Successful percutaneous transluminal angioplasty (PTA) of an internal mammary artery graft was performed in a 40 year old male patient who had recurrent angina soon after bypass surgery. Coronary angiography showed total occlusion of proximal portion of the left anterior descending artery and normal right coronary artery. Angiography of the left internal mammary artery graft revealed a tight stenosis (90% diameter narrowing) in the mammary artery at its insection into the left anterior descending artery.Angiography after the angioplasty demonstrated a widely patent graft (residual stenosis 10%) and translesional pressure gradient was 10 mmHg.
Adult ; Angiography ; Angioplasty* ; Arteries ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Vessels ; Humans ; Insects ; Male ; Mammary Arteries* ; Transplants*

Myocardial infarction is almost regularly associated with severe and widespread obstructive coronary artery disease. Recently, there have been some reports of myocardial infarction with normal of near normal coronary arteries on cineangiography. The following report concerns 6 cases (4% of a series of 142 consecutively studied patients with myocardial infarction) of myocardial infarction proved on clinical grounds with normal or near normal coronary arteries at coronary angiography obtained several months later. The clinical data was shown in Table 1 and Table 2. All 6 patients were male. Three were in the fifth, two in the sixth, and one in the seventh decade. Multiple risk factors were present in only one patient. Areas of localized dyskinesia or hypokinesia were demonstrated in five on the left ventricular cineangiography. The left ventricular end-diastolic pressure was greater than 12 mmHg in all 6 patients. One patient had hypertrophic cardiomyopathy and the remaining 5 patients had no underlying heart diseases. One patient had moderate congestive heart tailure. It is possible that prolonged, localized coronary artery spasm or platelet thrombi that subsequently resolved are a part of the pathogenic mechanism.
Blood Platelets ; Cardiomyopathy, Hypertrophic ; Cineangiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Dyskinesias ; Estrogens, Conjugated (USP) ; Heart ; Heart Diseases ; Humans ; Hypokinesia ; Male ; Myocardial Infarction* ; Risk Factors ; Spasm

Conventional dual chamber pacing (DDD) preserves atrioventricular synchrony but depend on appropriate sinus node function to achieve physiological heart rate with exercise by atrial tracking. Other indirect indicators of metabolic demand have been used to modulate pacing rate increases with exercise including sensing of pH, respiratory rate, ventricular repolarization and oxygen saturation. The activity sensing approach is unique in that noise generated by activity modulates the response and empirical programming of the unit allows for attaining the desired rate for a given level of activity. Physiologic rate increases can be obtained in patients with sinus node dysfunction or even atrial fibrillation. The lead can either be positoned in the atria for patients without atrial fibrillation or AV conduction disturbance or in the ventricle. We present two cases of rate responsive pacing using the Activitrax.
Atrial Fibrillation ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Noise ; Oxygen ; Respiratory Rate ; Sick Sinus Syndrome ; Sinoatrial Node

Coronary arterivenous fistula(CAVF) is an uncommon congenital coronary anomaly-Bilateral CAVFs that originate from both coronary arteries are very rare. Coronary arteriography performed in recent years has clarified the incidence and various features of this lesion. Baim et al.1) reported that only 5% of the coronary artery fistulas arose from bilateral coronary arteries. In this report, we present a case of bilateral coronary artery pulmonary artery fistulas associated with atypical chest pain.
Angiography ; Arteries* ; Chest Pain ; Coronary Vessels ; Fistula* ; Incidence ; Pulmonary Artery

High output heart failure due to congenital arteriovenous fistula is a rare disease and is difficult to treat. A 27 year old man, suffering from dyspnea, palpitation, lower extremity edema, and abdominal distension admitted May, 1987. At admission there were continuous thrill and bruit at left supraclavicular and infraclavicular area. The heart sound was irregular and rapid, and grade IV/VI pansystolic murmur was audible at the apex. Chest PA showed marked cardiomegaly with pleural effusion and notching at superior aspect of left 2nd rib. Selective left subclavian artery angiogram showed extensive congenital arteriovenous fistula at the area of left subclavian artery and its branches. After setrial feeding artery embolization and palliative operation, the fistula size decreased much with clinical improvement.
Adult ; Arteries ; Arteriovenous Fistula* ; Cardiomegaly ; Dyspnea ; Edema ; Fistula ; Heart Failure ; Heart Sounds ; Humans ; Lower Extremity ; Pleural Effusion ; Rare Diseases ; Ribs* ; Subclavian Artery* ; Thorax

