BACKGROUND AND OBJECTIVES: Platelet activation and aggregation, with resultant arterial thrombus formation, play pivotal roles in the pathophysiology of acute coronary syndrome (ACS). The efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin, or low molecular heparin (LMWH), in the management of ACS were evaluated. SUBJECTS AND MEHTODS: One hundred seventeen patients (60.8+/-10.9 years, 76 male), with unstable angina or non-ST elevation myocardial infarction, who had ST-T changes and elevated troponin, were divided into 4 groups : Group I (n=30 : heparin alone), Group II (n=28 : LMWH, dalteparin alone), Group III (n=29 : tirofiban combined with heparin) and Group IV (n=30 : tirofiban with LMWH). The major adverse cardiac events (MACE) among the 4 groups, during 6-month clinical follow-ups, were compared. RESULTS: Percutaneous coronary intervention, or a coronary artery bypass graft, was performed in 23, 19, 19 and 22 patients from Groups I, II, III and IV, respectively (p=0.87). A minor bleeding complication developed in 2 (6.7%), 1 (3.6%), 1 (3.4%) and 2 patients (6.7%) in groups I, II, III and IV, respectively (p=0.79). During the six-month follow-up MACE occurred in 7 (30.4%), 6 (31.6%), 3 (15.8%) and 4 patients (18.2%) in groups I, II, III and IV, respectively (p=0.02 : Group I and II vs. Group III and IV). CONCLUSION: Tirofiban combined with LMWH is safe and may improve the long-term prognosis of patients with ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Angioplasty ; Blood Platelets* ; Coronary Artery Bypass ; Dalteparin ; Follow-Up Studies ; Glycoproteins* ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight* ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Activation ; Prognosis ; Thrombosis ; Transplants ; Troponin

BACKGROUND AND OBJECTIVES: With the prolonged life expectancy and changes in dietary habits in Korea, the number and percentage of elderly patients with ischemic heart disease(IHD) has been increased. Primary success rate and long-term clinical outcomes of elderly patients were compared with younger patients, who underwent coronary artery stent(CAS). MATERIALS AND METHOD: A retrospective analysis of 379 patients, who underwent CAS at Chonnam National University Hospital from January 1993 to June 1998, was performed. Clinical characteristics, lipid profiles, coronary angiographic findings, success rates and in-hospital mortality rates and follow-up coronary angiographic findings of elderly patients older than 70 years (Group I; n=1, 73+/-4 years) were compared with the patients under the age of 70 years (Group II; n=88, 56+/-11 years). RESULTS: Female was more prevalent in Group I than Group II (41/91, 45.1% vs. 57/288, 19.9%, P < 0.001). Ejection fraction was lower in Group I than in Group II (56.9+/-6.4 vs. 63.8+/-15.3 %, P < 0.05) and left ventricular end-diastolic pressure was higher in Group I (17.9+/-7.9 vs. 14.0+/-7.7 mmHg, respectively P < 0.05) than in Group II. There were no significant differences in the distribution of the risk factor except for smoking (Group I; 26/91, 28.6% vs Group II; 130/288, 45.3%, P < 0.05). Lesion and procedural characteristics were not different between two groups. Primary success rate of Group I was 94.5%(86/91) and 96.5%(278/288), which were not different between two groups. On follow-up coronary angiogram, restenosis rate was not different between two groups (Group I: 9/37, 24.37% vs. Group II 50/154, 32.5%, P=S). CONCLUSION: The initial success rate and restenosis rate of coronary stenting in the elderly patients are not different from those of younger group. Thus coronary stent can be performed effectively in elderly patients.
Aged* ; Coronary Vessels* ; Female ; Follow-Up Studies ; Food Habits ; Heart ; Hospital Mortality ; Humans ; Jeollanam-do ; Korea ; Life Expectancy ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents*

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking. This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.
Adolescent ; Coronary Artery Disease ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Food Habits ; Humans ; Incidence ; Korea ; Male* ; Myocardial Infarction* ; Perfusion ; Risk Factors ; Smoke ; Smoking ; Stents ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography

