BACKGROUND: Patients with sinus rhythm, the left atrial appendage(LAA) appeared as a vigorously contracting structure and the blood flow patterns of LAA showed biphasic configuration. However, patients with AF rhythm the blood flow showed irregular or no configuration in doppler echocardiographic study. The purpose of this study is to evaluate relationship between the blood flow patterns of LAA with the presence of spontaneous contrast(SC) and thrombi in LAA. METHODS: We performed TEE and TTE simultaneously to 58 consecutive patients who had native mitral valve disease or mitral prosthesis. Spontaneous contrast(SC) and the presence and location of LAA thrombi were evaluated during TEE and left atrial dimension(LAD) & ejection fraction(EF) were evaluated during TTE. We divided the whole subjects into three groups according to the blood flow patterns ; regular pattern(Group 1), irregular pattern(Group 2), no flow pattern(Group 3). RESULTS: 1) Blood flow within the left atrial appendage is divided with three groups among of them, atrial fibrillation have two blood flow patterns. 2) Peak prositive & negative flow velocity within LAA in AF rhythm groups were slower than normal sinus rhythm group.(p<0.01) 3) Left atrial dimension in group 3 is significantly larger than others groups.(p<0.01) 4) Spontaneous contrast(SC) with LAA could be detected in 2(6.8%) of the 29 patients of group 1, 6(31.5%) of the 19 patients of group 2, 10(100%) of the 10 patients of group 3. Incidence of SC within LAA in group 3 is significantly higher than others groups. 5) LAA thrombi could be detected in 1(3.4%) of the 29 patients of group 1, 1(5.2%) of the 19 patients of group 2, 3(30%) of the 10 patients of group 3. Incidence of LAA thrombi is significangly higher than other groups. CONCLUSIONS: We can suggest that blood flow within LAA is divided into three groups according to the blood flow patterns, and spontaneous contrast and thrombi in LAA were closely related with the blood flow pattern.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Humans ; Incidence ; Mitral Valve ; Prostheses and Implants

OBJECTIVES: Radiofrequency(RF) ablation is an effective and low risk curative treatment for supraventricular arrhythmias. Catheter ablation produced cardiac lesions primarily through formation of coagulation necrosis. We evaluated the degree of myocardial injury after RF catheter ablation by means of serial measurement of myocardial enzyme. METHODS: Fifty-one patients with symptomatic supraventricular tachycardia were included. There were 32 men and 19 women(mean age. 39.5+/-15.4 years)All patients underwent electrophysiologic study to detect accessary pathway and ablation with radiofreguency current. A mean of 18.3+/-14.2 radiofrequency pulses were delivered. The pulses were at a power of 50 to 60 Volts for a duration of 20 to 30 seconds. Unipolar method and a 6F or 7F catheter with a 4 mm tip electrode was used. LDH, CPK and Ck-MB as a kind of cardiac enzyme were measured before and after ablation. RESULTS: 1) The concentration of LDH and CPK were elecated at 8 hours and 16 hours after ablation (p<0.05). 2) The concentration of CK-MB was elevated at 8 hours, 16 hours, 24 hours and 72 hours after ablation(p<0.05). 3) There was no correlation between the number of applications and amounts of radiofrequency current and rise in LDH, CPK, CK-MB concentration. CONCLUSION: The concentration of LDH, CPK and CK-MB were elevated after ablation but they were within normal limits. RF catheter ablation produced myocardial damage inevitably but were within normal limits. RF catheter ablation produced myocardial damage inevitably but minimally, then RF ablation is an effective and safe therapeutic modality for patients with symptomatic tachyarrhythmias.
Arrhythmias, Cardiac ; Catheter Ablation* ; Catheters ; Electrodes ; Humans ; Male ; Necrosis ; Tachycardia ; Tachycardia, Supraventricular*

