BACKGROUND/AIMS: The aim of this study was to identify changes in left ventricular (LV) performance in patients with a myocardial bridge (MB) in the left anterior descending coronary artery during resting and in an inotropic state. METHODS: Myocardial strain measurement by speckle-tracking echocardiography and conventional LV wall-motion scoring was performed in 18 patients with MB (mean age, 48.1 +/- 1.7 years, eight female) during resting and intravenous dobutamine challenge (10 and 20 microg/kg/min). RESULTS: Conventional LV wall-motion scoring was normal in all patients during resting and in an inotropic state. Peak regional circumferential strain increased dose dependently upon dobutamine challenge. Longitudinal strains of the anterior and anteroseptal segments were, however, reduced at 20 microg/kg/min and showed a dyssynchronous pattern at 20 microg/kg/min. Although there were no significant differences in radial strain and displacement of all segments at rest compared with under 10 microg/kg/min challenge, radial strain and displacement of anterior segments at 20 microg/kg/min were significantly reduced compared with posterior segments at the papillary muscle level (44.8 +/- 14.9% vs. 78.4 +/- 20.1% and 5.3 +/- 2.3 mm vs. 8.5 +/- 1.8 mm, respectively; all p < 0.001), and showed plateau (40%) or biphasic (62%) patterns. CONCLUSIONS: Reduced LV strain of patients with MB after inotropic stimulation was identified. Speckle-tracking strain echocardiography identified a LV myocardial dyssynchrony that was not demonstrated by conventional echocardiography in patients with MB.
Adrenergic beta-1 Receptor Agonists/*diagnostic use ; Adult ; Aged ; Chest Pain ; Coronary Angiography ; Diastole ; Dobutamine/*diagnostic use ; Echocardiography, Stress/instrumentation/*methods ; Female ; Humans ; Male ; Middle Aged ; *Myocardial Contraction ; *Myocardium ; Physical Exertion ; Systole ; *Ventricular Dysfunction, Left ; Ventricular Function, Left/*drug effects

PURPOSE: To evaluate the short-term results of medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot deformity. MATERIALS AND METHODS: Twenty four patients (25 feet) who had undergone medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot between July 2004 and May 2007 were included. The mean age was 43.6 years (16~78 years). The mean follow-up was 26 months (14~50 months). Clinical outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Six radiographic parameters were measured from weightbearing radiographs to assess the difference between preoperative and postoperative radiographs. RESULTS: The mean AOFAS score improved from 57.9 points preoperatively to 89.2 points at latest follow-up (p=0.000). The mean VAS improved from 62 points preoperatively to 23 points at latest follow-up (p=0.000). The mean talonavicular coverage angle on anteroposterior (AP) view changed from 20.2 degrees to 16.0 degrees (p=0.002). The mean calcaneal pitch angle on lateral view changed from 12.6 degrees preoperatively to 14.5 degrees at latest follow-up (p=0.001). Regarding these radiographic parameters, the difference between interobserver measurements was larger than that between pre- and post-operative measurements. The calcaneus was transferred medially by average 11.8 mm (p=0.003), which was 27.9% of the width of calcaneal tuberosity (p=0.000). The mean talo-first metatarsal angle on AP and lateral views, and navicular height on lateral view were not significantly changed. CONCLUSION: Medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot could lead to improve the clinical outcomes, although the restoration of medial longitudinal arch was not clinically significant.
Animals ; Ankle ; Calcaneus ; Displacement (Psychology) ; Flatfoot ; Follow-Up Studies ; Foot ; Humans ; Metatarsal Bones ; Osteotomy ; Weight-Bearing

PURPOSE: To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures. MATERIALS AND METHODS: The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery. RESULTS: At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000). CONCLUSION: In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.
Humans ; Retrospective Studies ; Spine

BACKGROUND AND OBJECTIVES: In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions. SUBJECTS AND METHODS: Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions > or =51 mm in length. RESULTS: The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0+/-18.15% in Group 1, 12.61+/-21.99% in Group 2, and 19.81+/-31.26% in Group 3(p< 0.05). Late lumen loss was 0.17+/-0.50 mm in Group 1, 0.39+/-0.66 mm in Group 2, and 0.59+/-0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm). CONCLUSION: DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.
Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Stenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Stents

A case of peripheral superior cerebellar artery aneurysm was treated using neuroendovascular therapy. Not only its rarity but also some specific considerations for diagnostic and therapeutic approach of peripheral superior cerebellar artery aneurysms will be discussed herein.
Aneurysm* ; Arteries*