Thrombi in the right atrium (RA) are infrequent, and are rarely diagnosed before death. In addition, right heart thrombi are frequently associated with major pulmonary thromboembolism, and carry a very high risk of mortality, and therefore, require accurate diagnosis and prompt treatment. RA thrombi are generally associated with dilatation of the atrium, a low cardiac output state, intracardiac catheters, such as endocardial pacemakers and central venous hyperalimentation catheters, recent cardiac surgery, involving the atrium, and peripheral deep vein thrombosis. In addition, some systemic diseases, such as malignant tumors, amyloidosis and nephrotic syndrome, have been shown to contribute to the formation of an intracardiac thrombus. Echocardiography is valuable in the diagnosis of RA thrombi. There are some options in the treatment of RA thrombi, such as anticoagulant therapy using heparin, thrombolytic therapy and surgical removal. However, there is still adverse criticism as to the selection of the correct treatment method. A patient with RA thrombi, who presented with sudden cardiogenic shock, was diagnosed by two-dimensional echocardiography. He had been in a prolonged bed-ridden state because of quadriparesis caused by an injury to the cervical spine. The RA thrombi were successfully treated with anticoagulant and thrombolytic agents.
Amyloidosis ; Cardiac Catheters ; Cardiac Output, Low ; Catheters ; Diagnosis ; Dilatation ; Echocardiography ; Fibrinolytic Agents ; Heart ; Heart Atria ; Heparin ; Humans ; Mortality ; Nephrotic Syndrome ; Pulmonary Embolism ; Quadriplegia ; Shock, Cardiogenic ; Spine ; Thoracic Surgery ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis

A bicuspid aortic valve is one of common congenital cardiac anomaly. But the septic embolism from bicuspid aortic valve into the left anterior descending artery (LAD) resulting in acute inferior myocardial infarction is very rare. A twenty eight year-old man suffered from severe chest pain and fever of four-week's duration. Acute inferior myocardial infarction was diagnosed on electrocardiogram. Transesophageal echocardiogram demonstrated vegetation on the bicuspid aortic valve directed into left coronary artery ostium, and diagnostic coronary angiogram revealed round filling defect within the distal LAD. He underwent operation for aortic valve replacement, which indicated vegetated bicuspid aortic valve directed into the ostium of left coronary artery.
Aortic Valve* ; Arteries* ; Bicuspid* ; Chest Pain ; Coronary Vessels ; Electrocardiography ; Embolism* ; Fever ; Inferior Wall Myocardial Infarction*

Aneurysms of sinus of Valsalva often remain undiagnosed until they rupture. A huge, heavily calcified unruptured aneurysm originating from the right sinus of Valsalva was detected incidentally in a 61-year-old man. Chest X-ray showed cardiomegaly and 10 cm sized huge calcified mass lesion around the cardiac shadow. Two-dimensional echocardiogrm revealed pericardial effusion with huge calcified mass compressing right ventricular outflow and color-flow Doppler echocardiogram visualized blood flow from aortic root into aneurysm. Chest CT scan and MRI revealed a large thrombosed aneurysm arising from aortic root measuring 1010cm. After pericardiocentesis cardiac catheterization was performed, which showed elevated right ventricular systolic pressure up to 80 mmHg. Aortic root angiogram revealed huge unruptured calcified aneurysm in the sinus of Valsalva arising from the right coronary sinus. The patient underwent surgical correction for the prevention of aneurysmal rupture and the relief of right ventricular outflow obstruction.
Aneurysm* ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Coronary Sinus ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pericardial Effusion ; Pericardiocentesis ; Rupture ; Sinus of Valsalva* ; Thorax ; Tomography, X-Ray Computed ; Ventricular Outflow Obstruction

A 25-year-old woman presented with effort-induced chest pain. Physical examination revealed different blood pressures, 180/100 mmHg in right arm and 100/60 mmHg in left arm. Resting electrocardiogram was normal, but down-slope depression of ST segment more than 3 mm in V3-6, II, III, aVF developed at the stage 1 of treadmill exercise test. Stress Thallium-201 scan showed severe ischemia in the anteroseptal and lateral wall of left ventricle. Diagnostic coronary angiogram showed critical stenosis in the ostium of left main coronary artery. The left subclavian artery was occluded totally with well-developed collateral circulation. The patient underwent ostioplasty of left coronary ostium using pericardial patch, and her symptom improved after surgery. Follow-up coronary angiogram one year after surgery showed patent coronary artery ostium with good flow and myocardial perfusion improved on follow-up Thallium-201 SPECT. She has no major cardiac events during 7-year clinical follow-up.
Adult ; Arm ; Chest Pain ; Collateral Circulation ; Constriction, Pathologic ; Coronary Vessels* ; Depression ; Electrocardiography ; Exercise Test ; Female ; Follow-Up Studies* ; Heart Ventricles ; Humans ; Ischemia ; Perfusion ; Physical Examination ; Subclavian Artery ; Takayasu Arteritis* ; Tomography, Emission-Computed, Single-Photon

