The effect of amiodarone on reperfusion arrhthmias after release of left anterior descending coronary artery(LAD) occlusion was studied in 22 anesthetized cats. All cats underwent 20 minutes LAD occlusion followed by reperfusion and amiodarone(20mg/Kg) or normal saline was given on cats which had reperfusion arrhythmias through the left ventricular catheter to observe the antiarrhythmic effect of amiodarone. And also the incidence and type of arrhymias during occlusion and reperfusion were analyzed. During the 20 minute LAD occlusion, 10 of 22 cats(45%) had no arrhythmias, and 12 cats(55%) had nonsustatined ventricular tachycardia. After release of occlusion, 5 of 22 cats(23%) had no arrthmias, and 17 cats(77%) developed sustained ventricular arrhythmias(ventricular tachycardia (n=5), ventricular fibrillation(n=12)). The 17 cats which had reperfusion arrhythmias were randomly divided and given normal saline(control(n=8)) or amiodarone(amiodarone group(n=9)). There was no difference on 2 groups. The reperfusion arrhythmias disappeared in 6 out of 9 cats(66.7%) vs none of 8 controls(P<0.01). We conclude that amiodarone seems to be the effective antiarrhythmic drug on reperfusion arrhythmias after release of LAD occlusion in anesthetized cats, and might be useful for the treatment of reperfusion arrhythmias in human.
Amiodarone* ; Animals ; Arrhythmias, Cardiac* ; Catheters ; Cats ; Humans ; Incidence ; Reperfusion* ; Tachycardia ; Tachycardia, Ventricular

We performed the same day dipyridamole stress/rest myocardial SPECT in 14 healthy young men, reconstructed the polar maps according to Cedars-Sinal method and quantitated the radioactivity of myocardial wall. We divided the whole myocardium to 9 sectors. The latero-anterior wall contains the highest count. The infero-septal wall contains the lowest count. There isn't any significant differences of radioactivity in each segment between stress and rest polar map. The hemodynamic parameters after dipyridamole injection in the subjects were significantly changed except systolic blood pressure : the heart rate was increased and diastolic blood pressure was decreased. Adverse effects were reported in 85.7%. We suggest that these data can be used to dectect perfusion defect in the coromary artery disease.
Arteries ; Blood Pressure ; Dipyridamole* ; Heart Rate ; Hemodynamics ; Humans ; Male ; Methods ; Myocardium ; Perfusion ; Radioactivity ; Tomography, Emission-Computed, Single-Photon*

In order to observe the development of arrhythmia during regional myocardial ischemia and reperfusion. Proximal left descending coronary artery(LAD) was ligated for 20 minutes and reperfused suddenly in fifty one cats which were grouped into control(n=16), alpha-receptor block group(n=8), beta-receptor block group (n=9), parasymphathetic system block group (n=10) and autonomic nervous system block group(n=8). In drug infused groups, drug infusion was started 5 minutes prior to occlusion with bolus. Epicardial electrocardiogram, left ventricular pressure and standard ECG(lead I) were simultaneously recorded with the paper speed of 25mm/sec at predetermined time intervals and when arrhythmias occurred, and those were recorded continuousely with the paper speed of 5mm/sec throughout the experiment. The results were as follows : 1) After ligation of LAD, the R wave and ST segment of QRS of epicardial ECG elevated to reach maximum level with first 10 minutes. 2) The incidence of occlusion ventricular tachycardia in autonomic nervous system block group and alpha-receptor block group was significantly lower than control group(P<0.01). 3) The incidence of reperfusion ventricular tachycardial and ventricular fibrillation in autonomic nervous system block group, beta-receptor block group and alpha-receptor block group was significantly lower than control group(P<0.05). 4) The arrhythmia score during LAD occlusion in autonomic nervous system block group and alpha-receptor block group was significantly lower than control group(P<0.05). 5) The arrhythmia score in reperfusion in autonomic nervous system block group, beta-receptor block group and alpha-receptor block group was significantly lower than control group (P<0.05). It was concluded that the reperfusion arrhythmia could be prevented by alpha-receptor and beta-receptor block. There was the synergism between alpha-receptor blocker and beta-receptor blokcer. But the occlusion arrhythmia was suppressed by only alpha-receptor blocker.
Animals ; Arrhythmias, Cardiac* ; Autonomic Nervous System* ; Cats ; Electrocardiography ; Incidence ; Ligation ; Myocardial Ischemia ; Reperfusion* ; Tachycardia, Ventricular ; Ventricular Fibrillation ; Ventricular Pressure

