The most feared complication of left ventricular thrombus (LVT) is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.
Brain ; Echocardiography ; Heart Ventricles ; Humans ; Sepsis ; Shock, Septic* ; Stroke* ; Thorax ; Thrombosis*

Preservation of the subvalvular apparatus has the merits of postoperative outcomes during mitral valve replacement for mitral regurgitation. We performed mitral valve replacement with anterior and posterior leaflet chordal preservation in a 65-year-old woman. On the 2nd postoperative day, routine postoperative trans-thoracic echocardiography showed an unknown aortic subvalvular mobile mass. We report a case of a remnant mitral subvalvular apparatus detected by echocardiography after chordal preserving mitral valve replacement which was confused with postoperative aortic valve vegetation.
Aged ; Aortic Valve ; Echocardiography ; Female ; Humans ; Mitral Valve ; Mitral Valve Insufficiency

Preservation of the subvalvular apparatus has the merits of postoperative outcomes during mitral valve replacement for mitral regurgitation. We performed mitral valve replacement with anterior and posterior leaflet chordal preservation in a 65-year-old woman. On the 2nd postoperative day, routine postoperative trans-thoracic echocardiography showed an unknown aortic subvalvular mobile mass. We report a case of a remnant mitral subvalvular apparatus detected by echocardiography after chordal preserving mitral valve replacement which was confused with postoperative aortic valve vegetation.
Aged ; Aortic Valve ; Echocardiography ; Female ; Humans ; Mitral Valve ; Mitral Valve Insufficiency

BACKGROUND AND OBJECTIVES: Mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function. This study assessed the change of mitral annulus velocity profile during diastole with aging and the differences between septal and lateral annulus. SUBJECTS AND METHODS: Simultaneous measurements of annular velocity at both septal and lateral annulus were performed in 171 consecutive patients who had no evidence of hypertension, diabetes, other heart diseases and rhythm disturbances. RESULTS: The mean age of the subjects was 44.6+/-15.2 years (range:16-74) and male 93, female 68. The Em and Em/Am were well correlated with age negatively, irrespective of the position of sample volume (Em(septum):r=-0.75, p<0.0001, Emlateral:r=-0.78, p<0.0001;Em/Am(septum):r=-0.72, p<0.0001, Em/Am(lateral):r=-0.71, p<0.0001). The Em and Em/Am were significantly decreased in septum compared with lateral annulus (Em:9.9+/-3.1 vs. 13.5+/-4.1, p<0.0001;Em/Am:1.15+/-0.57 vs. 1.53+/-0.75, p<0.0001). CONCLUSION: The indices of mitral annular velocity were well correlated with aging negatively. And the mitral annular velocity was decreased significantly at the septum compared with lateral annulus.
Aging ; Diastole ; Female ; Heart Diseases ; Humans ; Hypertension ; Male

BACKGROUND AND OBJECTIVES: Several studies have showed a large 'treatment gap' between clinical practice and the guidelines for treating hypercholesterolemia. There is little information on the real practice of managing patients with hypercholesterolemia in Korea. This study was done to investigate the "treatment gap" in the management of Korean hypercholesterolemic patients. SUBJECTS AND METHODS: 500 Hypercholesterolemic patients, who did not receive any lipid-lowering mediation during the prior six months to the index date and who were treated for more than one year thereafter, were included in the study. 100 investigators of general hospitals retrospectively reviewed the medical records of 500 hypercholesterolemic patients. The proportion of patients who reached their cholesterol goal was determined. Logistic regression was used to assess the patient characteristics associated with goal attainment. RESULTS: Of the total 500 patients, 369 patients (73.8%) had coronary heart disease (CHD) or CHD risk-equivalent disease. 86 patients (17.2%) were in the moderate risk group and 45 (9.0%) were in the low risk group. 45% of the CHD/CHD risk equivalent patients showed a baseline LDL cholesterol level of more than 160 mg/dL. The overall trend for the initial choice of the drug level for statin treatment showed a similar pattern among all patients, and this was not influenced by the presence of CHD or the serum lipid level. 77% of patients stayed on the same drug level and 41% of all patients (37% of CHD patients, 52% of non-CHD patients) attained their LDL cholesterol goal during the study period. CONCLUSION: The majority of hypercholesterolemic patients were treated without achieving their goal. More effective treatment of hypercholesterolemia is needed for the prevention of cardiovascular disease.
Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Health Expenditures* ; Hospitals, General ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Korea* ; Logistic Models ; Medical Records ; Negotiating ; Research Personnel ; Retrospective Studies

