We successfully closed the isolated patent ductusarteriosus(PDA) in 2 female patients using the Rashkind Double-Disc Occlusion system. nonsurgical closure of PDA usin plug was introduced by Porstmann in 1968 through transfemoral artery catheter and using umbrella by Rashkind in 1977 througth venous site. There has been continued improvement and simplification of the equipment as well as in the implantation technique. Nowaday, a multicenter study was conducted to test the safety and effectiveness of this interventioal method in States. Successful closure rate was high but some problems were reported such as embolization, abnormal deployment and residual shunt. Residual shunt was visualized by aortography in our both cases immediately after intervention but continuous murmur could not be heard in both cases. Oxygen step-up disappeared immediately after occluder implantation in both cases. Complete occlusion was expected with thrombus in near future.
Aortography ; Arteries ; Catheters ; Ductus Arteriosus, Patent* ; Female ; Humans ; Oxygen ; Thrombosis

We report the implantation of a balloon-expandable intravascular stent at proximal left anterior decending artery in a patients suffered from Canakian functional class III angina for 8 years. The patient received 3 times percutaneous transluminal coronary angioplasty at proximal left anterior descending and circumflex artery without benefits. Repeated angiography revealed restenosis at proximal left anterior descending artery. Atherectomy was tried with transluminal extraction catheter(TEC) with luminal dissection and coronary bypass graft followed. occluded vein grafts were defined by follow-up angiography and chest pain recurred. No residual stenosis or thrombosis was documented in 24 hour follow-up angiography and the patient was discharged without symptom at 10 days after stenting.
Angiography ; Angioplasty, Balloon, Coronary ; Arteries ; Atherectomy ; Chest Pain ; Constriction, Pathologic ; Follow-Up Studies ; Humans ; Phenobarbital ; Stents* ; Thrombosis ; Transplants ; Veins

BACKGROUND: Since the nonsurgical treatment of mitral stenosis using a single balloon has been introduced by Inoue et al. in 1984. percutaneous mitral valvuloplasty has became an accepted therapeutic modality for selected patients with mitral stenosis. Zeibag et al. demonstrated the double balloon technique showed a better outcome than the single balloon in obtainning the optimal mitral valve area. On the other hand, there are several reports that single balloon technique was comparable with the double balloon technique. Therefore, there are still controversies in efficacy, benefit and complications between balloon techniques. METHOD: To compare the efficacy and complications of percutaneous mitral valvuloplasty with the double balloon or the Inoue balloon technique, 40 patients were studied consecutively by random method in selecting the balloon technique. RESULTS: In all cases, percutaneous mitral valvulopasty was performed successfully. Optimal outcome defined as mitral valve area larger than 1.5cm2 was obtained in 12 cases out of 16(75%) in double balloon group and 15 out of 24(63%) in Inoue balloon group(p=NS). Mitral valve area was significantly increased after valvulopasty in both technique but there was no different between both groups(Mean+/-SD ; 0.9+/-0.3 to 1.7+/-0.2 vs 0.9+/-0.2 to 1.9+/-0.2cm2). There were also hemodynamic improvement significantly in mean mitral gradient(MG). pulmonary artery pressure (PAP) and left atrial pressure(LAP) after PMV but there were no difference between groups (18+/-8 to 7+/-2 vs 21+/-13 to 9+/-4 mmHg for MG. 29+/-12 to 22+/-9 vs 28+/-9 to 18+/-5mmHg for PAP and 22+/-8 to 11+/-5 vs 21+/-6 to 11+/-4 for LAP respectively). Mitral requrgitation greater than grade 2 occurred in 2 cases of the double balloon group and one case of the Inoue balloon group(p=NS). New development of atrial shunt was found in 3 cases in both groups. CONCLUSIONS: The double and Inoue balloon techniques were quite comparable in immediate outcome and complications.
Hand ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies* ; Pulmonary Artery

A case of a 39-year-old woman with corrected transposition of the great vessels without significant intracardiac anomaly or coronary disease is reported. The clinical diagnosis of coronary arterial disese was supported in this patient by electrocardiographic changes of probable old anteroseptal myocardial infarction. Coronary arteriographic study showed the morphologic left coronary artery supplied the right-sided ventricle, and the right coronary artery supplied the left-sided ventricle, and the right coronary artery supplied the left-sided ventricle. Although the condition is theoretically compatible with a normal life span, few patient with this lesion survive past 40 years of age because of the subsequent heart block or functioning as a systemic ventricle.
Adult* ; Anterior Wall Myocardial Infarction ; Coronary Angiography* ; Coronary Disease ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Female ; Heart Block ; Humans