A coronary artery perforation is a rare but often fatal complication of angioplasty. We experienced a coronary artery perforation and cardiac tamponade during balloon angioplasty. A polytetrafluorethylene (PTFE) -covered stent was used to successfully close the perforation.
Angioplasty ; Angioplasty, Balloon* ; Cardiac Tamponade ; Coronary Stenosis ; Coronary Vessels* ; Rupture ; Stents*

No abstract available.
Aneurysm ; Angiography ; Arteries ; Fistula

We evaluated the results of sequential SPECT dual-isotope imaging with Tl-201 and Tc-99m MIBI in 24 patients, all of whom also had coronary angiography within the past one month. Coronary angiography showed that 12 patients had no CAD, 4 patients had one-vessel CAD, 7 patients had two-vessel CAD and 1 patient had three-vessel CAD. Serial studies of resting Tl-201 and dipyridamole stress Tc-99m MIBI were completed within 2 hours. When more then 50% of coronary artery narrowing was considered significant. The overall sensitivity and specification of CAD detection were 91.7%. The sensitivity of CAD detection in patients with one-vessel and multi-vessel diseases was 75% and 100%, respectively. Therefore, sequential dual-isotope SPECT demonstrated high sensitivity and specificity of CAD detection. In conclusion, sequential dual-isotope imaging is feasible and can be completed in a short time and may therefore enhance laboratory throughput and patient convenience.
Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole ; Humans ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: There has been many reports for the effect of attenuation correction on myocardial perfusion SPECT. We studied the effect of attenuation correction with CT (computed tomography) in patients with normal coronary angiography. MATERIALS AND METHODS: Fifteen patients with normal coronary artery on angiography and low likelihood of coronary artery disease were enrolled in this study (male: 6, female: 9, mean age: 58+/-8 year). Myocardial perfusion SPECT was done with Millennium VG with Hawkeye device (GE, SPECT/CT camera). A visual analysis and polar map quantification (Emory tool box) was performed. In quantitative analysis, percent uptake of each myocardial wall on polar map (percent of maximal uptake) was compared between non-corrected (NC) and corrected (AC) images. RESULTS: Visual analysis showed AC images led to an increase of uptake in the inferior wall, but decrease of uptake in the anterior wall, apex and septum. Liver activity is also increased in AC images. In quantitative analysis, the percent uptake is decreased in the anterior wall, apex and septum, but increased in the inferior wall. It is helpful to interpret the images in the inferior wall after AC, but difficult in the apex and anterior wall after AC. CONCLUSION: AC is helpful in the inferior wall. But in the apex or anterior wall, AC must be carefully applied to normal perfused myocardium.
Angiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Liver ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

A 29-year old male was transferred to our hospital with an abnormal chest X-ray finding diagnosed as hypertrophic cardiomyopathy with apical necrosis and aneurysm formation. Four years after the initial hospitalization, we confirmed the aneurysm and necrosis using both integrated positron emission tomography (PET) and computed tomography (CT) scanning. The F-18 2-fluoro-2-deoxy-D-glucose (FDG) PET/CT enabled precise localization of the aneurysm, which was found to be composed of semi-lunar calcification of non-metabolic myocardium. A contrast-enhanced CT angiography showed an hour-glass appearance of the left ventricular cavity. The integrated PET/CT fusion scanner is a novel multimodality technology that allows for a comprehensive analysis of the anatomical and functional status of complex heart disease. Based on these findings, long standing mechanical and physiologic abnormalities may have led to chronic ischemia in the hypertrophied myocardium, induced necrosis and calcification at the cardiac apex.
Tomography, X-Ray Computed ; Positron-Emission Tomography ; Necrosis/complications/*diagnosis ; Male ; Humans ; Heart Ventricles/*pathology ; Heart Aneurysm/complications/*diagnosis ; Fluorodeoxyglucose F18/diagnostic use ; Contrast Media ; Cardiomyopathy, Hypertrophic/complications/*diagnosis ; Angiography, Digital Subtraction ; Adult