BACKGROUND: Catheter ablation of accessory pathways using radiofrequency(RF) energy was recently introduced to cure accessory pathway related tachyarrhythmias. The purpose of the present study was to evaluate the efficacy and safety of radiofrequency catheter ablation of accessory pathways and to determine factors influencing the outcome of catheter ablation. METHODS: Electrophysiology study was performed with standard technique and catheter ablation of accessory pathways using RF and conventional ablation technique. The outcome of RF catheter ablation were evaluated according to the location and the overtness of accessory pathways. Eighty patients(Mean +/-SD age, 36+/-15 years ; 50 male, 30 female)comprising 49(61%) with Wolff-Parkinson-White(WPW) syndrome and 31(39%) with atrioventricular reentry tachycardia(AVRT) using concealed bypass tract underwent RF catheter ablation for total of 85 accessory pathways in the Chonnam University Hospital. Five(6.3%) patients had multiple accessory pathways. RESULTS: Seventy-nine(92.9%) out of 85 pathways and all the pathways in 75(93.8%) out of 80 patients were ablated successfully. The success rate showed no significant difference between patients with overt accessory pathways and patients with concealed accessory pathways(92.0% vs. 93.9%). However, the success rate in right free wall location(72.7% of 11) was significantly lower than that in the other sites (95.9% of 74, p<0.05). More attempts were tried to ablate right-sided accessory pathway than left-sided pathways(6.4+/-24.1 vs. 3.8+/-6.8, p<0.05). Three(3.8%) pathways recurred within 30 minutes after the initial successful ablation. Four(5.1%) pathways recurred from 16 hours to 7 months after completion of the initial successful ablation session during the mean follow-up period of 43+/-24 weeks(range, 2-84 weeks). This late recurrence was more frequent, although statistically insignificant, in right-sided accessory pathways(11.1% vs. 3.3%, p=0.22). All 4 recurrent pathways(1 at the same session, 3 at the repeated sessions) reattempted for ablation were successfully ablated. As procedure-related complications, second degree AV block developed in a patients with mid septal and posteroseptal pahways and hemopericardium in a patients with a left anterolateral pathway. CONCLUSION: RF catheter ablation of atrioventricular accessory pathways is very effective and safe, with a success rate of 93.8% and a complication rate of 2.5%. Right-sided accessory pathways are more difficult to ablate than left-sided accessory pathways, requiring the development of a better technique for right free wall pathways.
Ablation Techniques ; Atrioventricular Block ; Catheter Ablation* ; Catheters* ; Electrophysiology ; Follow-Up Studies ; Humans ; Jeollanam-do ; Male ; Pericardial Effusion ; Recurrence ; Tachycardia

Stress cardiomyopathy is characterized by transient systolic dysfunction of the apical and/or mid segment of the left ventricle. The main pathophysiology of stress cardiomyopathy is the excessive release of catecholamine. Opioid withdrawal can initiate a surge of catecholamine and an attack of stress cardiomyopathy. In this case, we report a case of stress cardiomyopathy due to iatrogenic withdrawal from transdermal fentanyl.
Aged* ; Fentanyl* ; Heart Ventricles ; Humans ; Takotsubo Cardiomyopathy*

Coronary artery disease is the most important cause of mortality in patients with systemic lupus erythematous (SLE). After stenting for coronary artery disease in SLE patients similar to non-SLE patients, the risk of stent thrombosis is always present. Although there are reports of stent thrombosis in SLE patients, very late recurrent stent thrombosis is rare. We experienced a case of very late recurrent stent thrombosis (4 times) in a patient with SLE.
Coronary Artery Disease ; Drug-Eluting Stents ; Humans ; Lupus Erythematosus, Systemic ; Stents ; Thrombosis