A 45 year old man with a history of syncopal attacks of 3 days' duration showed complete heart block with occasional retrograde P waves following QRS complexes in the electrocardiogram. The site of A-V block seemed to be below A-V node judging from the QRS complexes when occasional capture occured. This may be a case of complete heart block progressing from right bundle branch block plus left posterior hemiblock. There was a rapid improvement of conduction with sublingual isoproterenol in a few days, EKG's showing normal A-V conduction and QRS complexes on discharge. The mechanism of the retrograde conduction in the presence of complete heart block is discussed with a review of literature.
Atrioventricular Node ; Bundle-Branch Block ; Electrocardiography ; Heart Block* ; Heart* ; Humans ; Isoproterenol ; Middle Aged

The electrocardiograms of a total of 12,796 patients taken in the past three years at Severance Hospital were reviewed for conduction disturbances which were found in 314 cases(2.46%). Th first degree atrioventricular block occurred in 65 cases, and second degree atrioventricular block with Wenckebach periodicity in 13. There were 9 cases of third degree atrioventricular block with nomal QRS complexes causing Adams-Stokes attacks which represented 2.9% of all conduction disturbances. It occurred equally in both sexes and predominantly after 6th decade of life. There were 99 cases of complete right bundle branch block(RBBB) and 12 cases of complete left bundle branch block(LBBB). The latter were mainly associated with significant heart diseases. As for the intraventricular conduction defects other than the simple bundle branch blocks, the findings were as follows; 1. Simple hemiblocks were found in 92 cases or 0.73% of total series and 29.3% of all conduction disturbances. Left anterior hemiblock(LAH) occurred 3 times more frequently than left posterior hemiblock(LPH). 2. Partial bilateral bundle branch block(BBBB) were found in 25 cases representing 0.2% of the total series and 8.0% of all conduction disturbances. Among the 25 cases of BBB, 11 had RBBB plus LAH, 10 RBBB plus LPH, 1 LBBB plus first degree A-V block, and 3 LBBB of diphtheritic cardic involvement. Trifascicular heart block causing Adams-Stokes attacks occurred in 9 of the 25 cases resulting in death in 7 cases. The underlying diseases were ischemic heart disease, hypertensive heart disease, congenital heart disease and diphtheritic carditis. This report represents the first electrocardiographical documentation of occurrence of trifascicular heart block progressing from BBBB in Korea.
Atrioventricular Block ; Bundle-Branch Block ; Electrocardiography* ; Heart Block ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Korea ; Myocardial Ischemia ; Myocarditis ; Periodicity

No abstract available.

PURPOSE: Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obsructive jaundice. METHODS AND MATERIALS: A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projecion imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. RESULTS: In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intraheparic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were dipicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography was successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases.
Bile Ducts ; Biliary Tract ; Cholangiography* ; Cholangiopancreatography, Endoscopic Retrograde ; Dilatation ; Gallbladder ; Healthy Volunteers ; Humans ; Jaundice ; Jaundice, Obstructive* ; Pancreatic Ducts ; Volunteers

No abstract available.
Fanconi Anemia*

No abstract available.
Aneurysm*

No Abstract Available.
Hidradenitis*

The ventricular septal defect with aortic insufficiency is a relatively uncommon congenital heart disease. Once the prolapse of aortic cusp complicates the ventricular septal defect, the prolapse of the aortic cusp is a progressive, rather than static lesion. With the curent possibility of surgical correction in cases of ventricular septal defect and other abnormalities, the differential diagnosis assumes marked importance. vTwo cases of ventricular septal defect with aortic insufficiency are presented with a review of pertinent literature. These young female patients had long standing palpitation and dyspnea on exertion since childhood. The physical examination showed with pulse pressure, bounding carotid pulsation and a systolic ejection-type murmur and a decrescendo diastolic murmur at the upper left sternal border, which simulated "machinery" type murmur of patent ductus arteriosus. The ventricular septal defect with aortic insufficiency was demonstrated by cardiac catheterization and cineangiocardiography.
Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Diagnosis, Differential ; Ductus Arteriosus, Patent ; Dyspnea ; Female ; Heart Defects, Congenital ; Heart Murmurs ; Heart Septal Defects, Ventricular* ; Humans ; Physical Examination ; Prolapse