Percutaneous mitral ballon vavuloplasty(PMV) using the double-ballon technique was performal in a 48 year old female patient with recurrent mitral stenosis 16 years after surgical open mitral commissurotomy. PMV resulted in an increase in mitral valve area by Gorlin's method from 0.9 to 2.2 cm2, a decrease in mean mitral diastolic pressure gradient from 30 to 17 mmHg, and an increase in cardiac output from 4.7 to 5.5 L/min. There was no evidene of significant left to right shunt through the atrial septal punture site PMV. After PMV minimal grade 1 mitral regurgutation developed. Mitral ballon valvuloplasty can be performed effectively and safely in selected patients with restenosis after surgical commissurotomy.
Blood Pressure ; Cardiac Output ; Female ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis

To determine factors involved in left ventricular aneurysm formation after transmural anterior myocardial infarction, 74 patients with a first myocardial infarction who underwent cardiac catheterization within 6 weeks of infarction were evaluated.Patients were divided into four groups depending on the status of the left anterioe descending artery(LAD) and the presence Group I(n=15);aneurysm with occluded LAD, Group II(n=16);no aneusrysm and occluded LAD, Group III(n=18);aneusrysm and patent LAD, and Group IV(n=25);no aneusrsm with patent LAD. Neither age, sex nor risk factors for coronary disease correlated with aneusrysm formation,but the duration of chest pain in patients with previous angina was significantly longer in group II(no aneusrysm with occluded LAD) compared with other groups(P<0.01). Single vessel disease was more commom in Group I and III(aneusrysm) compared with II and IV(no aneusrysm)(P<0.06). Collateral blood supply was more frequently observed in Group I and II(occluded LAD) compared with Group III and IV(patent LAD)(P<0.01) and was slightly less in Group I(aneusrysm) compared with Group II(no aneusrym)(P<0.07). Delta area decreasing rate of the left ventricle was significantly lower in Group I and III(aneusrysm)compared with Group II and IV(no aneusrysm)(P<0.01). Single vessel disease in assocition with poor collateral circulation tends to be a determinant of left ventricular aneusrysm formation after anterior myocardial infarction.
Aneurysm* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Collateral Circulation ; Coronary Disease ; Heart Ventricles ; Humans ; Infarction ; Myocardial Infarction* ; Risk Factors

Balloon angioplasty of stenosis involving a bifurcation of coronary arteries carries a significant risk of iatrogenic permanent occlusion of one of the adjacent branches. In order to prevent this complication, kissing balloon technique, inhitially, used for aortoplasty in Leriche synrome, was introduced into coronary angioplasty. Alternatively Oesterle described the single-guide, two-wire technique which is less traumatic with nearly equal outcomes. Among 200 coronary angioplasty cases done in our laboratory, 3 cases of unstable angina pectoris with stenosis involving major bifurcation sites were encountered. In 2 cases with stenosis involving left anterior descending artery and diagonal branch, kissing balloon technique was performed. Single-guide, two-wire technique was performed in remaining 1 case with stenosis of posterior descending and posterior lateral branchs. The outcome were successful without major complications.
Angina, Unstable ; Angioplasty* ; Angioplasty, Balloon ; Arteries ; Constriction, Pathologic ; Coronary Vessels

This study was done to determine the value of thallium-201 stress myocardial perfusion scanning for identifying disease in the individual coronary arteries. Segement analysis of rest and stress myocardial perfusion scanning was performed in 65 subjects who underwent coronary arteriography. Anterolateral wall detects had a sensitivity of 70%, a spectivity of 92%, and a predicitive accuracy of 93.3% for identifying left anterior descending(LAD) coronary artery disease(CAD). Anteroseptal wall defects had a sensitivy of 62.5%, a specificity of 80%, and a predictive accuracy of 83.3% for identifying LAD CAD. Septal wall defects had a sensitivity of 67.5%, a specificity of 92%, and a predictive accuracy of 94.4% for identifying LAD CAD. Inferior wall defects had a sensitivity of 65.4%, a specificity of 89.7%, and a predictive accuracy of 80.9% for identifying right CAD. Posterolateral wall defects had a identifying left circumflex CAD. Thus, although senmental analysis of stress myocardial perfusin scanning can identify LAD CAD with high sensitivity and specificity, only moderate sensitivity and specificity are achieved in identifying right CAD or left circumflex CAD. But stress myocardial perfusion scanning has tendency to identify the most severely ischemic area, use of segmental analysis may be of benefit in the evaluation of patients with ischemic heart disease before or after coronary artery bypass graft and percutaneous transluminal coronary angioplasty.
Angiography ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Myocardial Ischemia ; Perfusion* ; Sensitivity and Specificity ; Transplants

No abstract available.
Seizures*