No abstract available.
Hypertension*

Double-orifice mitral valve is a relatively rare congenital abnormality, usually discovered at autopsy or surgery. In most cases, the double-orifice mitral valve causes no hemodynamic effects, sometimes it is regurgitant, and rarely is stenotic. Appreciation of this echocardiographic abnormality is important because double orifice mitral valve is often associated with other congenital anomalies and this echocardiographic findings may be confused with other cardiac abnormalities. The authors report a case of isolated congenital double-orifice mitral valve in a 42-year-old woman. Data from the literature are reviewed and the echocardiographic images of the malformation are described.
Adult ; Autopsy ; Congenital Abnormalities ; Echocardiography ; Female ; Hemodynamics ; Humans ; Mitral Valve*

BACKGROUND AND OBJECTIVES: Perfluorocarbon exposed sonicated dextrose albumin (PESDA) microbubbles has been suggested to facilitate thrombus disruption under the transcutaneous ultrasound (US). Thus, we investigated whether such a noninvasive approach could augment thrombolytic effect of fibrinolytic agent in an experimental thrombotic model. MATERIALS AND METHODS: Thrombus formation was induced with electrical injury in the rabbit iliofemoral arteries (n=20): Thrombus occlusion was documented by angiography in all arteries. In the control group, only tissue plasminogen activator (t-PA, 3 mg/kg) was administered intrav-enously in five rabbits. In the Group 1 (n=9), injured arteries were exposed to transcutaneous US (20 kHz, 30 W/cm2, continuous mode) with t-PA (3 mg/kg). In the Group 2 (n=6), the same treatment was given while administering PESDA continuously (10 ml/min, intravenous). Angiographic results were evaluated at 10 minute interval for 1 hour respectively. RESULTS: In the control group, two of five iliofemoral arteries (40.0%) were recanalized and one of nine iliofemoral arteries (11.1%) was recanalized in Group 1. In contrast, four of six iliofemoral arteries (66.7%) were recanalized angiographically in Group 2 (p=0.392 vs. control group: p=0.047 vs. Group 1). However, late reocclusion occurred in all iliofemoral arteries of Group 2. CONCLUSION: Although PESDA with transcutaneous US significantly enhanced initial angiographic patency rate of t-PA, it was associated with high rate of reocclusion. Further studies will be necessary for clinical application of this noninvasive method in acute arterial occlusion.
Angiography ; Arteries ; Glucose* ; Microbubbles ; Rabbits ; Thrombolytic Therapy* ; Thrombosis ; Tissue Plasminogen Activator ; Ultrasonography*

We examined the associations between adiponectin or leptin and serum ICAM-1 levels in seventy-six hypercholesterolemic patients (mean age 59 yrs, 25 males and 51 females, LDL-cholesterol>=130mg/dL at screening). Blood lipid profiles and HOMA-IR derived from fasting glucose and insulin concentrations were determined. Serum levels of adiponectin, leptin and ICAM-1 were analyzed using ELISA. The results showed that serum levels of leptin were positively associated with serum levels of ICAM-1 independent of age, sex and BMI (r =0.392, p<0.001). Serum levels of adiponectin were negatively associated with serum levels of ICAM-1 independent of age, sex and BMI (r =-0.343, p<0.005). Stepwise multiple linear regression analysis showed that serum leptin was an independent factor to be associated with serum ICAM-1 levels after adjusting for age, sex, BMI, alcohol intake, smoking status, blood lipids such as total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol and HOMA-IR (p<0.001). With respect to adiponectin, its association with serum ICAM-1 was attenuated but still significant when further adjustments were made for age, sex, BMI, alcohol intake, smoking status, blood lipids such as total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol and HOMA-IR (p<0.005). In conclusion, this study suggests that adiponectin and leptin are associated with endothelial derived inflammation.
Adipokines ; Adiponectin* ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Female ; Glucose ; Humans ; Hypercholesterolemia ; Inflammation ; Insulin ; Intercellular Adhesion Molecule-1* ; Leptin* ; Linear Models ; Male ; Smoke ; Smoking ; Triglycerides