BACKGROUND: There are several echocardiographic parameters, such as early transmitral velocity/tissue Doppler mitral annular early diastolic velocity(E/Ea) or deceleration time, reported to be reliable indices to estimate pulmonary capillary wedge pressure(PCWP). Recently, B-type natriuretic peptide(BNP) level is also reported to increase in accordance with increased left ventricular filling pressure in systolic or diastolic heart failure. This study was performed to compare E/Ea and BNP for the ability to estimate PCWP. METHODS: Several echocardiographic Doppler parameters including especially E/Ea were obtained from transthoracic Doppler echocardiography. Simultaneously, serum BNP level and PCWP estimated by using Swan-Ganz catheter were obtained, respectively. RESULTS: E/Ea revealed a correlation of r=0.88 (p<0.001) with PCWP compared with r=0.45 (p<0.001) between BNP and PCWP. E/Ea > or =11 was the optimal cutoff to predict PCWP > or =15 mmHg (sensitivity, 94%; specificity, 90%), whereas the optimal BNP cutoff was > or =250 pg/mL (sensitivity, 52%; specificity, 74%). CONCLUSION: Mitral E/Ea has a better correlation with PCWP than BNP. Mitral E/Ea appears more sensitive and specific than BNP for PCWP > or =15 mmHg in cardiac patients.
Capillaries ; Catheters ; Deceleration ; Echocardiography ; Echocardiography, Doppler* ; Heart Failure, Diastolic ; Humans ; Natriuretic Peptide, Brain* ; Pulmonary Wedge Pressure* ; Sensitivity and Specificity

BACKGROUND: Cardiovascular MR has recently been reported that it can determine the viable myocardium. We investigated this study to determine the usefulness of cardiovascular MR in prediction of wall motion recovery after revascularization in acute myocardial infarction METHODS: Both cardiovascular MR with contrast enhancement and coronary angiogram were performed in 19 patients with acute myocardial infarction who treated with precutaneous intervention or thrombolytic therapy. Six months follow-up angiogram and MR study were also preformed. Thirty two matched segments model of the left ventricle were used to analysis the wall motion change and the grade of transmural extent of hyperenhancement (TEI). RESULTS: Among 628 segments, 177 segments showed wall motion abnormality. In group of segments showing hypokinesia (68 segments), the proportion of segments showing wall motion improvement was not different from that of the akinetic segments group (109 segments) (50% vs 41.3%, p=0.26). The proportion of segments showing wall motion improvement were 60.5% in group of TEI grade 0, 58.9% in TEI grade I, 51.2% in TEI grade III, 29.4% in TEI grade IV, 8% in TEI grade V. If the groups were divided into two according to cut-off value of TEI 50%, In the group of TEI less than 50%, 67 out of 118 segments (56.8%) showed wall motion improvement in contrast with 12 out of 59 segments (20.3%) in the group of TEI above 50% (p<0.001). The status of baseline wall motion abnormality (hypokinesia or akinesia) did not effect on wall motion improvement after revascularization. CONCLUSIONS: The baseline wall motion abnormality (hypokinesia or akinesia) did not predict the wall motion improvement. But, TEI grade was significant factor to predict the wall motion improvement.
Follow-Up Studies ; Heart Ventricles ; Humans ; Hypokinesia ; Magnetic Resonance Imaging ; Myocardial Infarction* ; Myocardium ; Thrombolytic Therapy

BACKGROUND: Cardiac troponin I (cTnI) is most recently described and has nearly absolute myocardial tissue specificity, as well as high sensitivity. But an increased value for cTnI that indicates myocardial injury is not always synonym of myocardial infarction or ischemia due to coronary artery disease. METHODS: Retrospective follow-up study for whom underwent coronary angiography for suspected coronary artery disease was done if they had an elevated cTnI value and angiographically normal or minimal disease. RESULTS: 33 patients were qualified. Cut-off value for elevated cTnI was 0.06 ng/mL. Increased cTnI values were attributed to severe congestive heart failure in 7 patients, variant angina in 7 patients, myocarditis in 5 patients, pericarditis in 1 patient, severe myocardial bridge in 1 patient, rhabdomyolysis in 1 patient and cerebral infarction in 1 patient. Tachycardia was precipitating cause in 4 patients (sinus tachycardia, paroxysmal supraventricular tachycardia, paroxysmal atrial fibrillation and sustained ventricular tachycardia for each), two of whom had hemodynamic compromise. 2 of 33 patients had no identifiable cause for a rise in cTnI value. There was no acute myocardial infarction at 42+/-34 weeks follow-up. CONCLUSIONS: Although cTnI is a sensitive and specific marker of myocardial injury, an elevation of cTnI value may have a cause other than myocardial infarction or ischemia and may occur without significant angiographic coronary artery disease.
Atrial Fibrillation ; Cerebral Infarction ; Coronary Angiography ; Coronary Artery Disease ; Follow-Up Studies ; Heart Failure ; Hemodynamics ; Humans ; Ischemia ; Myocardial Infarction ; Myocarditis ; Organ Specificity ; Pericarditis ; Retrospective Studies ; Rhabdomyolysis ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Troponin I* ; Troponin*

