No abstract available.
Biopsy* ; Child* ; Humans

Effusive constrictive pericarditis after open heart surgery is a rare complication occuring in 0.2% to 0.3%. Presenting symptoms after surgery are associated with right heart failure and an elevated jugular venous pressure is most common abnormal physical sign. Predisposing factors include hemorrhage, perioperative pericardial injury or inflammation, presence of postpericardiotomy syndrome and open pericardium. Early diagnosis is important because(1) if it is unrecognized, the patient may deteriorate clinically, and(2) if surgery is delayed, the patient may have an increased risk of operative death. Hereby we report a case of effusive constrictive pericarditis after ventricular septal defect repair, in which constriction physiology was suggested by Doppler echocardiography after pericardiostomy.
Causality ; Constriction ; Early Diagnosis ; Echocardiography, Doppler ; Heart Failure ; Heart Septal Defects, Ventricular* ; Hemorrhage ; Humans ; Inflammation ; Pericardial Window Techniques ; Pericarditis, Constrictive* ; Pericardium ; Physiology ; Postpericardiotomy Syndrome ; Thoracic Surgery ; Venous Pressure

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) for long coronary lesion is known to be associated with low success rate,suboptimal outcome,high complication and restenosis rates. Here we report the early clinical and angiographic results of long coronary stent implantations for long coronary lesions. METHOD: We analyzed the clinical,angiographic features and early results after stent implantations in 46 patients who were implanted long coronary stent(> or =20mm in length)among 174 stented patients at Chonnam University Hospital from Jan.through Nov.1996. RESULT: 1) Age was 59+/-7(35-78) years,and sex ratio was 2.5:1(33 male:13 female). clinical diagnosis was as follows; 24 patients with unstable angina, 21 with acute myocardial infarction, 1 with stable angina and 6 with old myocardial infarction. Left ventricular ejection fraction by left venriculogram was 58+/-10(27-87)%. 2) Involved numbers of vessel were single in 27 patients, two in 14 patients, and three in 5 patients. Target stented coronary arteries were 28 left anterior descending arteries, 17 rigtt coronory arteries, and 1 left circumflex artery. Morphologic types of target lesions were type C in 26 patients, type B2 in 20, and diameter stenosis(DS) was 76+/-13%, minimal luminal diameter(MLD) 1.0+/-0.3mm, length 21+/-6(10-38)mm. Indications for stent were 28 denovo lesions, 10 restenoses, 5 suboptimal PTCAs and 3 bailout procedures. Twenty six Microstents 2, 15 Wallstents, 4 Freedom stents, and 1 Wictor stent were used. Stent diameter was 3.2+/-0.3(2.5-5.0)mm and length 30+/-3(20-49)mm, stent diameter/reference diameter(RD) ratio 1.0+/-0.1, and stent minus lesion length 9.0+/-3.7mm. 3) Stents were deployed successfully in all 46 patients. No procedure-related death, myocardial infarction, emergency bypass surgery, and laboratory evidences of acute or subacute stent thrombosis were observed. 4) DS was decreased to 3.5+/-7.5%, MLD was increased to 3.2+/-0.3mm(p<0.0001, respectively). Acute gain was 2.2+/-0.4mm(71.8+/-15.6%,p<0.0001). CONCLUSION: We observed high success rate without major complications in long stent implantations for long coronary arterial lesions. Long-term follow-up should be required to prove long coronary stent as a better treatment modality to reduce acute complications and late restenosis.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Vessels ; Diagnosis ; Emergencies ; Follow-Up Studies ; Freedom ; Humans ; Jeollanam-do ; Myocardial Infarction ; Phenobarbital ; Sex Ratio ; Stents* ; Stroke Volume ; Thrombosis

