BACKGROUND: Carotid atherosclerosis and aortic at herosclerosis are both a predictor of atherosclertic cardiovascular diseases. However, the relationship between carotid and aortic atherosclerosis is not well known. METHODS: We performed B-mode ultrasound examinations of the carotid arteries in 38 consecutive elderly cases(13 men, mean age 69+/-3 years and 25 women, mean age 69+/-5 years) who underwent transesophageal echocardiography, to assess whether atherosclerosis in the carotid artery correlates with thoracic aortic atherosclerosis or may be a marker for it. RESULTS: The incidence of carotid and thoracic aortic atherosclerotic plaques were 44.7% and 50%, respectively. There was a significant relationship between carotid atherosclerosis and thoracic aortic atherosclerosis(r=0.532, p<0.01), and a increase in the extent of aortic atherosclerosis with increasing grades of carotid atherosclerosis. In the entire study cases, the presence of carotid atherosclerosis had a sensitivity 63.2%, specificity 73.7%, positive value 72.6% and negative predictive value 66.7% in detec-ting thoracic aortic atherosclerosis. CONCLUSION: In the Korean elderly, B-mode ultra sound examination of the carotid arteries is a easy and useful technique for the prediction of the presence and severity of thoracic atherosclerosis.
Aged* ; Aorta ; Aorta, Thoracic* ; Atherosclerosis* ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Artery Diseases* ; Echocardiography, Transesophageal ; Female ; Humans ; Incidence ; Male ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Ultrasonics ; Ultrasonography

Aneurysms of the pulmonary artery are uncommon in general but have a potentially fatal prognosis. This is derived from the potential for rupture of the aneurysm from the fact that there is commonly underlying severe pulmonary hypertension. Most cases are documented in the large postmortem series. Aneurysms of the pulmonary artery can be classified as congenital or acquired. Possible symptoms include dyspnea on exertion, cough, hemoptysis, and thoracic pain. When a large aneurysm formation of the pulmonary artery is diagnosed, surgical intervention is indicated because conservative treatment of the aneurysm will undoubtedly result in rupture with fatal outcome. We report a case of 46-year old patient with a giant left pulmonary artery aneurysm associated with severe pulmonary hypertension. A Doppler echocardiogram and a computed tomographic scan showed a giant saccular aneurysm of the left pulmonary artery (12 cm in diameter) and estimated systolic right ventricular pressure of 80 mmHg.
Aneurysm* ; Cough ; Dyspnea ; Fatal Outcome ; Hemoptysis ; Humans ; Hypertension, Pulmonary* ; Middle Aged ; Prognosis ; Pulmonary Artery* ; Rupture ; Ventricular Pressure

Ischemic heart disease is a common complication of thyrotoxicosis, although the exact mechanism has not been defined. In patient with dextrocardia as a part of situs inversus, coronary heart disease may occur with similar frequency and manifestation as in the general population. A case is reported of angina and thyrotoxicosis in patient with situs inversus totalis in which the angina was manifested by ST-segment elevation during graded exercise, relieved by antithyroid treatment. This unusual case establishes an association between hyperthy-roidism and ischemic heart disease.
Coronary Disease ; Dextrocardia ; Humans ; Hyperthyroidism* ; Myocardial Ischemia ; Situs Inversus* ; Thyrotoxicosis

Patent foramen ovales (PFOs) are common congenital cardiac defects that have been associated with the occurrence of stroke, especially with cryptogenic stroke, or those of undefined cause, accounting for up to 40% of all ischemic strokes. A number of studies have demonstrated the association of larger PFOs with increased shunting in patients with cryptogenic strokes. Medical treatment is often considered inadequate, and percutaneous closure offers an attractive, albeit controversial, alternative in stroke patients with PFOs. Although it is plausible that percutaneous PFO closure will reduce the rate of recurrent stroke in these patients, no prospective, randomized trials examining the efficacy of closure devices in this setting have been completed. This paper reviews the known relationship between PFOs and cryptogenic strokes and discusses current therapeutic options, including percutaneous closure.
Accounting ; Foramen Ovale, Patent ; Humans ; Stroke

No abstract available.
Aneurysm, Infected* ; Endocarditis* ; Mesenteric Artery, Superior*

BACKGROUND AND OBJECTIVES: The transradial approach has been suggested as an alternative entry site for coronary angiography. The complication and success rates of the vascular procedure have been associated with age. The aim of this study was to determine the safety, feasibility, and efficacy of transradial coronary angiography for patients greater than age 70 compared with younger patients. SUBJCETS AND METHODS: Clinical and angiographic data were reviewed retrospectively in 894 consecutive patients who underwent transradial coronary angiography from January 2001 through May 2003. Procedure-related results were used to compare 2 groups, patients aged < 70 years and those >70 years. RESULTS: In a consecutive series of 894 patients, 638 were < 70 years of age and 256 were >70 years of age. There was no significant difference in the rate of success in patients >70 years compared with patients < 70 (91.1% vs 93.6%). No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure-related variables, including procedure time, radiographic contrast use, and the number of catheters used per case, were similar between the two groups. CONCLUSION: Transradial access is a safe and feasible approach for coronary angiography in elderly patients, yielding results similar to those achieved with younger patients.
Aged* ; Catheters ; Coronary Angiography* ; Humans ; Retrospective Studies ; Rupture ; Stroke

