Echocardiographic examination was performed before, immediately after, 4-6 months after and 10-12 months after mitral valve replacement(MVR) surgery in 46 patients with mitral valve disease(8 patients with mitral regurgitation, 24 patients with mitral stenosis and 14 patients with mitral stenosufficiency) to evaluate the effects of mitral valve replacement on dimension of left atrium and left ventricle, volume of left ventricle, ejection fraction(EF) and fractional shortening(FS) of left ventricle. The results are as follows : 1) The endsystolic dimension(ESD), enddiastolic dimension(EDD), endsystolic volume(ESV) and enddiastolic volume(EDV) decreased significantly after operation in patients with mitral stenoinsufficiency(MSR), the ESD, EDD, ESV and EDV increased significantly after the operation, but returned to preoperative value 10-12 months after the operation. 2) The EF and FS of left ventrcle after MVR were significantly lower than preoperative value throughout the postoperative period in patients with MR. However in patients with MS or MSR, there were no significant postoperative changes in EF and FS, except transient depression in the patients with MS at the immediate postoperative period. 3) In all patients with mitral valve disease, the left atrial dimension and the ratio of domension of left atrium to the dimension of aorta decreased significantly after MVR. From above results, it is suggested that surgery should be considered seriously for the patients with MR before the ESD, EDD and ESV increase maekedly, even if the EF anf FS are in normal range and the symptoms are not severe, to prevent irreversible depression of myocardial function. It seems that serial echocardiographic examination is very helpful in this respect.
Aorta ; Atrial Natriuretic Factor ; Depression ; Echocardiography* ; Heart Atria ; Heart Ventricles ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Postoperative Period ; Reference Values

BACKGROUND: To compare the diagnostic usefulness of dobutamine stress echocardiography(DSE) and 99mTc-methoxyisobutyl isonitrile SPECT (MIBI SPECT), two studies were performed simultaneously. METHOD: Fifty-six consecutive patients undergoing coronary angiogram and MIBI SPECT for clinical indications without clincal evidence of myocardial infarction were studied prospectively. During the DSE, MIBI was injected at peak stress, and post-stress images of MIBI SPECT were required on hour later. Both echocardiographic and MIBI SPECT images were visually analysed in a blind fashion. RESULTS: On the basis of coronary angiographic findings, the sensitivites of the DSE and MIBI SPECT (n=36) were 89% and 86%, respectively. The specificities of those (n=20) were 90% and 85%, respectively. Among 33 patients without resting perfusion defect on MIBI SPECT, resting regional wall motion abnormalities on DSE were found in only one patient, whereas, resting perfusion defect on MIBI SPECT were found in 9 patients among 41 patients without resting regional wall motion abnormalities on DSE. Among 17 patients who had resting perfusion defects with partial reversibility on MIBI SPECT, resting wall motion abnormalities were present in 11 patients and five of them showed improvement in the regional wall motion during low dose dobutamine infusion. CONCLUSION: Both dobutamine stress echocardiography and MIBI SPECT are useful methods in the detection of the coronary artery disease, however, MIBI SPECT seems to overestimate the regional ischemic myocardium with contractile reserve that can hardly be evaluated with MIBI SPECT.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Humans ; Myocardial Infarction ; Myocardium* ; Perfusion ; Prospective Studies ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Angiotensin convertiong enzyme inhibitors have been shown to exert favorable effects on the left ventricular remodeling process associated with ventricular dilation after coronary occlusion. However, the effects of such therapy on global and regional left ventricular remodeling after coronart artery reperfusion have not been characterized, nor have such effects been assessed after exercise training. METHODS AND RESULTS: Female Sprague-Dawley rats(n=80) were randodmized into 4 groups at 5 days after 45 minutes of left coronary artery occlusion followed by reperfusion. Animals completion the experiment included : Untreated Sedentary group(n=20), Untreated with Swimming Exercise group(n=21), Captopril Treated Sedentary group(n=18) and Captoril Treated with Exercise group(n=21). At 3 weeks after randomization, global and regional morphologic changes of the left ventricle(LV) were examined from mid-ventricular transverse slices which were perfusion-fixed at a constant aortic pressure of 60mmHg and a left ventricular cavity pressure of 10mmHG. At rest and during exercise, compared to untreated rats, the captopril treated animals showed significantly decreased LV weight/tibial length ratio(LV/TL)(p<0.01),increased LV cavity area and dimension(both p<0.01), decreased total myocardial area and noninfarcted area(both p<30.001) and reduced wall thicknesses in the noninfarcted and infarcted regions(both p<0.001). Compared to treated and untreated dsedentary rats, exercise significantly increased LV/TL(p<0.05) and epicardial and endocardial areas in the infarcted zone(both p<0.05) and decreased transmurality(p<0.01). Exercise decreased LV cavity area in the captopril treated groups(42.3+/-10.4 vs. 40.4+/-6.0mm2),whereas exercise increased LV cavity area in the untreated groups(33.5+/-8.9 vs. 39.1+/-6.2mm2)(p<0.05). CONCLUSION: These findings provide evidence in rats for evidence in rats for exaggerated left ventricular dilation and supperssion of compensatory myocardial hypertrophy globally and in the infarct zone with 3 weeks of captopril treatment following coronary artery reperfusion with acute nontransmural myocardial infarction. In addition, the effects of captopril on LV dilation and suppression of global and regional hypertrophic response were partially reversible by swimming exercise.
Angiotensins ; Animals ; Arterial Pressure ; Arteries ; Captopril ; Coronary Occlusion ; Coronary Vessels* ; Enzyme Inhibitors ; Female ; Humans ; Hypertrophy ; Myocardial Infarction ; Myocardial Reperfusion ; Random Allocation ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Swimming ; Ventricular Remodeling*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine* ; Echocardiography, Stress* ; Humans ; Myocardium* ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Licensure*

