BACKGROUND: The coronary collateral circulation has been frequently observed in significant coronary artery disease and its protective role in ischemic myocardium is still remained unclear. But the study on the anti-ischemic effect in human model of ischemic myocardium is rare. METHODS: To observe the anti-ischemic role of coronary collateral circulation in ischemic myocardium, perfusion defect areas were measured during PTCA(percutaneous transluminal coronary angioplasty) in angina patients with single vessel disease and analyzed according to the grade of collateral circulation. The 99mTc-MIBI myocardial scanning images were obtained at 24 hours before PTCA with dipyridamole stress, at ballooning during PTCA and at 24 hours after the opening of the artery and perfusion defect volume ratios(DVR) were measured in each of the images of the patient with angina and single vessel disease. RESULTS: 1) Studied subjects were 14 patients(10 male, 4 female, mean age : 56.6+/-103) and subdivided into two groups. All patients had angina with single vessel disease, 7 proximal left anterior descending artery(LAD) stenosis, 4 middle LAD stenosis, 1 middle right coronary artery(RCA) stenosis and 2 proximal left circumflex artery(LCX) stenosis. Group A was composed of 7 patients with angina and coronary collateral circulation more than grade 1. Group B was 7 patients with angina and grade 0 collateral. 2) Mean age of group A was 62.4+/-8.2 years, 5 male and 2 female patients, That of group B was 56.6+/-8.9 years and all male patients. Group A was composed of 7 patients ; 5 unstable and 2 stable angina ; 2 proximal LAD stenosis, 3 midddle LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. One patients had grade 1, two patients grade 2 and four patients grade 3 coronary collateral circulation. All of the patients were unstable angina in group B showing 5 proximal LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. No collateral circulation was demonstrated in group B. 3) In group A, DVR was 17.5+/-13.9% on stress image before PTCA and 7.1+/-1.4% on the ballooning image during PTCA. DVR was smaller in ballooning image than in stress image(p<0.01). 4) In group B, DVR was 12.4+/-16.0% on stress image before PTCA and 26.6+/-10.0% on ballooning image during PTCA. DVR was larger in ballooning image than in stress image(p<0.001). 5) DVR on stress image and open image were not different in both groups, but DVR on ballooning image were 7.1+/-4.7% in group A and 26.6+/-10.0% in group B, which was larger than in group A(p<0.01). CONCLUSION: These results suggest that myocardial perfusion defect area may be smaller in angina patients with good collateral circulation than patients with no collateral, and coronary collateral circulation have a protective role on the jeopardized myocardium during coronary artery occlusion.
Angina Pectoris* ; Angina, Stable ; Angina, Unstable ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Dipyridamole ; Female ; Humans ; Male ; Myocardium ; Perfusion*

Pacemaker twiddler's syndrome is reported as a very rare complication of permanent pacemaker implantation. There was a recent report suggesting that the incidence of pacemaker twiddler's syndrome increase recently presumably as a result of the implantation of thinner and smaller pacemaker system than before. We experienced a case of pacemaker twiddler's syndrome complicated 3 times with the conventional method of implantation or replacement during 14 months after the first implantation(Optims MP 158C and Pacing lead 400, Telectronic)on June 13th 1987. This case was an 18 year-old high school girl who had suffered frequent syncope for 2 years and extertionl dyspnea for 5 years due to congenital complete heart block, of which block site was proved to be AV nodal by His bundle electrogram. Pacemaker twiddler's syndrome developed 3 times;firstly 6 weeks after the first implantation in the right subclavicular fossa, secondly 10 weeks after the replacement of the twisted pacing lead, thirdly 10 months after the change of implantation site to the left subcalvicular fossa with the replacement of the twisted and fractured lead. Finally, the pacemaker generator was anchored to the clavicular periostium and pectoralis fascia at several points by using Dacron pouch.
Adolescent ; Dyspnea ; Electrophysiologic Techniques, Cardiac ; Fascia ; Female ; Heart Block ; Humans ; Incidence ; Polyethylene Terephthalates ; Syncope

