Situs inversus with dextrocardia is a rare congenital anomaly of development involving a left-handed malrotation of visceral organs. The patients with dextrocardia usually have structurally normal heart but characterized by a mirror image position of the heart and abdominal aorta (descending aorta, left atrium, cardiac apex and stomach are all on the right side). Therefore the factors for complete coronary arteriography and revascularization are appropriate selection of catheters, originality and ingenuity of procedural technique based on the anatomic characteristics. We report a case of percutaneous transluminal coronary angioplasty (PTCA) and stent implantation to the left anterior descending artery (LAD) and left circumflex artery (LCX) in a patient with dextrocardia and situs inversus.
Angiography ; Angioplasty, Balloon, Coronary* ; Aorta ; Aorta, Abdominal ; Arteries ; Catheters ; Dextrocardia* ; Heart ; Heart Atria ; Humans ; Situs Inversus* ; Stents* ; Stomach

Percutaneous transluminal coronary angioplasty (PTCA) is often used in the management of coronary artery disease and the advances in equipment, technichal skill and acquisition of operator experiences have improved initial success rates and reduced the frequency of complications. However, acute coronary occlusion is the most common and serious complication related to angioplasty and its several potential mechanisms are intracoronary thrombus, coronary artery spasm and coronary artery dissection. Accordingly,heparinization, intracoronary thrombolysis, re-PTCA, stent implantation and emergency coronary artery bypass grafting have been previously used for reopening of an occluded coronary artery during angioplasty. In this report we describe our experience in the management of acute coronary occlusion of left anterior descending artery caused by dislodgement of thrombotic material during PTCA by means of aspiration thromboembolectomy instead of medical therapy,re-PTCA and stent implantation.
Angioplasty* ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Occlusion* ; Coronary Vessels ; Emergencies ; Spasm ; Stents ; Thrombosis

The isolated coronary ostial stenosis is a lesion of the aortic wall that encroaches on the orifice of the left main coronary artery, atherosclerosis is belived to be a common cause and premenopausal female patients are most commonly affected. Stenosis of the left coronary ostium is a critical lesion which requires urgent myocardial revascularization including a surgical intervention because this lesion jeopardizes such a large volume of left ventricular myocardium. We report the case of a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was performed successfully for the stenotic lesion of distal anastomotic site after surgical ostioplasty with autologous pericardium.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Constriction, Pathologic* ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Myocardium ; Pericardium*

PURPOSE: To diagnose the coronary artery disease, it is necessary to have a thorough knowledge on coronary anatomy and normal variations. We performed a morphological study on normal variations of coronary artery in Korean adults. MATERIALS AND METHODS: 1012 cases of coronary angiography were analyzed with particular emphasis on the normal variation of three coronary arteries and their major branches, including origin of conus artery, sinus node artery and atrioventricular node artery and the variation in posterior descending artery and ramus medianus. RESULTS: We found right dominance in 895 cases(88.4%), left domainance in 44 cases(4.3%), and balanced dominance in 73 cases(7.2%). Conus artery branched from right coronary artery in 468 cases(47.6%) and originated in right coronary sinus close to the os of right coronary artery in 515 cases(52.4%). Sinus node artery originated from left circumflex artery in 551 cases(54.4%), from right coronary artery in 442 cases(43.7%), and from both coronary arteries in 19 cases(1.9%). Atrioventricular node artery originated from right coronary artery in 943 cases(93.4%), from left circumflex artery in 59 cases(5.8%), and two atriovenricular node arteries from both arteries in 8 cases(0.8%). Posterior descending artery had the normal pattern in 505 cases(58.6%) and some variation in 357 cases(41.4%). We found short left main coronary artery, less than 2--3 mm, making it hard to cannulate in 172 cases(17.0%). Ramus medianus was found in 165 cases(16.5%) with marginal distribution in 84 cases(8.4%), diagonal distribution in 80 cases(8.0%) and coursing interventricular sulcus as double left anterior descending artery in 1 case(0.1%). Left main coronary artery gave off 4 branches in 8 cases(0.8%). Myocardial bridging was found in only 3 cases(0.3%). CONCLUSION: This study could provide basic morphological data on anatomy and normal variations of coronary arteries in Korean adults.
Adult ; Arteries ; Atrioventricular Node ; Conus Snail ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Sinus ; Coronary Vessels* ; Humans ; Myocardial Bridging

BACKGROUND: Although surgical angioplasty for isolated coronary ostial stenosis is assumend as an alternative approach to CABG, the clinical features of isolated coronary ostial stenosis, postoperative complications and follow-up angiographic results would have not been well studied. METHODS: We retrospectively studied 24 patients (female : male = 20 : 4, mean age 50.0 +/- 12.3 yr) who underwent surgical angioplasty for isolated coronary ostial stenosis using patch ( 22 fresh autologous pericardium, 2 saphenous vein) during the period of March 1990 through February 1998. Repeat coronary angiography (16 patients) and echocardiography (24 patients) were performed. Aortic regurgitation was evaluated semiquantitatively (Grade I - Grade IV). RESULTS: There were 3 deaths after surgical angioplasty. One death was due to acute coronary dissection perioperatively, the second due to low cardiac output syndrome 2 weeks post-surgery, and the third due to traumatic panperitonitis 10 months post-procedure. Angina recurred in 4 patients and the remaning 18 patients were symptom-free. Repeat angiography (19.3 +/- 20.7 Mo) showed widely patent ostium with excellent run-off except 2 patients (1 distal patch stenosis, 1 ostial restenosis in Takayasu's arteritis). The third symptomatic patient was proven to have coronary spasm by ergonovine test. AR increased in the fourth patient (Grade II -> III) with patent ostium. CONCLUSION: Surgical angioplasty may be feasible and alternative operative method to CABG for isolated coronary ostial stenosis. It should however be noted that postop AR can develop and/or increase. Further investigation is needed to evaluate the clinical significance of the AR.
Angiography ; Angioplasty* ; Aortic Valve Insufficiency ; Cardiac Output, Low ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Echocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Postoperative Complications ; Retrospective Studies ; Spasm