The antihypertensive effects of diltiazem was observed in 30 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral diltiazem was 42.0+/-2.5mmHg and 17.8+/-1.7mmHg. The results of antihypertensive therapy revealed good control in 50% fair control in 30% poor in 17% and failure in 3% of the cases. In 80% of the cases, good or fair control of Hypertension which means drop of diastolic pressure to the level of less than 100mmhg was observed. 2) Mean drop in heart rate was 21+/-2 beats/min. 3) Daily dose was 90-180mg. 4) The side effect of oral Diltiazem was mild headache and dizziness, respectively one case.
Blood Pressure ; Diltiazem* ; Dizziness ; Headache ; Heart Rate ; Hypertension

To study factors related to release of atrial natriuretic polypeptide(ANP) in human subjects, instracardiac pressure and plasma ANP concentration in peripheral and central circulation were measured in patients with various heart disease (18 valvular heart disease, 4 congenital heart disease, 2 cardiomyopathy). 1) The concentration in peripheral venous plasma were increased in 14 patients with New York Heart Associaion (NYHA) functional class III-IV (87+/-38 pg/ml) as compared with that in 10 patients with NYHA functional class I-II (39+/-21 pg/ml, P<0.005)and 15 normal subjects (51+/-21 pg/ml, P<0.01). 2)The concentration of plasma ANP in inferior vena cava, right ventricle, pulonary artery, left ventricle and aorta were markedly increased in patient with NYHA functional class III-IV, elevated mean right atrial pressure (MRAP> or =8 mmHg) elevated mean pulmonary capllary wedge pressure (MPCWP> or =15 mmHg) and/or elevated pulminary artery systolic pressure (PASP> or =35 mmHg), as compared with those in patients with NYHA functional class I-II and/or lower intracardiac pressure (MRAP<8 mmHg, MPCWP<15 mmHg, and/or PASP<35 mmHg). 3) A step up in ANP concentration between inferior vena cava and right atrium was seen in patients with elevated MRAP (81+/-28pg/ml, 137+/-60pg/ml, P<0.05), MPCWP (74+/-37pg/ml,112+/-62pg/ml, P<0.05) and/or PASP (75+/-29 pg/ml,119+/-64 pg/ml, P<0.05). But there were no differences among intracardiac ANP concentrations from right atrium though aorta. 4) Plasma concentrations in right atrium, pulmonary artery, left ventricle and aorta correlated with MRAP (r=0.82, 0.63, 0.56, p<0.005 and r=0.52, P<0.01, respectively), MPCWP (r=0.86, 0.75, 0.73 and 0.72 respectively, P<0.005 in all) and PASP (r=0.73, 0.57, 0.68 and 0.59 respectively P<0.005 in all). 5) Left atrial diameter correlated with plasma ANP concentration in peripheral plasma (r=0.55, P<0.01), inferior vena cava (r=0.51, P<0.025), right atrium (r=0.45, P<0.05), right ventricle (r=0.55, P<0.01), pulmonary artery (r=0.52, P<0.01), left ventricle (r=0.55, P<0.01) and aorta (r=0.56, P<0.005). These results suggest that the heart secrets atrial natriuretic polypeptide into right atrium in response to increased mean right atrial pressure, mean pulmonary capillary wedge pressure, pulmonary artery systolic pressure and/or left atrial distention.
Aorta ; Arteries ; Atrial Natriuretic Factor ; Atrial Pressure ; Blood Pressure ; Heart ; Heart Atria ; Heart Defects, Congenital ; Heart Diseases* ; Heart Valve Diseases ; Heart Ventricles ; Humans ; Plasma* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Vena Cava, Inferior

Parenteral reserpine was given intramuscularly to 32 hospitalized hypertensive patients: 10 hypertensive patients without renal insufficiency, 3 hypertensive patients with heart failure, 10 hypertensive patients of malignant phase or with uremia, and 9 hypertensive patients with cerebrovascular accident. Follwoings were the result. 1. In the majority of patients, the effective dose of reserpine was 2 to 3 mg. 2. Reserpine given intramuscularly lowered blood pressure in 2 to 4 hours, had its maximum effect in 3 to 6 hours and had a duration of 3 to more than 24 hours (average 9 hours). 3. When effective dose of reserpine was given, blood pressure was lowered significantly (more than 30mmHg in mean blood pressure) in 18 patients (81.7%) of 22 hypertensive patients without renal insufficiency, and in 4 patients (40%) of 10 hypertensive patients with renal insufficiency. 4. Major side effect was drowsiness which was more evident in the patients with renal insufficiency. 5. Reserpine administered parenterally is an effective and safe agent for the treatment of hypertensive emergencies on a short term basis especially in the patient without renal insufficiency.
Blood Pressure ; Emergencies ; Heart Failure ; Humans ; Renal Insufficiency ; Reserpine* ; Sleep Stages ; Stroke ; Uremia

The penetrating atherosclerotic ulcer of the aorta resulting from the atherosclerosis of the aortic wall can clinically mimic type III aortic dissection, since both diseases produce the ulceration and dissection of aortic wall. However, their imaging features and pathophsiologies are distinctly different from each other. Familial hypercholesterolemia(FH) menifests overt hyperlipidemia that can results in premature atherosclerosis of the aorta as well as the coronary artery. We report a clinically and radiologically evident case of perntrating atherosclerotic ulcer of the descending thoracic aorta which was developed in a 36-year-oldd heterozygote FH male.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Coronary Vessels ; Heterozygote* ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II* ; Male ; Ulcer*

No abstract available.