The only clinically avilable levo-isomer type of beta-recepter blocker is penbutolol sulfate, and it is already accepted as one of beta-receptor blockers for initial antihypertensive drug therapy according to the report of 1988 Joint National Committee on Detection, Evaluation, and Tratment of High Blood Pressure. To evaluate the antihypertensive efficacy, effect on the quqlity of life, and side effects of penbutolol recently introduced into Korea, penbutolol was administered to 29 essential hypertensive(mild 9, moderate10, and severe 10) patients for 12 weeks or longer. The result of the clinical analysis are as follows; 1) The mean age was 50.0+/-10.9(M+/-SD), and the sex distribution between male and female was16:13. 2) The blood pressure lowering effects of penbutolol as a monotherapy were marked in 16, moderate in 6, and insignificant in 2 cases. The systolic blood pressure was significantly decreased from 179.1+/-20.2 to 135.4+/-16.5mmHg(P<0.005), and the diastolic blood pressure from 112.6+/-13.5 to 84.0+/-11.9mmHg(P<0.005)after 12 weeks' penbutolol therapy. 3) The heart rate was significantly decreased from70.3+/-13.3 to 65.5+/-9.1 per minute(P<0.05). 4) The quality of life was improved markely in 5(17.2%) and slightly in 8 cases(29.6%). 5) There were no significant laboratory changes after 12 weeks' penbutolol therapy. 6) Two out of three cases with non-specific ST segment and T wave changes in EKG and two out of 9 cases with EKG were normalized, 2 cases of LAH with strain were improved. 7) The side effects of penbutolol were dizziness in 4, sexual dysfunction in 2, and skin rash in 1 case. 8) Final multifarious assessment of penbutolol therapy showed that it was very useful in 11(37.9%), useful in 4(13.8%) and slightly useful in 7 cases(24.1%). These reult suggest that penbutolol is a first-line antihypertensive agent with an effective antihypertensive action, improving quality of life, with no significant laboratory changes and few side effects.
Blood Pressure ; Dizziness ; Drug Therapy ; Electrocardiography ; Exanthema ; Female ; Heart Rate ; Humans ; Hypertension ; Joints ; Korea ; Male ; Penbutolol ; Pheniramine ; Quality of Life ; Sex Distribution

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest patin in this group of patients are not known exactly. To observe the changes of left ventricular function in patients with angina and normal coronary angiogram, the authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization. METHODS: The authors performed resting and treadmill exercise electrocardiogram, 201TI dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The systolic and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital. RESULTS: 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51+/-9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill exericise test and perfusion defects in 3 cases out of 8 cases during 201TI dipyridamole scan. 2) On echocardiogram, ejection fraction(EF) was 68.9+/-4.5%, fractional shortening(FS) 37.4+/-4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2+/-0.1, OR slope 3.8+/-0.8c,/sec, mitral valve Doppler E/A velocity ratio[E/A(V)] 0.9+/-0.2, mitral valve Doppler E/A area ratio[E/A(a)]1.3+/-0.3, early diastolic deceleration rate(EDDR) 4.3+/-1.3m/sec2, isovolumic relaxation time(IVRT) 96.2+/-15.7msec, isovolumic contraction time(IVCT) 38.1+/-9.1 msec and aortic valve Doppler peak flow velocity[Ao(V)] 0.8+/-0.2m/sec. EF, FS, IVCT and A(V) were normal. LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects. 3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3+/-5.1mmHg and ejection fraction by left ventriculogram 78.2+/-7.4%. There was no regional wall motion abnormality. CONCLUSION: Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.
Aortic Valve ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathies ; Catheterization ; Catheters ; Deceleration ; Dipyridamole ; Electrocardiography ; Esophageal Motility Disorders ; Female ; Humans ; Hypertension ; Jeollanam-do ; Male ; Microvascular Angina ; Mitral Valve ; Perfusion ; Relaxation ; Thorax ; Ventricular Function, Left*

OBJECTIVES: Refractory period and conduction time of the slow and fast pathways in the atrioven-tricular node are known to be the most important determinant of the inducibility of atrioventricular nodal reentrant tachycardia (AUNRT) but their relationship has not been determined in Korean. METHODS: Two hundred and ten patients under-gone electrophysioiogic study. One hundred twenty two patients with dual AV nodal pathways were divided into two groups (group I, 77 patients with no inducible AVNRT; group II, 45 patients with inducible AVNRT). RESULTS: Antegrade dual AV nodal pathways were documented in 77 patients (47%) out of 165 patients on whom AVNRT was not induced, Antegrade ERP of slow pathway in paced rhythm (600 msec) was shorter in group II than in group I (331 +/- 14 msec vs 269 +/- 47 msec, p<0.05). Ventriculoatrial block cycle length (VABCL) and retrograde ERP of the AV conduction system were significantly shorter in group 2 than in group 1 (p<0.001). Maximum slow pathway conduction times in sinus rhythm and paced rhythm (600msec) in group 2 were significantly longer than in group 1 (sinus rhythm: 332 +/- 68msec vs. 379 +/- 88msec, p<0.005; paced rhythm: 332 +/- 69msec vs. 392 +/- 85msec, p<0.005). The ERP gaps of two AV nodal pathways of group 2 in sinus rhythm and in paced rhythm were also significantly longer than those of group 1 (sinus rhythm 41 +/- 3msec vs. 78 +/- 50msec, p<0.001; paced rhythm 36 +/- 32 msec vs. 72 +/- 19msec, p<0.005). The incidence of intact ventriculoatrial conduction was significantly higher in group 2 than in group 1 (p<0.05). Antegrade slow pathway conduction time (A2H2 interval) at the time of AVNRT induction with single atrial premature depolarization (APD) with a coupling interval over 10 msec less than that of an APD producing AH jump were not correlated with VABCL (r=0.193, p<0.05). CONCLUSION: Dual AV nodal pathways were observed in 47% of patients with no-inducible AVNRT group. The inducibility of AVNRT appears to be closely ralated to the some conduction characteristics of the dual pathways and the refractoriness, i.e. maximum slow pathway conduction time, the ERP gap of two pathways, retrograde fast pathway ERP, VABCL.
Humans ; Incidence* ; Tachycardia, Atrioventricular Nodal Reentry*