BACKGROUND: Acute or subacute stent thrombosis, bleeding complications and restenosis remain major clinical concerns in coronary stenting despite high pressure inflation and intravascular ultrasound guidance. A new strategy of local heparin delivery may maintain sustained local concentration and limit systemic complications. To observe the feasibility and efficacy of local heparin delivery in stenting, local heparin deliveries were performed in stented patients. METHOD: Heparin was delivered(5,000 Units, 1.0ml/min over 10 min) using the Dispatch Catheter, after predilation of target lesons in 10 patients(4 unstable angina, 6 acute myocardial infarction, mean age 52+/-7 yr) in the left anterior descending artery without systemic heparin loading. After local heparin delivery. Palmaz-Schatz stents were placed using standard methods. APTT and CK were checked at 1hr, 3hrs and 24 hrs after local heparin delivery and stenting. Follow-up coronary angiograms were done at 48 hrs and 6 months after stenting. RESULTS: All patients had no ischemic symptoms or ECG changes during and after local heparin delivery. All APTT and CK values were unchanged at 3 hrs and 24 hrs after local heparin delivery and stenting. Follow-up quantitative coronary angiograms at 48 hrs and 6 months showed all stents patent, with TIMI III distal flow, and without intra-stent thrombus(%diameter stenosis : 79.4+/-4.2% before predilation, 32.9+/-7.7% after predilation, 32.4+/-13.1% after local delivery, 14.2+/-2.3% immediately after stenting, 13.9+/-2.5% at 48 hrs and 21.7+/-8.8% at 6 months after stenting). CONCLUSION: Intracoronary stenting may be performed safely and effectively without systemic heparin therapy by using local heparin prior to stent implantation. Long-term stent patency and lack of coronary events appear favorable.
Angina, Unstable ; Arteries ; Catheters ; Constriction, Pathologic ; Electrocardiography ; Follow-Up Studies ; Hemorrhage ; Heparin* ; Humans ; Inflation, Economic ; Myocardial Infarction ; Stents* ; Thrombosis ; Ultrasonography

BACKGROUND: Reversibly dysfunctional myocardium caused by chronic reduction of coronary perfusion was named as hibernating myocardium. The clinical characteristics, however, was not well studied. METHOD: To observed the effects of revascularization on regional wall motion(RWM) abnormalities in patients with chronic ischemic heart disease, letf ventriculogram and dipyridamole stress Tl reinjection scan with reinjection imagine were done in 60 patients with angina or old myocardial infarction before and after PTCA. Subjects were divided into two groups, group A(21 patients, improved RWM after PTCA) and group B(39 patients, no change or aggravated RWM after PTCA). RESULTS: There were no significant differences in age and sex distribution between two group. Single vessel disease was more prevalent in group A (7/21, 33.3%) than in group B(1/39, 2.6%, p<0.05), and old myocardial infarction was more prevalent in group B(24/39, 61.5%) compared to group A(7/21, 33.3%, p<0.05). Reversible perfusion defects on Tl scan were found in 19 patients, 15 of whom(78.9%) showed improved RWM after PTCA. CONCLUSION: Hibernating myocardium was more prevalent in single vessel disease and angina patients. Sensitivity of Tl reinjection scan for detection of viable myocardium was 78.9%.
Coronary Artery Disease* ; Coronary Vessels* ; Dipyridamole ; Hibernation* ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Myocardium* ; Perfusion ; Sex Distribution

