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

BACKGROUND AND OBJECTIVES: Eectrocardiogram (ECG) may provide valuable informations regarding the infarct-related artery (IRA), which may be of guidance in selecting the therapeutic modality. ST segment elevation in inferior leads usually indicates occlusion of right coronary artery, less often left circumflex coronary artery or rarely occlusion of left anterior descending coronary artery may be the cause. We are to determine whether the initial ECG can differentiate the right coronary artery (RCA) or left circumflex artery (LCx) occlusion in acute inferior myocardial infarction (IMI). MATERIALS AND METHOD: We compared retrospectively the ECG recorded within 12 hours from the onset of chest pain with coronary angiographic findings in 85 patients (34% of all 250 patients) having electrocardiographic criteria for IMI. RESULTS: 1) Angiographic characteristics. Of the 85 patients, IRA was RCA in 65 (76%) (38[58%] proximal, 27[42%] distal to first right ventricular branch), and LCx in 20 (24%) (nine[45%] proximal to first obtuse marginal branch or involving a high first marginal branch, eleven[55%] distal obstruction). RCA dominance was more common in RCA occlusion group (100% vs 80%, p=0.001), and LCx dominance in LCx occlusion group (15% vs 0%, p=0.001). No significant difference was noted between two groups regarding vessels diseased, involvement of left anterior descending coronary artery and contralateral artery (RCA or LCx), location of the lesion. 2) Electrocardio-graphic characteritics. Lateral limb leads (I, aVL) :ST segment depression (> or = 1 mm) was more common in RCA occlusion group (82% vs 45%, p=0.001). Isoelectric ST segment in I was more common in LCx occlusion group (100% vs 15%, p=0.001). Left precordial leads (V(5,6)) :ST segment elevation (> or = 1 mm) was more common in LCx occlusion group (60% vs 15%, p=0.001). Isoelectric ST segment was more common in RCA occlusion group (57% vs 20%, p=0.004). ST segment depression (> or = 1 mm) was not different between two groups. Right precordial leads (V(1-4)) :ST segment changes were not different between two groups. Lead I and left precordial leads (V(5,6)) :Isoelectric ST segment in lead I and ST segment elevation (> or = 1 mm) in V(5) or V(6) was more common in LCx occlusion group (60% vs 5%, p<0.05, sensitivity 60% specificity 95% positive/negative predictive value 80%/89%, test accuracy 87%). Amplitude of R wave in V(1) :Amplitude of R wave in V was greater in LCx occlusion group (3.60+/-1.42 mm vs 2.20+/-1.42 mm, p<0.05). CONCLUSION: The initial electrocardiogram was useful in differentiating LCx occlusion from RCA occlusion in patients with IMI. Absence of ST segment depression in I and aVL, and ST segment elevation in V(5,6), isoelectric ST segment in I, tall R wave in V(1) were significantly more common in LCx occlusion.
Arteries* ; Chest Pain ; Coronary Vessels ; Depression ; Electrocardiography* ; Extremities ; Humans ; Inferior Wall Myocardial Infarction* ; Retrospective Studies ; Sensitivity and Specificity

The therapeutic strategy of the left main disease is quite different frorn usual coronary artery disease. Therefore, the diagnostic evaluation should be done carefully. Eventhough coronary angiography has been considered as a gold standard for the diagnosis of left main disease, its diagnosis is not possible in all cases. In questionable situation, direct visualization of the left main coronary artery and Doppler measurements of coronary blood flow by transesophageal echocardiography may give some diagnostic aids. We report a case of suspected isolated ostial left main stenosis, which was helped diagnotically by perfoming transesophageal Doppler echocardiography.
Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Echocardiography, Doppler* ; Echocardiography, Transesophageal

BACKGROUND: Thrombus-containing lesions (TCL) are associated with lower initial success rates and higher restenosis rates after balloon dilation. Furthermore, it has been considered as an absolute contraindication of coronary stenting. With advances in antithrombotic regimens and implantation techniques, coronary stenting has been widened to lesions with adverse morphologic features or to patients with acute coronary syndrome. Here we report the early clinical and angiographic results of coronary stenting in TCL. METHODS: We studied 24 consecutive patients (58+/-8 years, 18 males) undergoing coronary stenting in TCL. Fifteen patients (63%) were treated for acute myocardial infarction (AMI) and 9 (37%) for unstable angina. Stenting was performed as the primary therapy in 23 patients (96%) and secondary after angioplasty failure in I patient (4%). RESULTS: 1) Twenty-five stents were deployed successfully in all 24 patients with TCL. Distal flow with TIMI grade 3 was obtained immediately in 21 patients (88%). Ventricular fibrillation occurred in 3 patients (13%) during the procedure-related death or emergency bypass surgery did not occur. Marked CK elevation (over 5000U/L) was observed in 5 patients (21%) with AMI who underwent primary stenting. Two of these 5 patients (8%) had distal flow with TIMI grade 2 consistent with distal embolization, and one (4%) had distal flow with TIMI grade 0, suggesting acute stent occlusion. All 24 patients (100%) were event-free and showed clinical improvement at the last follow-up visit (71+/-15 days). 2) Quantitative angiography demonstrated excellent angiographic results after stenting (minimal luminal diameter 0.3+/-0.3 vs. 3.4+/-0.3mm, diameter stenosis 90.1+/-10.7 vs. -13.3+/-8.1%, p<0.005 respectively). Acute gain was 3.1+/-0.3mm (p<0.005). CONCLUSIONS: With low incidents of complications, coronary stenting could be used successfully for select patients with TCL as a primary therapeutic option under aggressive antithrombotic therapy. Although early clinical results were excellent, the long-term benefits remain to be established.
Acute Coronary Syndrome ; Angina, Unstable ; Angiography ; Angioplasty ; Constriction, Pathologic ; Emergencies ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Phenobarbital ; Stents* ; Ventricular Fibrillation