Isolated pulmonary stenosis, a relatively common congenital anomaly that accounts for about 10 percent of all congenital heart disease, is characterized by stenosis of pulmonary valve itself, infundibulum or both of them. Since cardiac catherterization was applied to man by Cournand and Ranges, pulmonary stenosis had been easily diagnosed and many clinical studies had been investigated. It has a wide clinical spectrum depending on the degree of stenosis. The electrocardiogram, phonocardiogram and chest X-ray have proved useful in estimating the severity of hemodynamic facotrs in individual cases. This series comprises 47 cases in whom the clinical diagnosis of isolated pulmonary stenosis was confirmed by right heart catheterization with cardiac cineangiography at Severance Hospital, Yonsei University. An attempt was made to correlate the electrocardiographic, phonocardiographic, chest X-ray findings, and types of stenosis with the hemodynamic data in these cases. 1. Of 47 patients, 33 were male and 14 female. Their ages ranged from 2 to 42 years: the mean age was 19.1 years. 2. The incidence was 5.9 percent of all 797 catheterized congenital heart disease cases. The pulmonary valvular stenosis was 30 (68.3%), infundibular 7 (14.6%) and combined 10 (21.6%) cases. 3. The correlation between electrocardiogram and hemodynamic data were as follows. i) The regression equation between right ventricular sysytolic pressure (RVSP) and height of R wave in V1 lead (RV1) was RVSP=3.32 RV1+48.2: its correlation coefficient was 0.818 and it was very significant (p=0.000). ii) The higher the RVSP, the more the frontal axis of QRS complex shifted to the right side (r=0.55. p=0.001). iii) The RVSP of the groups with positive ECG findings such as p-pulmonale, right ventricular hypertrophy or right ventricular strain were much higher than the RVSP of the groups without such findings (p=0.032.0.000, 0.000). iv) The group with RV1 higher than 20 mm showed much more elevated mean of RVSP than the group with lower RV1 (p=0.000). v) The groups with the above mentioned positive ECG findings showed good correlation with the severity of RVSP which was arbitrarily classified as 49 or less, 50~100, and 100 mmHg or more (chi-square=8.96, 26.69, 19.06; p=0.011, 0.000, 0.000). 4. The group with late occurrence of the maximum intensity of the ejection systolic murmur showed higher mean of RVSP than the group with early peak of the murmur (p=0.014). 5. The means of RVSP of the groups with chest X-ray findings such as decreased pulmonary vascularity, were much higher than the means of RVSP of the groups without such findings (p=0.000, 0.005, 0.015). The groups with above mentioned positive chest X-ray findings showed good corelations with the severity of RVSP which was classified as above limits (chi-square=7.55, 10.94, 13.36; p=0.022, 0.004, 0.001). 6. Combined pulmonary valvular and infundibular stenosis showed more severe systolic pressure gradient and higher mean of RVSP than the isolated types (p=0.000).
Axis, Cervical Vertebra ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Catheters ; Cineangiography ; Constriction, Pathologic ; Diagnosis ; Electrocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics* ; Humans ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Pulmonary Valve ; Pulmonary Valve Stenosis* ; Systolic Murmurs ; Thorax

We report the implantation of a balloon-expandable intravascular stent at proximal left anterior decending artery in a patients suffered from Canakian functional class III angina for 8 years. The patient received 3 times percutaneous transluminal coronary angioplasty at proximal left anterior descending and circumflex artery without benefits. Repeated angiography revealed restenosis at proximal left anterior descending artery. Atherectomy was tried with transluminal extraction catheter(TEC) with luminal dissection and coronary bypass graft followed. occluded vein grafts were defined by follow-up angiography and chest pain recurred. No residual stenosis or thrombosis was documented in 24 hour follow-up angiography and the patient was discharged without symptom at 10 days after stenting.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Atherectomy ; Chest Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis ; Transplants ; Veins