BACKGROUND: To evaluate the clinical efficacy of Simvastatin, a HMG-CoA reductase inhibitor, We ibsweved the changes of clinical characteristics and lipid profiles after Simvastatin administration in patients with hypercholesterolemia. METHODS AND RESULTS: Simvastatin 10mg was given once daily for 12 weeks in 35 patients (60+/-6.0 years : 14 male, 21 female) with hypercholesterolemia. High density lipoprotein-cholesterol (HDL-C) was increased from 38+-10 to 45+-9mg/dl(p<0.05). Simvastatin significantly decreased total cholesterol(TC) from 235+-15 to 181+-21mg/dl(23.0%), low-density lipoprotein cholesterol (LDL-C) from 164+-19 to 104+-18mg/dl(36.5%), TC/HDL-C from 7.0+-2.0 to 4.4+-1.1, LDL-C/HDL-C from 4.9+-1.7 to 2.5+-0.8(p<0.01 respectively). Apo B was decreased by 31%(119+-19 to 87+-15mg/dl), apo B/A1 ratio was decreased by 41%(1.2+-0.2 to 0.7+-0.2) amd lipoprotein(a) edcreased by 12%(33+-22 to 29+-17), while apo A1 was increased by 25%(104+-18 to 130+-23mg/dl, p<0.01 respectively). No patients complained of chest pain, but two had skin rashes. Creatine kinase and creatinine were not changed in all patients. CONCLUSIONS: Somvastatin is an effective and well tolerated cholesterol lowering agent in patients with hypercholesterolemia.
Apolipoprotein A-I ; Apolipoproteins ; Apolipoproteins B ; Chest Pain ; Cholesterol ; Creatine Kinase ; Creatinine ; Exanthema ; Humans ; Hypercholesterolemia* ; Lipoprotein(a) ; Lipoproteins ; Male ; Oxidoreductases ; Simvastatin*

BACKGROUND: Coronary artery stent has been introduced recently to overcome major problems of percutaneous trausluminal coronary angioplasty(PTCA). To evaluate the success rate, complications and predictive factors associated with restenosis in coronary artery stenting, clinical analysis after coronary srtery stent was performed. METHODS: Sixteen patients who underwent coronary artery stent in Chonnam University Hospital beteen Apr. 1992 and Dec. 1993 were observed. The authors analyzed the stent dilivery success, rate complications and restenosis after follow-up coronary angiogram. RESULTS: 1) The palmaz-Schatz stents were implanted in 16 patients(12 male, 4 female, mean age : 53.3 years) and clinical diagnosis of patients were 7 myocardial infarction, 8 unstable angina and one stable angina. Stents were implanted in 10 cases of left anterior descending arteries and 6 cases of right coronary arteries. Three stents were implanted in a patient with long spiral dissection after middle right coronary artery PTCA, single stent was implanted in the other patients. 2) Stent delivery was successful in all cases, but acute stent thrombosis developed just after bail-out procedure for PTCA-induced intimal dissection in myocardial infarction patient who had multivessel lesion and intracoronary thrombus. Subacute stent thrombosis and major bleeding requiring transfusion were not documented. 3) On follow-up coronary angiogram in 10 patients, no restenosis observed in 5 right coronary arterial stents, but restenosis developed in 3 of 5 left anterior descending artery stents. Restenosis was observed in none of 4.0mm stents, two of six 3.5mm stents and one of two 3.0mm stents. 4) Stent restenosis was observed in 3 cases of positive201TI dipyridamole scan which was performed one month after coronary artery stenting. CONCLUSION: Coronary artery stent is a safe and effective in elective procedure. The restenosis rate after intracoronary stent is lower in right coronary artery than left anterior descending artery and larger stent.
Angina, Stable ; Angina, Unstable ; Arteries ; Coronary Vessels* ; Diagnosis ; Dipyridamole ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Jeollanam-do ; Male ; Myocardial Infarction ; Stents* ; Thrombosis

