BACKGROUND: Coronary arterioveonus fistula(CAVf) is a rare congerital coronary artery anomaly in adults. CAVF is related with some clinincal significances, such as angina, congestive heart failure and bacterial endocarditis. METHOD: We analyzed clincial characteristics in 10 patients(mean age=52.1 +/- 12.5 year) of adult CAVF, who were diagnosed as CAVF by coronary angiogram from Jan. 1993 to Mar. 1997 in Chonnam University Hosptial. RESULTS: Five out of 10 patients complained of chest pain, four had dyspnea and one had hemoptysis. In seven patients, arteries of CAVF were originated from left coronary arteries, from right coronary artery in one, and from both coronary arteries in two. CAVF was drained into pulmonary artery in six patients, right ventricle in two, right atrium in one, and left ventricle in one. CONCLUSION: Chest pain and dyspnea are common in symptomatic patients with CAVF are originated most commonly from left coronary arteries and drained into pulomonary arteries in Korean adults.
Adult* ; Arteries ; Arteriovenous Fistula* ; Chest Pain ; Coronary Vessels ; Dyspnea ; Endocarditis, Bacterial ; Heart Atria ; Heart Failure ; Heart Ventricles ; Hemoptysis ; Humans ; Jeollanam-do ; Pulmonary Artery

BACKGROUND: Aspirin, one of the antiplatelet agents, improves the survival rate after myocardial infarction. This beneficial effect is known to be obtained in part by the antiarrhythmic action of aspirin. It is not known whether other antiplatelet agents have such effects. This study was performed to compare the effects of aspirin, ticlopidine, and abciximab (platelet glycoprotein IIb/IIIa receptor antagonist) on the ischemia-induced arrhythmias with a rat model of cardiac regional ischemia. METHODS: Experiments were performed in 4 groups of rats. The 4 groups were as follows : control, n=10:aspirin-pretreated, 300 mg/kg po for 1 week:ticlopidine-pretreated, 200 mg/kg po for 1 wk:abciximab-pretreated, 2 mg/kg iv 10-20 minutes before experiment. The electrocardiogram and blood pressure were recorded during 20 minutes. The time to the onset of ST-segment elevation and ventricular tachyarrhythmias, frequency and incidence of ventricular tachyarrhythmias, and death rate were assessed during acute myocardial ischemia induced by ligation of proximal left anterior descending coronary artery in anesthetized rats. RESULTS: Platelet aggregations to ADP were significantly lower in aspirin (42.8%), ticlopidine (43.8%), and abciximab group (34.0%) than in control group (66.4%). The frequencies of sustained ventricular tachycardia (VT) were 6.8+/-3.6 in control, 3.6+/-3.8 aspirin, 4.7+/-3.7 ticlopidine, and 1.4+/-2.5 abciximab group. The frequency of sustained VT in the abciximab group was significantly lower than in control group. The incidences of ventricular arrhythmias for 20 min were 10/10 for VT and 8/10 for ventricular fibrillation (VF) in control group, 7/10 for VT and 3/10 for VF in aspirin group, 10/10 for VT and 3/10 for VF in ticlopidine group, and 5/10 for VT and 4/10 for VF in abciximab group. The incidences of cardiac death during 20 min were 8/10 in control group, 4/10 in aspirin group, 2/10 in ticlopidine group and 5/10 in abciximab group. The incidence of VT in the abciximab group was significantly lower than in control group, incidences of VF in the aspirin and ticlopidine groups were significantly lower than in control group, and death rate in ticlopidine group was significantly lower than in control group. CONCLUSION: The present study suggested that aspirin, ticlopidine, and abciximab could prevent ventricular tachycardia or ventricular fibrillation in a rat model of cardiac regional ischemia and their antiarrhythmic effects improve the survival rate.
Adenosine Diphosphate ; Animals ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Blood Pressure ; Coronary Vessels ; Death ; Electrocardiography ; Glycoproteins ; Incidence ; Ischemia ; Ligation ; Models, Animal ; Mortality ; Myocardial Infarction ; Myocardial Ischemia* ; Platelet Aggregation Inhibitors* ; Rats* ; Survival Rate ; Tachycardia* ; Tachycardia, Ventricular ; Ticlopidine ; Ventricular Fibrillation