BACKGROUND: In vitro study, normal cardiac prosthetic valve has functional regurgitation due to structural characteristics of prosthetic valve. To evaluate functional regurgitant characteristics of prosthetic valves, we examined patients who had clinically normal mitral prosthesis. METHODS: Transesophageal two-dimensional and color doppler echocardiography were performed to 25 patients who had the clinically normal mitral prosthesis. RESULTS: Seven patients had the mitral bioprosthesis and 18 patients had the mitral mechanical prosthesis. Regurgitation was found in 4 patients(57%) with bioprosthetic valve, and the pattern of regurgitation was central in three patients and unilateral in one patient. But regurgitation was detected in 17 patients(94%) with mechanical prosthesis, and the pattern of regurgitation was bilateral in twelve patients, unilateral in four patients and central in one patient(p=0.0035). The length of regurgitant jets were 22.00+/-6.73(mm) in bioprosthetic valve and 28.65+/-7.33(mm) in mechanical valve. The regurgitant jets were detected in systolic period in most of patients. But in 4 patients who had tachycardia during TEE, regurgitation was detected in systolic and early diastolic period. CONCLUSION: Regurgitation was found in clinically normal cardiac prosthetic valves by TEE. These findings may be useful to differentiate between normal and abnormal cardiac prosthesis.
Bioprosthesis ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal* ; Humans ; Prostheses and Implants* ; Tachycardia

BACKGROUND: The prompt and accurate diagnosis of acute aortic dissection is decisive for the prognosis of the patient, since an effective surgical and medical therapy can improve the high rate of mortality due to this pathology. Among the various diagnostic methods, transesophageal echocardiography can provide a rapid and accurate method of diagnosing and evaluating dissecting aortic aneurysm and permits prompt initiation of appropriate treatment. Thus we performed transesophageal echocardiography in patients supected to dissecting aortic aneurysm, as a preliminary examination, and now we reported the result. METHODS: We have studied 4 case of dissecting aortic aneurysms among the patient received examination of cardiovascular system by transesophageal echocardiography, since January 1991 at Keimyung University hospital. In these 4 cases, 3 cases had CT scan, 2 cases had MRI scan, and all cases had transthoracic echocardiography simultaneously as a adjuvant diagnostic method. RESULTS: All 4 cases could be promptly and accuratoly diagnosed and typed by transesophageal echocardiography. As a consequence, patients could receive the early medical treatment and good clinical results. CONCLUSION: Transesophageal echocardiography is fast, inexpensive and accurate method in diagnosis of dissecting aortic aneurysm. So we recommend transesophageal echocardiography, as a preliminary examination in case of suspecting dissecting aortic aneurysm.
Aortic Aneurysm* ; Cardiovascular System ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Magnetic Resonance Imaging ; Mortality ; Pathology ; Prognosis ; Tomography, X-Ray Computed

BACKGROUND: Radiofrequency(RF) catheter ablation has rapidly emerged as the treatment of choice for symptomatic reentrant arrythmia associated with accessory pathway or atrioventricular node conduction. Rarely RF catheter ablation therapy can produce the cardiac perforation, ventricular function insufficiency and arrythmia. So, the purpose of this study was to determine the correlation between the RF energy and muscle injury. METHODS: Bovine skeletal muscle was immersed in normal saline, and the entire chamber was heated to 36-37degrees C by water bath. The 4mm tip 7 Fr electrode catheter was placed horizontally on the skeletal muscle surface withoup pressure. RF energy was delicered to tissue for the pulse duration of 10, 20, 30, 40, 50, 60 seconds and voltage of 10, 15, 20, 25, 30, 35, 40, 45volt and total 432 lesions were produced. Horizontal, vertical lesion diameters and depths were measured, and the area and volume of lesion were calculated. RESULTS: Increasing voltage and duration of RF increased the horizontal and vertical diameter, depth, area and volume of lesion(p<0.0001). The RF pulse duration and voltages made lesion below 5mm depth were 45volt applied dbelow 20seconds, 40volt applied below 25seconds, 35volt applied below 32seconds, 30volt applied below 38seconds, 25volt applied during any duation of time. CONCLUSION: So, for prevention of undesirable tissue damage, the adequate pulse duration and voltage of RF must to be delivered to tissue.
Arrhythmias, Cardiac ; Atrioventricular Node ; Baths ; Catheter Ablation ; Catheters ; Electrodes ; Hot Temperature ; Muscle, Skeletal* ; Ventricular Function ; Water