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.
Catheter Ablation ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Korea ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinoatrial Nodal Reentry ; Tachycardia, Supraventricular* ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

BACKGROUND: It is known that dyslipidemia plays and important role in atherogenesis and progression for the disease. Recently it was reported that apolipoprotein levels are important in athcrogenesis. In Korean patients the study of the apolipoprotein levels as for the risk factor for atherogenesis is still needed. Subjects and METHODS: The 107 patients who underwent coronary angiography to differentiate chest pain syndrome were subjected to this study. Thirty-two patients who had no significant coronary artery disease served as a control group and 75 patients who had one or more coronary stenoses more than 50% narrowing by luminal diameter served as the coronary artery disease(CAD) group. Plasma levels of total cholesterol, triglycerides, high density lipoprotein cholestero(HDL-C), apolipoprotein A-1(Apo- A1) and apolipoprotein B(Apo B) were measured from venous blood after overnight fastion, and the results were compared between the groups. RESULTS: The male gender and smoking habits were more prevalent in the CAD group. Total cholesterol levels were significantly higher in the CAD group but the HDL-C level was not significantly different in two groups though the mean level of the HDL-C was some lower in the CAD group. The Apo A-1 level was lowere in the CAD group while the Apo B level was higher in teh CAD group compared to those of the control, Apo B / Apo A-1 ratio much more distinctly discriminated the two groups. CONCLUSION: Theses results suggest that the plasma Apo-A-1, Apo B levels and the ratio of Apo B / Apo A-1 can be used for risk statification of CAD.
Apolipoprotein A-I* ; Apolipoproteins B ; Apolipoproteins* ; Atherosclerosis ; Chest Pain ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Dyslipidemias ; Humans ; Lipoproteins ; Male ; Phenobarbital ; Plasma* ; Risk Factors ; Smoke ; Smoking ; Triglycerides

BACKGROUND: The lesion length of coronary artery stenosis has been regarded as a risk factor for acute complication and long segment stenosis of the coronary artery is associated with a less chance of successful percutaneous transluminal coronary angioplasty(PTCA). Many new interventional techniques auch as excimer laser angioplasty, directional atherectomy, and long-balloon angioplasty catheter have been developed and used for long lesion of coronary artery stenosis. Only a little data is, however, available on long-balloon PTCA. This study was carried out to see the clinical results of PTCA using long-balloon angioplasty catheters. SUBJECTS AND METHODS: Fifty-four coronary arterial stenotic lesions in 49 patients(M:F=32:17, 54.48.9 years)were attempted to dilate with long-balloon PTCA. Clinical diagnoses in 49 patients were acute myocardial infarction in 13, old myocardial infarction in 9, unstable angina in 18, andd stable angina in 9. Lesion length and TIMI(Thrombolysis in Myocardial Infarction) flow of target lesions were measured before PTCA. PTCA was performed in standard fashion using long-balloon angioplasty catheters. Immediate success rate, complications, and retenosis rate were evaluated. RESULTS: The associated risk factors of atherosclerosis were hypertension in 16, hypercholesterolemia in 10, smoking in 27, and diabetes mellitus in 9 patients. The target vessels were 34 left anterior descending arteries, 6 left circumflex arteries, and 14 right coronary arteries. PTCA using long-balloon catheters was performed as an adjunct to suboptimal PTCA using standard balloon catheters in 6 patients. In the remaining 44 patients, long-balloon PTCA was primarily performed due to lesion length greater than 2.0 cm. The overall success rate of long-balloon PTCA was 85.2%, and the procedure-related complications were occurred in 12(22.2%) lesions. Restenosis was revealed in 9(50%) of 18 lesions which were evaluated with follow-up coronary angiography. CONCLUSION: Above results suggest that PTCA using a long-balloon angioplasty catheter is efficacious in dilation long segment stenosis of coronary artery with a low complication rate.
Angina, Stable ; Angina, Unstable ; Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Atherectomy ; Atherosclerosis ; Catheters ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus ; Diagnosis ; Follow-Up Studies ; Humans ; Hypercholesterolemia ; Hypertension ; Lasers, Excimer ; Myocardial Infarction ; Risk Factors ; Smoke ; Smoking