BACKGROUND AND OBJECTIVES: The transradial approach has been suggested as an alternative entry site for coronary angiography. The complication and success rates of the vascular procedure have been associated with age. The aim of this study was to determine the safety, feasibility, and efficacy of transradial coronary angiography for patients greater than age 70 compared with younger patients. SUBJCETS AND METHODS: Clinical and angiographic data were reviewed retrospectively in 894 consecutive patients who underwent transradial coronary angiography from January 2001 through May 2003. Procedure-related results were used to compare 2 groups, patients aged < 70 years and those >70 years. RESULTS: In a consecutive series of 894 patients, 638 were < 70 years of age and 256 were >70 years of age. There was no significant difference in the rate of success in patients >70 years compared with patients < 70 (91.1% vs 93.6%). No severe complications, such as death, vascular dissection, rupture, and major cerebrovascular accidents were present in either group. Procedure-related variables, including procedure time, radiographic contrast use, and the number of catheters used per case, were similar between the two groups. CONCLUSION: Transradial access is a safe and feasible approach for coronary angiography in elderly patients, yielding results similar to those achieved with younger patients.
Aged* ; Catheters ; Coronary Angiography* ; Humans ; Retrospective Studies ; Rupture ; Stroke

BACKGROUND: Primary pulmonary hypertension(PPH) that affects predominantly young and productive people, is a progressive fatal disease of unknown cause. The objectives of this study were to characterize mortality in patients with PPH and to investigate the factors associated with their mortality. METHODS: Thirteen patients with PPH were enrolled between 1988 and 1996 and followed up through July 1999. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. RESULTS: 1) The mean age of the patients with PPH enrolled into the study was 36.1+/-9.3 years with female predominance. 2) The estimated median survival was 3.4+/-0.6 years. 3) Decreased cardiac index was the only significant predictor of mortality(Cox proportional hazards model). CONCLUSION: Patients with PPH have a high mortality. In this limited study with a small number of patients, mortality is largely associated with decreased cardiac index.
Diagnosis ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Mortality ; Prognosis

BACKGROUND: There has been reports which suggest that non-specific symptom of patients with mitral valve prolapse is associated with autonomic dysfunction. METHODS: To assess autonomic dysfunction of patients, we examined five cardiovascular reflex tests in 25 asymptomatic MVP patients(identified as MVP group), 25 symptomatic MVP patients(identified as MVP syndrome group) and 25 control group. RESULTS: In the five cardiovascular autonomic function tests, abnormalities of Valsalva ratio were detected in 1(4%) control group, 7(28%) MVP group, 9(36%) MVP syndrome group, heart rate response to deep breathing in 0(0%), 2(8%), 4(16%) respectively, immediate heart rate response to standing in 0(0%), 2(7.4%), 2(8%) respectively and in postural hypotension, there were no abnormal group. Abnormalities of blood pressure response to sustained handgrip were only detected in 2(8%) MVP syndrom group. According to the five categories of cardiovascular autonomic functon tests, normal in 24(96%) and early damage in 1(4%) were detected in control group. In the MVP group, normal 17(68%), early damage 6(24%) and definite damage 2(8%) were noted. In the MVP syndrome group, normal 9(36%), early damage 13(52%), definite damage 1(4%) and combined damage 2(8%) were detected. In case of heart rate response to deep breathing, we found significant differences between control and MVP syndrome group(p=0.043), and between MVP and MVP syndrome group(p=0.0043). In case of heart rate response to standing, between control and MVP syndrome group(p=0.0009), between MVP and MVP syndrome group(p=0.001), the differences were noted. In case of blood pressure response to standing, between control group and MVP group(p=0.0019), between MVP and MVP syndrome group(p=0.0075), we found significant differences. Resulting from our study, heart rate response to deep breathing and standing, blood pressure response to standing were of considerable value in assessing the autonomic dysfunction of patients with mitral valve proapse. CONCLUSION: We found autonomic dysfunction in addition to increased autonomic tone and responsiveness which have been already known previously in mitral valve prolapse. And autonomic dysfunction was more severe in symptomatic patients with mitral valve prolapse than asymptomatic ones.
Blood Pressure ; Heart Rate ; Humans ; Hypotension, Orthostatic ; Mitral Valve Prolapse* ; Mitral Valve* ; Reflex ; Respiration

BACKGROUND: Anomalous origin of a coronary artery is rare, but it can lead to angina pectoris, acute myocardial infarction, or even sudden death in the absence of atherosclerosis. Even when an anomalous vessel is identified angiographically, it may be difficult to delineate its true course on the basis of angiography alone. We attempted to determine whether transesophageal echocardiography (TEE) is of value in making the diagnosis and outlining the course of anomalous left circumflex (LCx) or right coronary arteries (RCA). METHOD: Eight adult patients with anomalous origin of LCx or RCA documented by selective coronary angiography were studied by transthoracic echocardiography (TTE) and multiplane TEE. RESULTS: Anomalous coronary ostia were visualized in all eight patients by TEE, but in only one with anomalous RCA out of eight patients by TTE. The proximal segments of anomalous coronary vessels were delineated in all eight patients by TEE and in only three with anomalous LCx out of eight patients by TTE. CONCLUSION: TEE is a valuable adjunctive diagnostic tool for the identification of anomalous coronary origin and course and is superior to TTE in adult patients.
Adult ; Angina Pectoris ; Angiography ; Atherosclerosis ; Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Myocardial Infarction