for congestive heart failure were aortic valve endocarditis and endocarditis with vegetation. Risk factor for death was left ventricular dysfunction.
Abscess ; Aortic Valve ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Embolism ; Endocarditis* ; Female ; Heart Diseases ; Heart Failure ; Humans ; Incidence ; Male ; Retrospective Studies ; Rheumatic Heart Disease ; Risk Factors ; Ventricular Dysfunction, Left