Annuloaortic ectasia, cystic medial degeneration of the afflicted aortic wall leading to progressive dilatation, is often accompanied by Marfan's syndrome. Some portions of intimal flap is commonly demonstrated along the aorta in the noninvasive diagnosis of aortic dissection. We report the first case of circumscribed aortic dissection developed in a 28 year old obese non-Marfanoid patient. He was transferred after thrombolytic therapy at a community hospital because of severe chest pain and ST segment elevation. Transthoracic echocardiography showed markedly dilated aortic root, moderate amount of pericardial effusion, mild aortic regurgitation in spite of normal regional wall motion of left ventricle. Intimal flap, characteristic of aortic dissection, was not seen with computed tomography. Intimal tear was demonstrated just above aortic valve only by transesophageal echocardiography. Two parallel intimal tear and small circumscribed dissection was demonstrated by autopsy.
Adult ; Aorta ; Aortic Valve ; Aortic Valve Insufficiency ; Autopsy ; Chest Pain ; Diagnosis ; Dilatation ; Dilatation, Pathologic* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Ventricles ; Hospitals, Community ; Humans ; Marfan Syndrome ; Pericardial Effusion ; Thrombolytic Therapy

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.
Adenomyosis* ; Animals ; Female ; Humans ; Hypertrophy ; Leiomyoma* ; Magnetic Resonance Imaging ; Mice ; Myoma ; Myometrium ; Pregnancy ; Prospective Studies ; Uterus

BACKGROUND: Plaque rupture of the atherosclerotic plaque is an important pathophysiologic mechanism of acute coronary syndrorne(acute myocardial infarction or unstable angina). Plaque rupture and resulting thrombus formation could be identified by intravascular ultrasound (IVUS), even though the sensitivity was variable in previous reports. We sought to know the morphologic characteristics, incidence of plaque rupture and thrombus formation by ultrasound in patients with acute coronary syndrome. METHOD: Between April and Septernber 1997, 23 admitted patients who was diagnosed as unstable angina or acute rnyocardial infarction was included. We performed coronary angiography with IVUS examination within 2 weeks. Atherosclerotic plaque was classified into soft, fibrous, calcific, and mixed plaque, and plaque rupture was defined as rupture of fibrous cap with discontinuity and / or backflow into plaque. Thrombus was defined as a scintillating, movable mass or layering materials that could be distinguished from underlying plaque. RESULTS: Most of the plaques were soft and mixed types(14 and 6, out of 23 cases). Plaque rupture could be identified only in small portion(6 cases, 26%) of the cases. Thrombus was noted in 12 cases(52%). 4 cases showed both plaque rupture and thrombus. CONCLUSION: Soft plaque is the most frequent plaque pye in acute coronary syndrome. IVUS is a useful tool to identify the morphologic features of the plaque such as rupture and thrombus formation.
Acute Coronary Syndrome* ; Angina, Unstable ; Coronary Angiography ; Humans ; Incidence ; Infarction ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture ; Thrombosis ; Ultrasonography*

Anomalous origin of the left circumflex coronary artery(LCx) from the right sinus of Valsalva is the most common coronary anomaly and, generally, is considered to be benign. Nevertheless, myocardial infarction or sudden death in young patients with this coronary anomaly has infrequently been described. The LCx arises from the right sinus of Valsalva or proximal right coronary artery, courses posterior to the aorta to enter the left atrioventricular groove, and provide branches to the left lateral wall of heart. Transthoracic or transesophageal echocardiography may provide a useful diagnostic clue although coronary angiography is the standard diagnostic method. We report 2 cases of anomalous origin of the LCx from right aortic sinus with typical echocardiographic images.
Aorta ; Coronary Angiography ; Coronary Vessels* ; Death, Sudden ; Echocardiography* ; Echocardiography, Transesophageal ; Heart ; Humans ; Myocardial Infarction ; Sinus of Valsalva

No abstract available.
Jaundice, Obstructive* ; Pancytopenia* ; Ticlopidine*

Persistent left superior vena cava (PLSVC) is a rare but one of the most common venous anomalies. Its incidence is reported as 0.3 - 0.5% in the general population, but in those with congenital heart disease, its incidence may range as high as 3 - 10%. PLSVC draining into coronary sinus is usually of little hemodynamic consequences, but it may become significant during cardiac catheterization, transvenous pacemaker insertion and cardiac surgery. Some investigators suggested that this anomaly is related with cardiac electrical instability due to anomalous development of AV nodal tissue with venous draining anomaly, and others suggested that the predisposing anomaly is in the sinus node and the dysrrhythmia is part of sick sinus syndrome. We report a 48 year-old female who had intermittent palpitation and near syncope, was diagnosed as sick sinus syndrome and underwent to implant permanent dual pacemaker implantation. Before implantation, we suspected PLSVC in 2-dimensional and contrast echocardiogram and confirmed it by cardiac catheterization. So, we successfully performed pacemaker implantation via right subclavian approach.
Cardiac Catheterization ; Cardiac Catheters ; Coronary Sinus ; Echocardiography ; Female ; Heart Defects, Congenital ; Hemodynamics ; Humans ; Incidence ; Middle Aged ; Research Personnel ; Sick Sinus Syndrome* ; Sinoatrial Node ; Syncope ; Thoracic Surgery ; Vena Cava, Superior*