Anomalous origin of the right coronary artery from the pulmonary artery is a rare congenital anomaly that has generally been found incidentally during autopsy or surgery. Sudden death may occur without antecedent symptoms in apparently healthy, asymptomatic patients and hence operation is recommended when the lesion is recognized. As opposed to the more frequent anomalous origin of the left coronary artery from the pulmonary artery, only a few children with this anomaly have been reported to have undergone surgical treatment. This report describes a 2-year old patient whose diagnosis was made by echocardiography, confirmed by angiocardiography, and successfully corrected by reimplantation of the anomalous coronary artery into the aorta.
Angiocardiography ; Aorta ; Autopsy ; Child ; Child, Preschool ; Coronary Vessels* ; Death, Sudden ; Diagnosis ; Echocardiography ; Humans ; Pulmonary Artery* ; Replantation

BACKGROUND: Milrinone is a bipyridine phosphodiesterase III inhibitor that exerts both positive inotropic and direct vasodilatory effects. The efficacy and safety of intravenous milrinone in heart failure has been evaluated in a number of clinical studies. In addition, performance of the right ventricle is improved primarily in reduced right ventricular afterload, and pulmonary vascular resistence as milrinone produces minimal inotropic effects on the right ventricle. Most clinical studies have been performed in left ventricular failure patients. Therefore, we investigated whether intravenous milrinone improves the hemodynamics in patients with pulmonary hypertension due to valvular heart disease. METHODS: This study included 33 patients undergoing a valvular replacement with pulmonary hypertension (mean pulmonary artery pressure > or = 30 mmHg after induction). Patients were randomly divided into two groups, normal saline group (N) and milrinone group (M). In group N, normal saline was infused. In group M, a single intravenous bolus of milrinone (50mug/kg body weight) was injected over 10 min. Hemodynamic data were measured at preinjection, 5, 10, and 20 min after injection. RESULTS: There was no significant difference in systemic mean arterial pressure and central venous pressure between both groups. In group M, systemic vascular resistance was reduced at 5 min after injection and cardiac index was improved at 10 min after injection. There was no significant difference in pulmonary mean arterial pressure and vascular resistance between both groups. CONCLUSIONS: Milrinone had no effect on pulmonary artery pressure and pulmonary vascular resistance in patients with pulmonary hypertension due to valvular heart disease. However, it increased cardiac index and decreased systemic vascular resistance.
Arterial Pressure ; Central Venous Pressure ; Cyclic Nucleotide Phosphodiesterases, Type 3 ; Heart Failure ; Heart Valve Diseases* ; Heart Ventricles ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Milrinone* ; Pulmonary Artery ; Vascular Resistance ; Vasodilation

OBJECTIVETo study the effects of yiqi huoxue recipe and Coxsackie B virus type 3 (CVB3) on the expression of ribosomal protein S20 in rat cardiac myocytes, to explore the pathogenesis of myocarditis induced by CVB3 and the mechanism of yiqi huoxue recipe on gene level, and to further investigate whether yiqi huoxue recipe is an effective prescription for CVB3 myocarditis.

METHODSA modified suppression subtractive hybridization (SSH) was used to isolate differentially expressed genes between the CVB3 infection group and the treatment group with yiqi huoxue recipe. The results were further verified by fluorescence RT-PCR.

RESULTSThe results of SSH showed that the gene expression of ribosomal protein S20 in the treatment group was higher than that in the CVB3 infection group (P<0.05), which agreed with the results of fluorescent RT-PCR.

CONCLUSIONDown-regulation of ribosomal protein S20 mRNA expression might be one of the mechanisms in CVB3 myocarditis, and yiqi huoxue recipe could achieve the treatment of viral myocarditis by regulating the expression of ribosomal protein S20.

Animals ; Coxsackievirus Infections ; drug therapy ; virology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Enterovirus B, Human ; drug effects ; metabolism ; Gene Expression Regulation ; drug effects ; Myocytes, Cardiac ; drug effects ; metabolism ; virology ; Nucleic Acid Hybridization ; Rats ; Rats, Wistar ; Reverse Transcriptase Polymerase Chain Reaction ; Ribosomal Proteins ; genetics ; metabolism

BACKGROUND: There are very few cohort studies on the hypertension in family practice. In order to investigate epidemiological characteristics of hypertensive patients and assess the safety and tolerability of newly prescribed antihypertensive monotherapies in Korean patients, a prospective study was carried out. METHODS: A total of 1,181 patients were observed from July 1997 to August 1999. At 2, 4, 8 and 12 weeks after initiation of antihypertensive monotherapy, the patients were evaluated for whether treatment is continued and development of any adverse reactions. RESULTS: Calcium channel blockers(CCBs) were the most commonly prescribed initial drug class (44.2%) in family practice, followed by angiotensin converting enzyme inhibitors(ACEI)(21.0%), angiotensin II receptor antagonists(ARA)(11.8%), beta blockers(9.6%), alpa blockers(3.9%), and diuretics(3.6%). During the first 12 weeks, the percentage of subjects continuing their initial ACEIs(40.7%) was substantially lower than the percentages that of subjects continuing ARAs(66.2%), alpa blockers(63.0%), CCBs(61.3%), beta blockers(55.8%), and diuretics(53.5%), respectively(P<0.01). The following adverse reactions were detected: cough(7.5%), headache(6.1%), dizziness(3.9%), flushing(3.7%) and impotence(2.4%). The incidence of cough associated with ACEI(27.9%) was higher than those of other classes(P<0.01). CONCLUSION: CCBs were the most commonly prescribed initial drug class in family practice, followed by ACEIs, ARAs, beta blockers, alpa blockers, and diuretics. The tolerability of antihypertensive medication was the highest in Korean patients treated with ARAs, followed by CCBs, beta blockers, diuretics, alpa blockers, and ACEIs.
Calcium Channels ; Cohort Studies ; Cough ; Diuretics ; Family Practice* ; Humans ; Hypertension ; Incidence ; Peptidyl-Dipeptidase A ; Prospective Studies* ; Receptors, Angiotensin