To investigate the significance of precordial ST-segment depression in acute inferior myocardial infarction, electrocardiographic findings in 51 consecutive patients with acute inferior myocardial infarction were analysed with clinical findings and coronary artery angiography. Thirty patients(Group A) had no or <1.0mm ST depression, and twenty one patients(Group B) had > or =1.0mm ST depression in two or more precordial(VI-6) leads were included in this study. Patients in Group B thd greater summed ST-segment elevation in leads II, III, AVF(6.3+/-6.1 vs 2.4+/-2.3mm, p<0.05), higher plasma peak CK levels(1776.8+/-1503.3 vs 5666.6+/-587.7 IU/L, p<0.05), higher plasmal peak CK-MB levels(141.2+/-1553.3 vs 34.1+/-35.7 IU/L, p<0.05), more prevalence of proximal left anterior descending coronary artery disease (46.6% vs 16.6%, p<0.05) than patients in Group A. There was no significant difference between Group A and Group B in the LV ejection fraction, delta area decreasing rate, infarction related asynergy, complications during hospitalization and cardiac events during follow up period. In conclusion, patients with acute inferior myocardial infarction who have associated with precordial ST depression had more extensive myocardial damage probably due to concomitant left anterior descending coronary artery disease.
Angiography ; Coronary Artery Disease ; Coronary Vessels ; Depression* ; Electrocardiography ; Follow-Up Studies ; Hospitalization ; Humans ; Infarction ; Inferior Wall Myocardial Infarction* ; Plasma ; Prevalence

Aortic dissection is a medical emergency requiring prompt diagnosis and maybe emergency surgery especially if the ascending aorta is involved. We have performed transesophageal echocardiography(TEE) in 22 consecutive patients with suspected aortic dissection. The diagnosis was subsequently proven in 14 patients(9 males, 2 females, mean age 51+/-11years) on the basis of TEE. The results and effectiveness were compared with computed tomography (CT) and aortography. Seven patients had type I aortic dissection, three had type II and four had type III. Twelve patients had hypertension. There was aortic regurgitation in five of seven patients with type I dissection and in all three patients with type II dissection. Type I dissection was found by TEE in seven patients who had intimal flap showing parallel movement to the aortic wall. CT was positive in only three of five of these patients. Type II dissection was seen in three patients by TEE. CT demonstrated dissection in one of three of these patients. In one patient the false lumen was filled with a thrombus, which was negative at angiography. Type III dissection was found by TEE in four patients. CT was positive in two of four patients. Aortography was performed and positive in one patient. The starting point of aortic dissection could be demonstrated in all four patients by TEE. TEE was well tolerated by patients with aortic dissection and associated with no major complications. In conclusion. TEE was very useful in detecting aortic dissection and in providing a dynamic information of the intimal flap and of the presence and extent of luminal thrombus with flow dynamics.
Angiography ; Aorta ; Aortic Valve Insufficiency ; Aortography ; Diagnosis ; Echocardiography, Transesophageal* ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Phenobarbital ; Thrombosis

Juvenile xanthogranuloma (JXG) is a benign and self-limiting non-Langerhans-cell histiocytosis that generally occurs during infancy and childhood. It develops frequently in the head and neck but is very rare in the nasal cavity. To date, only five cases of JXG in the nasal cavity have been reported. Here, we report the second case of JXG in the nasal cavity in Korea. A 19-year-old male patient presented with a protruding 1.1 cm mass in the left nasal vestibule. Histologically, a dense dermal infiltrate of histiocytes with Touton giant cells was observed. Immunohistochemically, the histiocytes tested positive for CD68 and the S-100 protein but negative for CD1a. This shows that a S-100-positive histiocytic lesion dose not exclude a diagnosis of JXG.
Diagnosis ; Giant Cells ; Head ; Histiocytes ; Histiocytosis, Langerhans-Cell ; Histiocytosis, Non-Langerhans-Cell ; Humans ; Korea ; Male ; Nasal Cavity* ; Neck ; S100 Proteins ; Xanthogranuloma, Juvenile* ; Young Adult