BACKGROUND: Aspirin, one of the antiplatelet agents, improves the survival rate after myocardial infarction. This beneficial effect is known to be obtained in part by the antiarrhythmic action of aspirin. It is not known whether other antiplatelet agents have such effects. This study was performed to compare the effects of aspirin, ticlopidine, and abciximab (platelet glycoprotein IIb/IIIa receptor antagonist) on the ischemia-induced arrhythmias with a rat model of cardiac regional ischemia. METHODS: Experiments were performed in 4 groups of rats. The 4 groups were as follows : control, n=10:aspirin-pretreated, 300 mg/kg po for 1 week:ticlopidine-pretreated, 200 mg/kg po for 1 wk:abciximab-pretreated, 2 mg/kg iv 10-20 minutes before experiment. The electrocardiogram and blood pressure were recorded during 20 minutes. The time to the onset of ST-segment elevation and ventricular tachyarrhythmias, frequency and incidence of ventricular tachyarrhythmias, and death rate were assessed during acute myocardial ischemia induced by ligation of proximal left anterior descending coronary artery in anesthetized rats. RESULTS: Platelet aggregations to ADP were significantly lower in aspirin (42.8%), ticlopidine (43.8%), and abciximab group (34.0%) than in control group (66.4%). The frequencies of sustained ventricular tachycardia (VT) were 6.8+/-3.6 in control, 3.6+/-3.8 aspirin, 4.7+/-3.7 ticlopidine, and 1.4+/-2.5 abciximab group. The frequency of sustained VT in the abciximab group was significantly lower than in control group. The incidences of ventricular arrhythmias for 20 min were 10/10 for VT and 8/10 for ventricular fibrillation (VF) in control group, 7/10 for VT and 3/10 for VF in aspirin group, 10/10 for VT and 3/10 for VF in ticlopidine group, and 5/10 for VT and 4/10 for VF in abciximab group. The incidences of cardiac death during 20 min were 8/10 in control group, 4/10 in aspirin group, 2/10 in ticlopidine group and 5/10 in abciximab group. The incidence of VT in the abciximab group was significantly lower than in control group, incidences of VF in the aspirin and ticlopidine groups were significantly lower than in control group, and death rate in ticlopidine group was significantly lower than in control group. CONCLUSION: The present study suggested that aspirin, ticlopidine, and abciximab could prevent ventricular tachycardia or ventricular fibrillation in a rat model of cardiac regional ischemia and their antiarrhythmic effects improve the survival rate.
Adenosine Diphosphate ; Animals ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Blood Pressure ; Coronary Vessels ; Death ; Electrocardiography ; Glycoproteins ; Incidence ; Ischemia ; Ligation ; Models, Animal ; Mortality ; Myocardial Infarction ; Myocardial Ischemia* ; Platelet Aggregation Inhibitors* ; Rats* ; Survival Rate ; Tachycardia* ; Tachycardia, Ventricular ; Ticlopidine ; Ventricular Fibrillation