Cardiac manifestations of hypereosinophilic syndrome rarely include left ventricular thrombosis leading to peripheral emboli. And the cases of thrombectomy in patients with left ventricular thrombus and hypereosinophilic syndrome are extremely rare. Recently we experienced a 58-years-old woman with hypereosinophilic syndrome, the history of thalamic infarction and a huge thrombi in left ventricle. We report this case with literatures.
Female ; Heart Ventricles ; Humans ; Hypereosinophilic Syndrome* ; Infarction ; Thrombectomy ; Thrombosis*

BACKGROUND AND OBJECTIVES: The hyperlipidemia by a high-fat diet induce the endothelial dysfunction. We have performed this study to determine the relationship between postprandial hypertriglyceridemia and endothelial function and to know the effects of vitamin E on the endothelial function. MATERIALS AND METHOD: Endothelial function was measured by flow-mediated brachial artery vasodilation (FMD) as percent diameter changes. We have serially measured lipid profiles and FMD after a meal in normal subjects (10 males, mean:26 yr), which test was repeated according to types of meal (high-fat, low-fat and high-fat meal with 800 IU vitamin E). The second stage of this study is consisted of 10 patients with coronary artery disease (CAD, mean:50 yr) and 10 diabetes (DM, mean:48 yr). RESULTS: The serum triglycerides were significantly increased at 2 and 4 hours after a high-fat meal. The FMD was transiently decreased (p<0.001) to 7+/-4% and 7+/-2% at 2 and 4 hours only after a high-fat meal from 13+/-4% at fasting state. The FMD was inversely related with postprandial hypertriglyceridemia (r=0.52, p<0.05). The baseline FMD in patients with CAD and DM were all lower, 9+/-4% and 10+/-5% respectively, than 15+/-2% of normal subjects. The FMD in patients with CAD were improved to 13+/-4%, 13+/-4% and 11+/-6% at 2, 4, and 6 hours after a meal plus vitamin E, respectively. The FMD in diabetic patients were not decreased as same manor in normal subjects. CONCLUSION: The vitamin E can prevent the endothelial dysfunction which is induced by postprandial hypertriglyceridemia in normal subjects and can improve the endothelial dysfunction in patients CAD as well as DM.
Brachial Artery ; Coronary Artery Disease ; Coronary Disease* ; Diet, High-Fat ; Fasting ; Humans ; Hyperlipidemias ; Hypertriglyceridemia ; Male ; Meals* ; Triglycerides ; Vasodilation ; Vitamin E* ; Vitamins*

OBJECTIVES: Among the current therapeutic options for paroxysmal supraventricular tachycardias, only surgery and ablative techniques are curative. However, surgery is associated with substantial cost, morbidity, and rarely death. Recently, catheter ablation techniques have been developed to treat paroxysmal supraventricular tachycardias. These techniques are effective and low-risk curative treatment for supraventricular tachycardias. This article shall describe our clinical experiences in radiofrequency catheter ablation for supraventricular tachycardias and review the literature. METHODS: The study population consisted of 154 patients with supraventricular tachycardias from January 1993 to August 1995. Eighty one patients were men and seventy three patients were women, and their mean age was 41.29 +/- 15.41 years. Radio-frequency currents(mean) were applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus or atrioventricular node. RESULTS: Among 154 patients, the mechanisms for paroxysmal supraventricular tachycardias were found to be atrioventricular reentrant tachycardia involving a concealed accessory pathway in 51(33.1%), Wolff-Parkinson-White syndrome in 57(37%), and atrioventricular nodal reentrant tachycardia in 46 (29.9%). Successful outcomes were achieved in 46 of 46 patients(100%) with atrioventricular nodal reentrant tachycardia, 7 of 8 patients(87.5%) with double accessory pathways, 69 of 72 patients(95.8%) with left-sided accessory pathway, and 19 of 28 patients (67.9%) with right-sided accessory pathway. Total 141 of 154 patients(91.6%) with supraventricular had a successful outcome with radio-frequency current application(mean). CONCLUSIONS: Radiofrequency catheter ablation techniques are highly effective in ablating accessory pathways or modifying atrioventricular node, with low morbidity and no mortality.
Accessory Atrioventricular Bundle ; Atrioventricular Node ; Catheter Ablation* ; Catheters ; Coronary Sinus ; Electrodes ; Female ; Humans ; Male ; Mortality ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome

BACKGROUND AND OBJECTIVES: It has been recently reported that coronary artery disease (CAD) is more correlated with postprandial triglyceride (TG) levels than fasting TG levels. We performed this study to compare the patients with CAD to age- and sex-matched controls in regard to postprandial TG levels and to know the effects of fenofibrate on postprandial TG levels. MATERIALS AND METHOD: Serum TG, total cholesterol (C), HDL-C and LDL-C were measured before, and 2, 4, 6, 8, and 24 hours after a high-fat meal in 22 patients (mean: 60 yr) with CAD and 12 normal subjects (mean: 54 yr). The same parameters were also serially measured after the high-fat meal plus fibrate in 10 patients with CAD (mean: 59 yr). RESULTS: he patients group without fibrate showed that more prolonged and exaggerated hypertriglyceridemia following the meal than normal subjects, especially 4 to 8 hours after the meal and that lower HDL-C throughout the test duration. These changes were also persisted when hyperlipidemic patients were excluded out of the patients group. The patients with fibrate did not show such a significant elevation of TG levels 4 to 8hours after the meal compared when normal subjects. The time to reach the peak TG levels after the meal was 4, 6, and 4 hours after the meal in normal subjects, patients with CAD, and fibrate group, respectively. CONCLUSION: Coronary artery disease is clearly related with postprandial hypertriglyceridemia than fasting TG levels and postprandial hypertriglyceridemia can be somewhat prevented by fibrate.
Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Fenofibrate ; Humans ; Hypertriglyceridemia* ; Meals* ; Triglycerides

PURPOSE: It has been reported that the Nitroblue Tetrazolium(NBT) test is more accurate than the urine pH, leukocyte esterase and nitrite test as a screening test of urinary tract infection (UTI). The purpose of this study is to compare the NBT test with other screening tests and evaluate the clinical usefulness of the NBT test as a screening test. METHODS: We selected 298 results out of the 304 urine cultures which were performed from March, 1999 to July, 1999 and compared them with screening tests such as NBT, urine pH, leukocyte esterase and nitrite tests. We interpreted those results as the urinary tract infection when the screening results were urine NBT(+), pH(>6.5), leukocyte esterase(>or=++) and nitrite(+). RESULTS: Urine NBT, pH and leukocyte esterase tests showed the statistical significance in comparison with the urine culture results(chi-square tests; P<0.001, <0.05, <0.001), while urine nitrite tests did not show statistical significance. As time passing, the sensitivity of 10 min, 30 min, 60 min NBT test was increased to 35%, 72%, 80% respectively but the sensitivity of urine pH and leukocyte esterase was as low as 33%, 16% respectively. But, the specificity of NBT test was reduced from 93% to 53% as the time went by, while the specificity of urine pH and leukocyte esterase tests were as high as each 79%, 96% respectively. Urine NBT tests at 10 min and 30 min showed a higher positive and negative predictive value than those of the other screening tests. CONCLUSION: Urine NBT test as a screening test for UTI was more accurate than the urine pH, nitrite and leukocyte esterase tests. But we think that we should develop a more quick and precise screening test in the future, because of the long time it requires to perform it.
Child* ; Humans ; Hydrogen-Ion Concentration ; Leukocytes ; Mass Screening* ; Nitroblue Tetrazolium ; Sensitivity and Specificity ; Urinary Tract Infections* ; Urinary Tract*