BACKGROUND: Conventional echocardiography provides fundamental information about mitral valve morphology and function but is often subjective and has a relatively low specificity in evaluating valve calcific deposit, which is critical information for the preoperative decision. We hypothesized that mitral valvular calcification could be detected in standard two-dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis so that we could overcome the subjectivity and low specificity of conventional echocardiography. METHODS: We tested this hypothesis by performing standard 2.5MHz two-dimensional echoes on mitral valve and myocardium in 30 patients with mitral stenosis, scheduled to undergo mitral valve replacement. We compared gray level of each region of interest in mitral valve and myocardium in stop-frame images with the degree of calcifications identified by pathologic and radiographic examinations. RESULTS: Ratio of mean gray level of mitral valve to mean gray level of myocardium was the most reliable value in evaluating degree of calcification. Quantitatively, region of calcification displayed the ratio of significantly higher value than that of no calcification. In case of anterior mitral valve, the ratio of the evident calcified region was greater than 3.11, that of the region without calcification was less than 2.42 and that of microcalcification was betwwn 2.42 and 3.11. For posterior mitral valve, the ratio of the evident calcified region was greater than 3.50, that of the region without calcification was less than 2.19 and that of microcalcification was between 2.19 and 3.50. The sensitivity and specificity of this method for assessment of degree of calcification was 75% and 100% for anterior mitral valve and 9% and 87.5% for posterior mitral valve. CONCLUSION: Mitral valvular calcification could be detected quantitatively in standard two dimensional echocardiograms of mitral valve in vivo by evaluating regional gray level(echo amplitude) using computerized image analysis.
Echocardiography ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Myocardium ; Sensitivity and Specificity

BACKGROUND: Ischemic preconditioning(a prior short period of coronary artery occlusion) has been known to have protective effects on ischemia-induced myocardial injury. The purpose of this study was to investigate the effects of hypoxic preconditioning or ischemic preconditioning on the
Animals ; Anoxia ; Arrhythmias, Cardiac* ; Cats* ; Coronary Vessels ; Heart* ; Hypoventilation ; Ischemic Preconditioning ; Methods ; Reperfusion ; Tachycardia, Ventricular ; Thoracotomy ; Ventilation ; Ventricular Fibrillation

Mitral regurgitation is a progressive disease that may lead to left ventricular dysfunction. Medical treatment is of limited value in chronic progressive mitral regurgitation except in those with comorbid hypertension or LV dysfunction. Recent advances in surgical techniques has changed the roles of medical and surgical therapies. Therefore the prime importance of treating physicians is to identify the optimal timing ofsurgery in this population. Two important factors should be taken into consideration while deciding the optimal timing of surgical intervention. One is functional cardiac status and the other is the left ventricular response to volume overload. Besides, the pathologic nature of mitral regurgitation, the severity of mitral regurgitation, the possibility of successful mitral repair, the development of atrial fibrillation and the presence of pulmonary hypertension, together with the hemodynamic response to exercise. Advances in the understanding of natural pathophysiologic nature of progressive mitral regurgitation and successful technical surgical repair have extended the role of early surgical intervention even in asymptomaticpatients with normal LV function.
Atrial Fibrillation ; Hemodynamics ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Insufficiency* ; Ventricular Dysfunction, Left

Mitral regurgitation is a progressive disease that may lead to left ventricular dysfunction. Medical treatment is of limited value in chronic progressive mitral regurgitation except in those with comorbid hypertension or LV dysfunction. Recent advances in surgical techniques has changed the roles of medical and surgical therapies. Therefore the prime importance of treating physicians is to identify the optimal timing ofsurgery in this population. Two important factors should be taken into consideration while deciding the optimal timing of surgical intervention. One is functional cardiac status and the other is the left ventricular response to volume overload. Besides, the pathologic nature of mitral regurgitation, the severity of mitral regurgitation, the possibility of successful mitral repair, the development of atrial fibrillation and the presence of pulmonary hypertension, together with the hemodynamic response to exercise. Advances in the understanding of natural pathophysiologic nature of progressive mitral regurgitation and successful technical surgical repair have extended the role of early surgical intervention even in asymptomaticpatients with normal LV function.
Atrial Fibrillation ; Hemodynamics ; Hypertension ; Hypertension, Pulmonary ; Mitral Valve Insufficiency* ; Ventricular Dysfunction, Left

