We sudied, with echocardiography as a main tool, the natural processes of 211 patients with uncomplicated ventricular septal defect (VSD) (incidence, 5.33 per 1,000 live births); 146 (69.2%) had a perimenbranous VSD and 32 (15.2%) had a subarterial, 25 (11.8%) had a muscular type of VSD. Cumulative rate of spontaneous closure was 26.1%. In the closure processes, about three-fourth of perimembranous VSD showed a partial closure or tunnel formation by changes of septal leaflet of the tricuspid valve, remaining one-fourth showed a "functional" complete closure. Four of 58 neonates had a partially closed-perimembranous VSD. Rates of infundibular stenosis and Eisenmenger syndrome were 6.6% and 1.4% respectively. Aortic prolapse with insufficiency was detected in 6 patients who were over 6 years of age. Surgical closure was required in 27.5% of all studied patients and in 12% of infants (14 of 177). No natural deaths were observed during the study-periods of recent 3 years. But, 3 of 58 (5.2%) were dead postoperativel (two were early, one late). Doppler color flow mapping is a valuble aid in the diagnosis of VSD and may be on reason for the observed increase in the incidence of VSDs.
Constriction, Pathologic ; Diagnosis ; Echocardiography* ; Eisenmenger Complex ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Infant ; Infant, Newborn ; Prolapse ; Tricuspid Valve

Mitral regurgitation (MR) was analyzed by Doppler echocardiography, preoperatively and postoperatively, in 59 patients with patent ductus arteriosus (PDA). The ratio of left atrial dimension and aortic root dimension (LAD/AOD) and the maximal velocity of the mitral valve (MVmax) were compared in pre, postop group. The degree of the regurgitation was given to the MR group. In preop MR group (13 of 59,22%), we compared the LAD/AOD by echo and the Qp/Qs by catheterization with non-MR group. The following results were obtained: 1) In preop MR group, about half of them had a grade 1 regurgitation, where as one fourth showed grade 2, remaining one fourth showed grade 3. The later were all changed to grade 2, postoperatively. The whiffle or mild MR (grade 1 or 2) shown preoperatively were slightly reduced in their degrees of regurgitation, but most were not disappeared and persisted to 7th postop day. 2) LAD/AOD and MVmax were significantly reduced at postop state of PDA. 3) In preop MR group (n=13), LAD/AOD was significantly increased. Qp/Qs was higher in MR grade 2 group (n=6). In conclusion, left atrial dilatation could be a factor causing mitral regurgitation in the PDA. The amount of the pulmonary blood flow also related to that. The size of the PDA itself, Rp/Rs and associated cardiac lesions were not related to the regurgitation.
Catheterization ; Catheters ; Dilatation ; Ductus Arteriosus, Patent ; Echocardiography, Doppler ; Humans ; Mitral Valve ; Mitral Valve Insufficiency*

BACKGROUND: It is known that methylmercury poisoning, Minamata disease is very toxic to human body. But, cardiotoxic mechanism of methylmercury is left unknown, Recent study has been reported that the cleavage of methylmercury produce oxygen radicals as well as methyl radicals, and also these radicals induce the release of excitotoxic amino acids(EAAs). So, oxygen radicals and EAA are regarded as a causative factors in the various diseases such as heart disease induced by toxicity of methylmercury. We studied to know the cardiotoxic effect of methylmercury on cultured myocardial cells derived from neonatal rat in order to evaluate the toxic mechanism of methylmercury. METHODS: Myocardial cells of neonatal rat were incubated with various concentrations of methylmercuric chloride for 1-96 hours. MTT90 and MTT50 values were measured and cell viability was determined by MTT assay. In addition, morphological study was performed by light microscope after cultured myocardial cells that were exposed to methymercuric chloride. RESULTS: MTT90 and MTT50 values were 1microM and 15microM of methylmercuric chloride in cultured myocardial cells of neonatal rat respectively. Exposure of cultured rat myocardial cells to methylmercuric chloride resulted in a significant cell death in a time-dependent manner. In the observation of morphological changes, cultured cells treated with methlymercuric chloride showed decrease of cell number and disconnection between cultured myocardial cells. CONCLUSION: These observation suggest that methylmercury has a severe myocardiotoxicity on cultured myocardial cells derived from neonatal rat by the decrease of cell viability and morphological changes.
Animals ; Cell Count ; Cell Death ; Cell Survival ; Cells, Cultured ; Heart Diseases ; Human Body ; Mercury Poisoning, Nervous System ; Poisoning ; Rats* ; Reactive Oxygen Species