ACE inhibitiors have been recently used to treat the chronic congestive heart failure after the use of the antihypertensive agents.The enalapril was added to the chronic congestive heart failure patients unresponded to diuretics and digoxin. The echocardiography, serum chemical examinations, ECG, chest X-ray and clinical manifestations were done to the 47 patients with chronic severe congestive heart failure unresponded to diuretics and digoxin before and 2 months after the addition of enalapril between Feb. 1991 and Nov. 1991 in Dong-A Univerity Hospital. The results were followed : 1) The dyspnea, the hepatomegaly, the engorged jugular vein, cough, edema, palpitation, chest discomfort, and the tachycardia were improved 2 months after the treatment of enalapril. 2) The cardiomegaly and lung edema on the chest PA, and the elevated GOT, GPT and serum creatinine were improved 2 months after the treatment of enalapril. 3) Left ventricular end systolic dimension, fractional shortening, left ventricular end diastolic volume, and ejection time on the ECHO were significantly increased after 2 months of the treatment of enalapril. ACE inhibitor, enalapril revealed the effectiveness of the treatment to the patients with the severe congestive heart failure, and we should try to study the mortality rates to decrease compared with the control groups without the treatment of enalapril.
Cardiomegaly ; Cough ; Creatinine ; Digoxin ; Diuretics ; Dyspnea ; Echocardiography ; Edema ; Electrocardiography ; Enalapril* ; Estrogens, Conjugated (USP)* ; Heart Failure* ; Hepatomegaly ; Humans ; Jugular Veins ; Lung ; Mortality ; Stroke Volume ; Tachycardia ; Thorax

BACKGROUND: Sonographic evaluation of arterial wall morphology and elasticity, and the evaluation of pulse wave velocity (PWV) are widely used noninvasive modalities for evaluating atherosclerosis and cardiovascular risk assessment. Several studies suggest that intima-media thickness (IMT) and arterial elasticity indices may sensitively reflect different vasculopathic processes. Thus the purpose of this study was to evaluate the relationship between carotid IMT, distensibility and PWV. METHODS: We examined 14 consecutive patients (mean age 51+/-8 years, 8 males) with carotid ultrasound and noninvasive vascular screening device. Carotid IMT, carotid artery distensibility, and brachial-ankle PWV were measured. RESULTS: The brachial-ankle PWV was inversely correlated with carotid distensibility (r= 0.628, p<0.05), but not correlated with IMT (r=0.099, p=0.738). And there was no relationship between IMT and carotid distensibility (r= 0.207, p=0.478). CONCLUSION: Carotid distensibility had good correlation with brachial-ankle PWV, so it might be used for assessing arterial stiffness and evaluating cardiovascular risk.
Atherosclerosis ; Carotid Arteries* ; Carotid Intima-Media Thickness* ; Elasticity ; Humans ; Mass Screening ; Pulse Wave Analysis ; Risk Assessment ; Ultrasonography ; Vascular Stiffness