BACKGROUND: Pulsed Doppler measurement of transmitral flow has been widely used to assess the left ventricular relaxation abnormality noninvasively in patients with failing heart. However pulsed Doppler-derived indices are affected by multiple factors, including active relaxation and distensibility of the left ventricle, the pressure gradient between the left ventricle and atrium, and altered loading condition. The purpose of this study is to assess the role of new index, the rate of propagation of left ventricular peak filling flow in early diastole using color M-mode Doppler for the evaluation of left ventricular diastolic function. METHOD: The study group comprised 41 patients(24 males, 17 felames, mean age: 56+/-12). The clinical diagnosis were angina pectoris 32, acute myocardial infarction 3, peripheral arterial obstructive disease 2 and atypical chest pain 4. We measured rate of propagation(ROP) and propagation ratio of peak early filling flow by color M-mode Doppler echocardiography using baseline shifted first aliasing limit technique and compared with pulsed Doppler measurements of transmitral flow. RESULTS: 1) Pulsed Doppler-derived indices of mitral flows were as below. The maximal velocity of E wave was 65.4+/-21.3cm/sec in control group, 54.3+/-7.9cm/sec in group I patients(p<0.05 versus control group) and 70.9+/-15.2cm/sec in group II patients(p<0.01 versus group I). The maximal velocity of A wave was 70.0+/-20.9cm/sec in control group, 78.6+/-3.8cm/sec in group I patients and 60.0+/-14.1cm/sec in group II patients(p<0.01 versus group I). The E/A ratio was 1.01+/-0.42 in control group, 0.69+/-0.10 in group I patients(p<0.05 versus control group) and 1.19+/-0.16 in group II patients(p<0.01 versus group I). The deceleration time was 166.7+/-36.3msec in control group, 202.9+/-17.0msec in group I patients(p<0.01 versus control group) and 160.0+/-10.0msec in group II patients(p<0.01) versus group I). 2) The rate of propagation was 145.0+/-83.4cm/sec in control group, 50.0+/-13.2cm/sec in group I patients(p<0.01 versus control group) and 59.9+/-26.0cm/sec in group II patients(p<0.01 versus control group). 3) The propagation ratio was 2.27+/-1.29cm/sec in control group, 0.93+/-0.25cm/sec in group I patients(p<0.05 versus control group) and 0.86+/-0.36cm/sec in group II patients(p<0.01 versus control group). CONCLUSION: Analysis of filling flow propagation by color M-mode Doppler is an easy and noninvasive method for evaluation of left ventricular diastolic function and may be an additional tool to pulsed Doppler measurement of transmitral flow, especially in differentiation between normal and pseudonormal, but care must be taken in interpretation because of overlapping of values.
Angina Pectoris ; Arterial Occlusive Diseases ; Chest Pain ; Deceleration ; Diagnosis ; Diastole ; Echocardiography, Doppler* ; Heart ; Heart Ventricles ; Humans ; Male ; Myocardial Infarction ; Relaxation

BACKGROUND: Left atrial thrombus(LAT) has long been recognized as a complication of mitral stenosis(MS).The transesophageal echocardiographic approach readily visualize LAT. We evaluated the risk factors for left atrial thrombus in patients with MS using transthoracic(TTE) and transesophageal echocardiography(TEE). METHODS AND RESULTS: One hundred and forty-three(patients) who had moderate to severe MS were consecutively studied with TTE and TEE. They were 43 males(30%) and 100 females(70%).The mean age was 44+/-11 years(range 21-70). Twenty-five patients had at least one episode of embolic events. Ninety-six patients were in atrial fibrillation(AF). LAT was detected in 30 pts(21%) : 16 had thrombus confined to the LA appenge(LAA), 14 to true LA cavity and/or LAA. TTE variables were compared between LAT group and non-LAT group. Univariate predictors of LAT were mitral valve area(MVA)(0.78+/-0.22cm2 vs 1.05+/-0.32cm2, p=0.001), pressure half time(353+/-88ms vs 258+/-118ms, p=0.002). LV ejection fraction(EF)(55+/-11% vs 62+/-8%,p=0.008), LA size (58+/-11mm vs 52+/-7mm, p=0.033) and AF(p=0.001). Stepwise logistic regression analysis revealed significant independent predictors of LAT to be AF(p=0.02), MVA(p=0.02) and EF(p=0.03). CONCLUSION: Left atrial thrombus was not uncommon in patients with rheumatic mitral stenosis. Small mitral valve area and reduced ejection fraction of left ventricle appear to be significant predictors of LAT in mitral stenosis with atrial fibrillation.
Atrial Fibrillation ; Echocardiography* ; Heart Ventricles ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Stenosis* ; Risk Factors ; Thrombosis*