BACKGROUND: The endovascular stent has been applied clinically in acute arterial occlusions after intimal dissection by angioplasty and in the prevention of restenosis. However, subacute stent thrombosis and restnosis remain major concerns in clinical stenting despite intravscular ultrasound guidance and high pressure inflation. Moreover, anticoagulation before and after stent implantation may be required for long periods and complicated by bleeding. A new strategy may be local drug delivery, which maintains sustained local concentration and may limit systemic complications. To evaluate the efficacy of local Nitric Oxide(NO) donor delivery on acute or subacute stent thrombosis and bleeding complications in patients, local NO donor delivery was performed in stented patients. METHOD: NO donor (2.0mg, Molsidomine) was delivered (1.0ml/min over 10min) using the Dispatch Catheter, after predilation of target lesion in 15 patients (8 angina, 7 myocardial infarction, mean age 5311.5 yr.) without heparin or nitrate infusion after stenting. After local NO donor delivery, Palmaz-Schatz stents were placed with standard methods. APTT and CK were checked at 1 hr, 3 hrs and 24 hrs after local NO donor delivery and STENTING. Follow-up coronary angiograms were done 48 hrs after stenting. RESULT: All patients had no hypotensive effects, no ischemic symptoms or no ECG changes during and after locaL NO donor delivery. ARTT and CK values were not changed at 3 and 24 hrs after local NO donor delivery and stenting. This allowed early arterial sheath removal. Follow-up coronary angiograms at 48 hrs showed all stents patent without stent recoil, with TIMI III flow, and without intra-stent thrombus. No target lesion revascularization and 100% event free survival were obsered for one month's clinical follow-up after NO donor delivery and stenting. Conclusion: Local NO donor delivery prior to stenting prevents acute and subacute stent thrombosis, systmic complications of nitrate, and maintains stent blood flow without stent recoil within the first one month after stenting.
Angioplasty ; Catheters ; Disease-Free Survival ; Electrocardiography ; Follow-Up Studies ; Hemorrhage ; Heparin ; Humans ; Inflation, Economic ; Myocardial Infarction ; Nitric Oxide* ; Stents* ; Thrombosis ; Tissue Donors* ; Ultrasonography

BACKGROUND: The prevalence of diabetes mellitus (DM) continues to increase, and the disease burden is the highest of any medical condition in Korea. However, large-scale clinical studies have not yet conducted to establish the basis for diabetes prevention in Korea. METHODS: The hospital-based Korean Diabetes Prevention Study (H-KDPS) is a prospective, multi-center, randomized, open-label controlled study conducted at university hospitals for the purpose of gathering data to help in efforts to prevent type 2 DM. Ten university hospitals are participating, and 744 subjects will be recruited. The subjects are randomly assigned to the standard care group, lifestyle modification group, or metformin group, and their clinical course will be observed for 36 months. RESULTS: All intervention methodologies were developed, validated, and approved by Korean Diabetes Association (KDA) multi-disciplinary team members. The standard control group will engage in individual education based on the current KDA guidelines, and the lifestyle modification group will participate in a professionally guided healthcare intervention aiming for ≥5% weight loss. The metformin group will begin dosing at 250 mg/day, increasing to a maximum of 1,000 mg/day. The primary endpoint of this study is the cumulative incidence of DM during the 3 years after randomization. CONCLUSION: The H-KDPS study is the first large-scale clinical study to establish evidence-based interventions for the prevention of type 2 DM in Koreans. The evidence gathered by this study will be useful for enhancing the health of Koreans and improving the stability of the Korean healthcare system (Trial registration: CRIS KCT0002260, NCT02981121).
Clinical Study ; Delivery of Health Care ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Early Intervention (Education) ; Education ; Hospitals, University ; Incidence ; Korea ; Life Style ; Metformin ; Prediabetic State ; Prevalence ; Primary Prevention ; Prospective Studies ; Random Allocation ; Risk Reduction Behavior ; Weight Loss

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

PURPOSE: Barriers to cardiopulmonary resuscitation (CPR) education are magnified by relative cost and course availability. E-learning has emerged as a viable solution for continuous, on-demand training and organizational learning. We assessed the hypothesis that E-learning is a viable strategy for CPR training of the general public and sought to evaluate its effects on CPR quality compared to traditional classroom-based methods. METHODS: The E-learning program was specifically designed to teach basic life support skills, and consisted of 50 minutes internet lectures and simulation videos. The training session was freely available to twenty two officers in rural South Korea. The trainees were able to practice with a mannequin and an automated external defibrillator (AED) trainer at their place of employment over the course of 3 days. The control group was trained at a hospital by certified instructors using the same equipment during a 2 hour period. At the end of the course, the participant's skills were evaluated using a checklist and a skill performance test. RESULTS: Forty two subjects were enrolled finally with 19 and 23 belonging to the E-learning and the control groups, respectively. One E-learning trainee was excluded because he was absent from the skills test. The mean time to learn CPR and AED techniques was 29.0+/-24.5 minutes in the elearning group. The mean age of the E-learning group was significantly older than that of the control group (32.4+/-4.0 vs. 26.0+/-1.5, p<0.001). However, we did not find any significant differences in their weight, height or CPR educational status. Before the education sessions, the willingness to perform CPR and their confidence in performing CPR were not significantly different among the two groups. Regarding skill performance, there were no significant differences between the groups except the volume of ventilation. The control group showed a higher volume of ventilation than the elearning group (1,031.7+/-521.6 vs. 548.8+/-303.3, p=0.004). CONCLUSION: E-learning accompanied with appropriate practice can be a helpful tool for public CPR training. The demand for E-learning will increase, and this study shows that e-learning programs can be successful, yielding similar results as traditional, classroom-based training.
Cardiopulmonary Resuscitation ; Checklist ; Defibrillators ; Education, Distance ; Educational Status ; Employment ; Hypogonadism ; Internet ; Learning ; Lectures ; Life Support Care ; Manikins ; Mitochondrial Diseases ; Ophthalmoplegia ; Republic of Korea ; Ventilation