BACKGROUND: Because its efficacy and percutaneous approach, percutaneous mitral ballon valvotomy(PMV) could be an alternative to surgery for mitral restenosis after surgical commissurotomy, somewhat decreasing the mortality and morbidity associated with second thoracotomy. This study assesses the efficacy of PMV in patients with mitral restenosis after surgical commissurotomy compared with in patients without prior surgery. METHODS: PMV were performed in 367 patients to compare the effectiveness between patients with mitral restenosis after surgical commissurotomy(group 1, n=22) and patients with unoperated mitral stenosis(group 2, n=345). Twenty two had undergone closed or open mitral commissurotomy average 11.2 years before. RESULTS: There were no significant differences in clinical profiles between two groups. Mitral valve area was increased from 1.0+/-0.8 to 1.8+/-0.6cm2 in group 1 and 0.9+/-0.3 to 2.0+/-0.7cm2 in group 2(p>0.05). Mitral gradient was decreased from 14+/-5.9 to 6+/-2.6mmHg in group1 and 18+/-7.0 to 7+/-5.3mmHg in group2(p>0.05). Increment of mitral regurgitation and significant left to right shunt after PMV were not significantly different(10% versus 14.7%, 5% versus 10.4% respectively, p>0.05). Optimal results defined as final valve area more than 1.5cm2 with gain a more than 25% of initial valve area were attained in 75% of patients in group1 and in 84.3% of group 2 patients(p>0.05). CONCLUSIONS: PMV in mitral restenosis after surgical commissurotomy may be safe in selected patients and equally effective as in unoperated mitral stenosis.
Balloon Valvuloplasty* ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mortality ; Thoracotomy

Twenty-five patients(6.3% of 400 cases with significant coronary disease) with 50 percent or greater diameter obstruction in the left main coronary artery(Group 1) were compared with 187 patients with at least two vessel disease without left main involvement (Group 2) in clinical, arteriographic and hemodynamic findings. The ratio of male to female was 4:1 in Group 1 and 4.8:1 in Group 2, and the average was 51.0+/-11.6 and 55.6+/-8.6 years respectively. Twenty-two patients(88%)had moderate to server angina pectoris important risk factors, cigarette smoking was present in 10 patients(40%), hypertension in 7 (28%), diabetes mellitus in 7 (28%), and hypercholesterolemia(over 220 mg%) was in 4 (16%) out of 25 patients(Group 1). There were no difference between patients with Group1 and Group 2 in sex, clinical manifestation, duration of chest pain, treadmill test, major risk factors and the average resting left ventricular end-diastolic pressure. But the average age of Group 1 was slightly lower than that of Group 2(P<0.05). Image intensification fluoroscopy revealed clacification in the left main coronary artery in 5 patients. Sixteen patients(64%)had significant obstructive disease in the other coronary arteries. Contraction abnormalities in the left ventricullgram were present in 7(28%). The left ventricular end-diastolic pressure wea greater than 12mmHg in 13 of the 23 patients(56.5%). The average resting left ventricular end-diastolic pressure was 12.0+/-5.2mmHg. No significant comlplications were associated with cardiac catheterization. Three of 11 patients who underwent aocoronary bypass surgery died. One patients underwent PTCA, and the remaining 13 patients were treated medically.
Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Exercise Test ; Female ; Fluoroscopy ; Hemodynamics* ; Humans ; Hypertension ; Male ; Risk Factors ; Smoking

Six cases of bileaflet mechanical mitral valve thrombosis were serially assessed by Doppler echocardiography and cinefluoroscopy during thrombolytic therapy with urokinase. Two patients had dual mechanical valve replacement in the aortic and mitral positions simultaneously. Bileaflet thrombosis was diagnosed by 2-dimensional echocardiography in three cases, Doppler echocardiography and cinefluoroscopy in six cases. Thrombolytic therapy using urokinase was successful in five patients (3 cases : UK 1,000,000 unit x 3 hours for 2 days, 2 cases ; UK 1,000,000 unit/24 hours for 5 and 7 days respecitively, 1 case ; UK 1,000,000 unit/hr x 3 hours for 1 day). The other one patients had massive cerebral thromboembolism and subsequently died. These study demonstrated the usefulness of Doppler echocardiography and cinefluoroscopy in diagnosis and serial assessment of thrombolytic therapy in the patients with mechanical mitral valve thrombosis.
Diagnosis* ; Echocardiography ; Echocardiography, Doppler ; Humans ; Mitral Valve* ; Thromboembolism ; Thrombolytic Therapy* ; Thrombosis* ; Urokinase-Type Plasminogen Activator*