BACKGROUND AND OBJECTIVES: This study was performed to assess the morbidity and mortality of 311 patients implanted with at least one Omniscience prosthetic valve between January 1992 and January 2000. SUBJECTS AND METHODS: Following valve implantation all patients were followed up with routine interviews, physical examination and echocardiography. RESULTS: The mean follow-up duration was 5.8+/-0.9 (standard error, SE) years with a mean follow-up interval of 8.5+/-0.7 (SE) months. The 311 patients received the following type (s) of valve: mitral, aortic, both or tricuspid valve, in 166 (47.9%), 99 (32.0%), 44 (19.5%) and 2 (0.6%) of cases, respectively. The cumulative follow up was 1143.4 patient-years (pt-yr). Death occurred in eight patients (0.7%/ pt-yr at linearized rate), and redo-operations were required in 27 patients (2.4%/pt-yr) due to valve failure. Actuarial freedom from all complication was 72.5%+/-8.2% (SE). Freedom from pannus formation, paravalvular leak, or thromboembolism plus anticoagulant related bleeding were 83.1%+/-3.5% (MVR/AVR 92.7%+/-4.7%/73.4%+/-2.8%), 95.2%+/-2.1% (MVR/AVR 96.8%+/-4.2%/93.6%+/-3.2%), and 96.1%+/-2.5% (MVR/AVR 95.6%+/-5.6%/96.7%+/-4.7%) respectively. CONCLUSION: Our results with this prosthesis demonstrate relatively high incidences of valve related complication especially due to pannus formations and paravalvular leaks. We could reduce the incidences of mortality by earlier detection of complications, redo-operations and routine checks.
Echocardiography ; Follow-Up Studies* ; Freedom ; Heart Valve Prosthesis ; Hemorrhage ; Humans ; Incidence ; Mortality ; Physical Examination ; Prostheses and Implants ; Prosthesis Failure ; Thromboembolism ; Tricuspid Valve

Heart failure is a recognized, although uncommon, cause of massive liver cell necrosis, the clinical consequence of which are intermingled with those of cardiac insufficiency in most case. But, hepatic coma is rerely caused by hepatic congestion only. We report the three cases with heart failure resulted in massive liver cell necrosis and fulminant hepatic failure. The manifestations of fulminant hepatic failure were hepatic encephalopathy, jaundice, marked increase of prothrombin time and serum transaminase and there were no evidences of viral hepatitis and toxic hepatitis as a cause of liver failure.
Drug-Induced Liver Injury ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatic Encephalopathy ; Hepatitis ; Jaundice ; Liver ; Liver Failure ; Liver Failure, Acute* ; Necrosis ; Prothrombin Time

A network of strands (Chiari Network) in the right atrium with attachments extending from the crista terminalis to eustachian valve and thebesian valve or sometimes to the floor of the right atrium in the region of the opening of the coronary sinus. While this congenital remnant is seldom clinically important, this membranes have been reported as site of thombus formation, and hence potential etiologies of pulmonary emboli as well as a source of entrapment of a right-heart catheter and arrhythmia. We report two cases of right atrial mass-like chiari form network incidentally detected by transthoracic echocardiography (TTE) and confirmed by transesophageal echocardiography (TEE).
Arrhythmias, Cardiac ; Catheters ; Coronary Sinus ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Membranes

Takayasu,s arteritis is a systemic disease characterized by occlusion of aorta and its major branches because of a panaortitis with thickening of the adventitia. Coronary artery narrowing is due to extension of inflammations that occur in aorta. Angina pectoris may be the first symptom of the disease if the coronary arteries are the initial site of severe arterial narrowing. We present a case of bilateral coronary ostial stenosis where Takayasu,s arteritis was pathologically proved as an etiology. The patient was taken coronary ostial angioplasty with good result.
Adventitia ; Angina Pectoris ; Angioplasty ; Aorta ; Arteritis ; Constriction, Pathologic* ; Coronary Vessels ; Humans ; Inflammation ; Takayasu Arteritis*

A 63 year old male suffered from a acute huge inferolateral and posterior myocardial infarction with vertricular septal perforation(1x1.5cm). Cardiogenic shock and ventricular tachycardia occured on the 3rd day in hospital. After cardiopulmonary resuscitation the deteriorated condition of the patient was improved by intraaortic balloon counterpulsation(IABP). The invasive diagnostic procedure(LV angiography and coronary angiogram) was carried out under the employment of IABP and artificial ventrilation. The patients has recovered from the operation(coronary artery bypass graft and VSD patch op) and myocardial infarction. Because of recurrent aspiration pneumonia the patient was nourished per gastrostomy. He died 3 month later due to upper gastrointestinal bleeding.
Angiography ; Arteries ; Cardiopulmonary Resuscitation ; Counterpulsation* ; Employment ; Gastrostomy ; Hemorrhage ; Humans ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Pneumonia, Aspiration ; Shock, Cardiogenic* ; Tachycardia, Ventricular ; Transplants ; Ventricular Septal Rupture*