No abstract available.
Echocardiography, Doppler* ; Heart Diseases* ; Heart*

Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.
Abdominal Pain ; Abscess ; Adult ; Cecum ; Diarrhea ; Early Diagnosis ; Edema ; Emergencies* ; Emergency Service, Hospital ; Enterocolitis, Neutropenic ; Fever ; Humans ; Incidence ; Neutropenia ; Typhlitis*

BACKGROUND: Noninvasive estimation of pulmonary artery pressure is an important component of echocardiographic studies. A number of methods are available for estimation of pulmenary pressure, each with varying degrees of reported accuracy. To assess accuracy and difficulties, noninvasive pulmonary artery pressure estimates were performed in infants and children with congenital heart diseases. METHODS: Noninvasive estimates from 8 methods were compared with catheterization measurements. Systolic pressure was estimated by the Burstin method and from perak tricuspid regurgitation velocity, and also from systolic pressure gradients through the VSD(ventricular septal defect) and PDA(patent ductus arteriosus). Mean pressure was estimated by acceleration time divided by ejection time measured from Koppler spectrum obtained at the right ventricular out flow tract. Diastolic pressure was estimated from pulmonary regurgitation velocity spentrum at end-diastolic, and also from diastolic pressure gradient through the patent ductus arteriosus. RESULTS: IN systolic pressure, Burstin and tricuspid regurgitation velocities estimates correlated significantly(r=0.92, 0.90 respectively), whereas VSD and PDA estimates correlated less well with catheterization estimates(r=0.83, 0.65 respectively). The mean pressure, measured from RVOT(right ventricular outflow tract) Doppler spectrum corresponded well with catheterization pressure(r=0.89), whereas those obtained from the main pulmonary artery correlated less well(r=0.74). The diastolic pressure estimates from pulmonary regurgitation velocity spectrum, revealed good correlation(r=0.79), but those from diastolic Doppler spectrum at PDA correlated less well with catheterization estimates(r=0.63). CONCLUSION: All of eight Doppler echocardiographic methods seemed to be easily performable for estimation of pulmonary artery pressure. But, the degree of accuracy was variable. Because a pressure estimante from only a single method may be in error, care should be taken in combining use of other(one or two) methods.
Acceleration ; Blood Pressure ; Catheterization ; Catheters ; Child ; Ductus Arteriosus, Patent ; Echocardiography* ; Echocardiography, Doppler ; Heart Diseases ; Humans ; Infant ; Pulmonary Artery* ; Pulmonary Valve Insufficiency ; Tricuspid Valve Insufficiency

Isolated infernal iliac artery aneurysms and rupture are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis for abdominal pain. The consequences can be grave, The incidence of isolated iliac artery aneurysm is 1~2% of that of abdominal aortic aneurysm(AAA). The natural history is of gradual enlargement, with rupture the most common clinical presentation. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper surgical treatment before possible rupture. Here is a case of ruptured aneurysm of left internal iliad artery. A 73-year-old man was presented to our emergency center with severe abdominal pain and voiding difficulty Abdominal Computed Tomography(Cf) and angiography showed ruptured aneurysm of left infernal iliad artery. Emergency operation was successfully performed for the ruptured internal iliad artery aneurysm.
Abdominal Pain ; Aged ; Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Humans ; Iliac Artery* ; Incidence ; Natural History ; Pelvis ; Rupture ; Rupture, Spontaneous*

No abstract available.
Heart Failure* ; Heart* ; Hypertension, Pulmonary* ; Nifedipine*

No abstract available.

No abstract available.
Echocardiography* ; Heart Defects, Congenital*