BACKGROUND AND OBJECTIVES: Recent randomized studies have shown a significant reduction in the rate of recurrent cardiac events with adjunctive pharmacotherapy, using Glycoprotein IIb/IIIa inhibitors (GPI), in patients undergoing percutaneous coronary intervention (PCI) procedures. However, in Korea, there is a paucity of data concerning complications of tirofiban therapy in patients with acute coronary syndrome (ACS). Therefore, this study was performed to evaluate the safety of tirofiban therapy. SUBJECTS AND METHODS: ACS patients who underwent tirofiban administration between May 2002 and October 2003 were reviewed. The rates of bleeding, transfusion, and thrombocytopenia were analyzed, and the rates of complications by ages, gender and PCI compared with medical treatment, renal function and vascular access route. RESULTS: A total of 261 ACS patients (male/female=150/111) underwent tirofiban therapy. The mean ages of the subjects was 64.5 years, the rates of minor bleeding, major bleeding, transfusion and thrombocytopenia were 8.1% (n=21), 2.3% (n=6), 4.6% (n=12) and 1.2% (n=3), respectively. Minor bleeding occurred at similar rates in both sexes (8 vs. 8.1%) and to a greater extent in old age (> or =65) (12.5 vs. 2.6%, p=0.093), but major bleeding occurred to a greater extent in females and old age (5.4 vs. 0% and 4.2 vs. 0%, p=0.25 and 0.093, respectively). The rates of thrombocytopenia and transfusion were greater in old age (2.1 vs. 0% and 8.3 vs. 0%, p=0.052 and 0.087, respectively). In-hospital days were greater in old age (14.7+/-9.5 vs. 11.9+/-4.4 days, p=0.065). The rates of complications were similar in both groups when compared by PCI or medical treatment and vascular access route. The serum creatinine was 3.3 mg/dL in those with major bleeding, which was higher than in the other groups (p=0.000). CONCLUSION: The tirofiban therapy in patients with ACS did not induce an increase in the bleeding rates, in-hospital days and it was safe and well tolerated in old age.
Acute Coronary Syndrome* ; Coronary Disease ; Creatinine ; Drug Therapy ; Female ; Glycoproteins ; Hemorrhage ; Humans ; Korea ; Percutaneous Coronary Intervention ; Thrombocytopenia

BACKGROUND AND OBJECTIVES: Cardiovascuar MR using contrast enhancement has recently been reported to be useful for diagnosing myocarditis. It is also well known that irreversible myocardial injury by epicardial coronary artery flow obstruction spreads from the endocardium to the epicardium in a wave-front pattern with a time-dependent manner. We investigated characteristics of the patterns of contrast-enhanced MR imaging according to the underlying myocardial injury mechanism. SUBJECTS AND METHODS: Of all 275 patients who underwent coronary angiogram at our hospital due to cheat pain and elevated cardiac enzymes between October, 2002 and August, 2003, 48 patients who underwent cardiac MR were enrolled in this study. We retrospectively analyzed the pattern of delayed hyperenhancement according to presence or absence of a documented infarct related artery. Endomyocardial biopsies were done in selected patients. RESULTS: Contrast MR images of all patients showed delayed hyperenhancement. The study group was divided into 2 groups according to whether the areas of hyper-enhancement were involved in the sub-endocardial portion (endocardial sparing pattern, ESP) or not. In 8 patients (Group A, 17%) who showed the endocardial sparing pattern on contrast MR, the findings of coronary angiogram were all normal. In 40 patients (Group B, 83%), who did not show the endocardial sparing pattern on contrast MR, 39 patients (97.5 %) had an infarct related artery on coronary angiogram (p=0.001). Endomyocardial biopsies were performed in 3 patients of group A. The findings of the 3 biopsies were 2 cases of definite myocarditis and 1 case of myocardial degeneration. CONCLUSION: The endocardial sparing pattern of myocardial injury demonstrated by delayed enhancement MR imaging was very useful to predict the presence of an infarct related artery in patients with myocardial necrosis that has been determined by elevated cardiac enzymes. This result can be a useful clue to determine the nature of the underlying injury mechanism such as ischemic or non-ischemic.
Arteries ; Biopsy ; Coronary Vessels ; Endocardium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction ; Myocarditis ; Necrosis ; Pericardium ; Retrospective Studies