PURPOSE: To evaluate factors influencing the CT assessment of mediastinal lymph node metastasis in patientswith non-small cell lung cancer. MATERIALS AND METHODS: CT scans of 198 patients who had undergone thoracotomyand mediastinal lymph node dissection for non-small cell lung cancer were retrospectively evaluated using a sizecriterion of > or = 10mm in the short axis. To evaluate the accuracy of CT in diagnosing lymph node metastasis on anodal station-by-station basis, CT and pathological results were correlated. Analysis included a comparison of thesensitivity and specificity of CT according to 1) cell type of tumor, squamous cell carcinoma versusadenocarcinoma (excluding bronchioloalveolar cell carcinoma) ; 2) histologic differentiation;3) tumor size;4)central and peripheral of the tumor;5) the presence or absence of obstructive pneumonitis and/or atelectasis;6)the presence or absence of prior granulomatous disease. RESULTS: The overall sensitivity, Specificity, positive predictive value, and negative predictive value of CT in diagnosing mediastinal lymph node metastasis were 65%,84%, 43%, and 93%, respectively. Sensitivity for squamous cell carcinoma (72%) was significantly higher than thatfor adenocarcinoma(44%)(p<0.01). Higher specificities were noted in patients without obstructive pneumonitisand/or atelectasis(91% versus 75%)(P<0.01), and with a peripherally located tumor (90% versus 82%)(P<0.01).sensitivity and specificity were not appreciably altered by other variables. CONCLUSION: In the CT assessment ofmediastinal lymph node metastasis the cell type of adenocarcinoma adversely affected sensitivity, with a highfrequency of normal-sized metastatic nodes. Obstructive pneumonitis caused by central tumor adversely affectedspecificity with the frequent occurrence of hyperplastc nodes.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis* ; Pneumonia ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: The purpose of our study was to identify the CT findings that help detect pleural dissemination from lung cancer and to evaluate the usefulness of selected diagnostic criteria. MATERIALS AND METHODS: After a computerized database search of 606 patients who had undergone thoracotomy for primary lung cancer, 23 patients were identified as h aving surgically documented pleural dissemination. From the same database, 50 patients without pleural dissemination during thoracotomy were randomly selected as controls. Preoperative CT scans and medical records were rev i ewed retrospectively, and findings were compared between the two groups. RESULT: One or more of three types of pleural thickening (plaque-like, nodular, and fissural) were identified on CT as the most discriminating finding (sensitivity, 74 % ; specificity, 60 %; p = 0.007). The following findings were also significantly discriminating (p<0.05): contiguity of primary tumor with the pleural surface as seen on CT; adenocarcinoma in cell type; and a peripheral tumor defined as one in which bronchoscopy revealed no endobronchial lesion. The use of combinations of these findings in addition to pleural thickening rendered diagnostic criteria more specific at the cost of the sensitivity. CONCLUSION: During preoperative CT evaluation of lung cancer, the recognition of subtle pleural thickening helps detect pleural dissemination. The likelihood that subtle pleural thickening represents pleural dissemination is increased when a primary tumor is contiguous with the pleural surface, is an adenocarcinoma, or is peripherally located.
Adenocarcinoma ; Bronchoscopy ; Humans ; Lung Neoplasms* ; Lung* ; Medical Records ; Retrospective Studies ; Sensitivity and Specificity ; Thoracotomy ; Tomography, X-Ray Computed

Double right coronary arteries (RCA) are very rare congenital anomalies of coronary artery. We report a case of double RCA with total occlusion, incidentally found by collateral flows. A 71-year-old patient underwent percutaneous coronary intervention of left coronary arteries for angina, and the presence of double RCA was missed at initial coronary angiography (CAG). About 20 months later, second CAG was performed due to recurrent angina, and the CAG showed newly developed collateral flow suggesting the presence of the other missed RCA. There was a total occlusion at missed RCA and the lesion was successfully revascularized with drug eluting stent. If there was no collateral flow, the other RCA could not be found and its critical lesion could not be managed properly. Our case suggests that collateral flow can be a useful clue in detecting coronary anomaly. Besides, it is important to fully understand coronary anatomy, not to miss uncommon coronary lesion.
Acute Coronary Syndrome ; Aged ; Coronary Angiography ; Coronary Vessels* ; Heart Defects, Congenital ; Humans ; Percutaneous Coronary Intervention ; Stents