BACKGROUND: Coronary stents are effective in the treatment of acute complications after angioplasty and the prevention of restenosis. However, complications may arise posttreatment, the major cinical problems are stent thrombosis and restenosis. All coronary stents are imported from western countries and are not covered by medical insurance in Korea. Korean stents should be developed to reduce patient's economic burden. METHODS: We placed five Maximum Arterial Re-Creation (MAC) and five Palmaz-Schatz (PS) stents in ten porcine coronary arteries. Stent and artery diameter ratio was 1.3 : 1.0. Follow-up coronary angiogram and histopathologic examinations were performed four weeks after stent overdilation injury. RESULTS: All of the stented arteries were patent on follow-up coronary angiograms. Angiographic diameter stenosis was 23.1+/-9.2% in MAC stents and 18.5+/-12.3% in PS stents and pathologic area stenosis was 35.6+/-11.4% in MAC stent and 39.8+/-9.9% in PS stent at 4 weeks after stenting, which were not different between two stents. Maximal intimal thickness (0.28+/-0.12 vs. 0.36+/-0.17mm) and neointimal area (1.83+/-1.01mm2 vs. 1.50+/-0.65mm2) were not different between MAC and PS stent. CONCLUSIONS: MAC stents are as effective as PS stents in the prevention of stent restenosis in a porcine stent restenosis model.
Angioplasty ; Arteries ; Constriction, Pathologic ; Coronary Vessels ; Follow-Up Studies ; Insurance ; Korea ; Stents* ; Thrombosis

BACKGROUND: Coronary intervention is a well established treatment of ischemic heart diseases. However, acute arterial occlusion and restenosis have remained as the principal limitations of coronary intervention. This study was aimed to analyze the acute and long-term, and the clinical angiographic results of the coronary intervention for restenotic lesions. METHOD: Between March 1996 and July 1997 at Chonnam University Hospital, second interventions were performed in one hundred restenotic coronary lesions of ninety patients (age 58.5+/-9.0 year, M:F = 5:1), i.e. percutaneous transluminal coronary angioplasty (PTCA) or stent implantation for the treatment of restenosis. RESULTS: 1) Initial interventions were PTCA in 75 lesions (Group I) and stent in 25 lesions (Group II). There were no differences in clinical manifestations, angiographic findings and follow-up period between the two groups. 2) The method of the second intervention for the restenotic lesions after PTCA were either PTCA or stent implantation ; in Group I PTCA was performed in 27 (37%) lesions and stent in 46 (63%), In Group II, PTCA was performed in 20 (91%) lesions and stent in 2 (9%) lesions. The overall success rate of the second intervention for the restenotic lesion was 96%. 3) Follow-up angiogram at 5.5+/-2.9 months after the second intervention revealed the second restenosis rates of 44% (8/18) after stent and 50% (7/14) after PTCA. CONCLUSION: Second intervention for restenotic lesion can be performed with high success rate. Second restenosis rate are not different between the PTCA and stent groups.
Angioplasty, Balloon, Coronary ; Follow-Up Studies* ; Humans ; Jeollanam-do ; Myocardial Ischemia ; Stents

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