PURPOSE: N-13 ammonia uptake and retention in the myocardium is related to perfusion and metabolism. There are several potential advantages of N-13 ammonia positron emission tomography (PET) to detect myocardial ischemia, such as higher spatial resolution, greater counting efficiencies, and robust attenuation correction. But there are few reports comparing Tc-99m myocardial perfusion single photon emission tomography (MPS) and N-13 ammonia PET. We thus compared adenosine stress N-13 ammonia PET/CT and Tc-99m sestamibi MPS in patients with suspected coronary artery stenosis. MATERIALS AND METHODS: Seventeen patients (male 13 : 63+/-11 years old) underwent adenosine stress N-13 ammonia PET/CT (Discovery ST, GE), Tc-99m sestamibi MPS (dual head gamma camera, Hawkeye, GE) and coronary angiography within 1 week. N-13 ammonia PET/CT and Tc-99m sestamibi MPS images were assessed with a 20-segment model by visual interpretation and quantitative analysis using automatic quantitative software (Myovation, GE). RESULTS: Both sensitivities and specificities of detecting an individual coronary artery stenosis were higher for N-13 ammonia PET/CT than Tc-99m sestamibi MPS (PET/CT: 91%/ 89% vs MPS: 65%/ 82%). N-13 ammonia PET/CT showed reversibility in 52% of segments that were considered non-reversibile by Tc-99m sestamibi MPS. In the 110 myocardial segments supplied by the stenotic coronary artery, N-13 ammonia PET/CT showed higher count densities than Tc-99m MPS on rest study (p<0.01), and the difference of count density between the stress and the rest studies was also larger on N-13 ammonia PET/CT. CONCLUSION: Adenosine stress N-13 ammonia PET/CT had higher diagnostic sensitivity and specificity, more reversibility of perfusion defects and greater stress/rest uptake differences than Tc-99m sestamibi MPS. Accordingly, N-13 ammonia PET/CT might offer better assessment of myocardial ischemia and viability.
Adenosine ; Ammonia ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Gamma Cameras ; Head ; Humans ; Myocardial Ischemia ; Myocardium ; Perfusion ; Positron-Emission Tomography ; Retention (Psychology) ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND OBJECTIVES: The elderly is the fast growing segment of the population in Korea. Elderly patients undergoing coronary revascularization are considered a high-risk group. Few data exist that relate the results of stenting in treating coronary artery disease in the elderly population. This study sought to compare the short- and long-term outcomes of elderly patients undergoing coronary artery stenting with those of younger patients. METHODS: All elderly patients 70 years of age who underwent coronary artery stenting between January 1997 and July 1999 (n = 106) at our centers were compared to the patients <70 who underwent coronary artery stenting during the same time period (n = 597). METHODS: Elderly patients presented with lower ejection fraction (52.9% vs. 57.4%, p = 0.001), more unstable angina (47% vs. 31%, p = 0.003), and more multivessel disease (67% vs. 51%, p = 0.005) than younger patients. Major in-hospital complications including death (0.9% vs. 0.5%, p = NS), procedural acute Q-wave myocardial infarction (0.9% vs. 0.3%, p = NS), and emergency CABG (0% vs. 0.3%, p = NS) did not differ between two groups. And also vascular complication rate was similar between two groups(1.9% vs. 1.0%, p = NS). Angiographic follow-up, obtained in both groups, demonstrated similar restenosis rates (26.5% vs. 24.9%, p = NS). Long-term clinical follow-up at 12 months showed major adverse cardiac events including death, acute myocardial infarction, and repeat revascularization were significantly higher in elderly patients than in younger patients (18.3% vs. 12.6%, p = 0.04). CONCLUSIONS: Elderly patients with higher risk factors who underwent coronary artery stenting had similar rates of in-hospital procedural complications and similar rates of 6 months angiographic restenosis, compared to younger patients. Overall rates of major adverse cardiac events in the elderly population at 12 months postcoronary artery stenting were significantly higher than those of younger patients.
Aged* ; Angina, Unstable ; Arteries ; Coronary Artery Disease ; Coronary Vessels* ; Emergencies ; Follow-Up Studies* ; Humans ; Korea ; Myocardial Infarction ; Risk Factors ; Stents*