BACKGROUND: Angina with normal coronary angiogram has been called syndrome X or microvascular angina, but pathophysiologic mechanisms for chest patin in this group of patients are not known exactly. To observe the changes of left ventricular function in patients with angina and normal coronary angiogram, the authors analyzed the left ventricular systolic and diastolic function with echocardiogram and cardiac catheterization. METHODS: The authors performed resting and treadmill exercise electrocardiogram, 201TI dipyridamole scan, M-mode and Doppler echocardiogram, cardiac catheterization and coronary angiogram in patients with angina and normal coronary angiogram. The systolic and diastolic left ventricular function indices from M-mode and Doppler echocardiogram, left ventricular catheterization and coronary angiogram were analyzed in 12 patients excluding diabetes, hypertension, cardiomyopathy and esophageal motility disorders among 1626 patients who underwent coronary angiogram between Jan. 1991 and Aug. 1992 in Chonnam University Hospital. RESULTS: 1) Studied subjects were 12 patients, 5 male and 7 female, mean age was 51+/-9.4 year-old. Resting electrocardiograms were normal in 8 cases and ST-T changes in 4 cases. Ischemic ST-T changes were observed in all cases during treadmill exericise test and perfusion defects in 3 cases out of 8 cases during 201TI dipyridamole scan. 2) On echocardiogram, ejection fraction(EF) was 68.9+/-4.5%, fractional shortening(FS) 37.4+/-4.4%, ratio of left atrial to aortic root dimension(LAD/AOD) 1.2+/-0.1, OR slope 3.8+/-0.8c,/sec, mitral valve Doppler E/A velocity ratio[E/A(V)] 0.9+/-0.2, mitral valve Doppler E/A area ratio[E/A(a)]1.3+/-0.3, early diastolic deceleration rate(EDDR) 4.3+/-1.3m/sec2, isovolumic relaxation time(IVRT) 96.2+/-15.7msec, isovolumic contraction time(IVCT) 38.1+/-9.1 msec and aortic valve Doppler peak flow velocity[Ao(V)] 0.8+/-0.2m/sec. EF, FS, IVCT and A(V) were normal. LAD/AOD and IVRT were increased, but E/A(V), E/A(a), OR slope and EDDR were decreased compared to normal subjects. 3) On cardiac catheterization and angiogram, mean left ventricular end-diastolic pressure was 15.3+/-5.1mmHg and ejection fraction by left ventriculogram 78.2+/-7.4%. There was no regional wall motion abnormality. CONCLUSION: Above results suggest that angina with normal coronary angiogram may be associated with impaired left ventricular diastolic function.
Aortic Valve ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathies ; Catheterization ; Catheters ; Deceleration ; Dipyridamole ; Electrocardiography ; Esophageal Motility Disorders ; Female ; Humans ; Hypertension ; Jeollanam-do ; Male ; Microvascular Angina ; Mitral Valve ; Perfusion ; Relaxation ; Thorax ; Ventricular Function, Left*

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia

BACKGROUND: One of major limitations of percutaneous transluminal coronary angioplasty(PTCA) is restenosis. The reliable factors predicting restenosis after successful PTCA might be important in the prevention and treatment of coronary restenosis after PTCA. METHODS: To see whether any of the clinical, angiographic. or procedural factors is likely coronary angiography due to recurrent ischemic symptoms and positive stress tests among 529 patients recived PTCA between Jul '90 and Sep '93 at the Chonnam University Hospital were analysed. RESULTS: 1) Follow-up coronary angiogram demonstrated restenosis in 67 patient(group A, 55.1+/-10.3 year, 58 male, 9 female) and no restenosis in 27 patients(group B, 55.4+/-10.3 year, 24 male, 3 female) demonstrating restenosis rate of 60.6% in this clinically suspicious group. 2) Age, sex, class and duration of angina, and clinical diagnosis were not different from each other between two groups. But the time interval from PTCA to follow-up angiogram was shorter in group A (5.3 +/-5.2 months) than in group B(9.1+/-5.6 months) and hypertension was more prevalent in group A (83.3%) than in group B(16.7%). 3) Angiographic findings such as AHA lesion types, lesion sites, TIMI flow, angulation, lesion length, branching lesion, dissection and residual stenosis were similar in two groups. But all of the eleven lesions with coronary artery calcification were found to develop restenosis. 4) As procedural factors, total ballon inflation time, the numbers of repeated inflations and maximal inflation pressure were not significantly different between two groups. CONCLUSION: Above results show that any single or combined clinical and angiographic findings except symptoms or signs suggesting myocardial ischemia, hypertension and coronary calcification could not predict the development of coronary restenosis ie the patients with shorter duration from PTCA to the clinical evidence suggestive of myocardial ischemia, hypertension and coronary calcification demonstrated by cineangiography were more likely to develop subsequent restenosis.
Angioplasty, Balloon, Coronary* ; Cineangiography ; Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Vessels ; Diagnosis ; Exercise Test ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Jeollanam-do ; Male ; Myocardial Ischemia