Since the introduction of percutaneous balloon angioplasty by Gruentzig in 1979, percutaneous coronary intervention (PCI) has become the main treatment modality for the management of coronary heart disease. More than 1,000,000 PCI procedures are performed annually worldwide. With the advent of new therapeutic technologies, the indications for PCI have markedly expanded. Nowadays, improvements in balloon technology, popular use of coronary stent, and the proper administration of antiplatelet agents including GPIIbIIIa inhibitors have influenced the acute procedural outcomes. This technological and procedural advance in PCI has resulted in angiographic success rates of 96 to 99%, with Q-wave MI rates of 1 to 3%, emergency coronary bypass surgery rates of 0.2 to 3%, and unadjusted in-hospital mortality rates of 0.5~1.4%. However, despite the marked improvements in the acute outcome of PCI, long-term results including the restenosis rate are less impressive. The restenosis rate following balloon angioplasty reaches 30~40%, and is higher in certain clinical and angiographic subsets. The recent introduction of intracoronary stent and brachytherapy (intracoronary lesional ionizing radiation therapy) has a favorable impact on the restenosis precess including elastic recoil and intimal hyperplasia. Intracoronary stents decreased elastic recoil and remodeling and intracoronary radiation reduced intimal hyperplasia. Several randomized clinical trials to assess the efficacy of stents and intracoronary brachytherapy are ongoing with impressive results. In 2001, a breakthrough has been made in the prevention and the treatment of restenosis with the advent of a drug-eluting stent. Balloon-expandable stents coated with rapamycin or paclitaxol showed nearly 0% restenosis rate at 6-month follow-up. We might expect to solve restenosis completely in a very near future.
Angioplasty, Balloon ; Brachytherapy ; Coronary Disease ; Drug-Eluting Stents ; Emergencies ; Follow-Up Studies ; Hospital Mortality ; Hyperplasia ; Percutaneous Coronary Intervention* ; Platelet Aggregation Inhibitors ; Radiation, Ionizing ; Sirolimus ; Stents

BACKGROUND: It is now well established that hypercholesterolemia is an important cause of coronary heart disease, and clinical intervention studies have demonstrated the therapeutic value of correcting hypercholesterolemia. One of lipoprotein, lipoprotein(a) [LP(a)] contains one(or two) molecule of apo(a) linked to apo B100 by a disulphied bridge, is associated with an increased risk of coronary heart disease. NIDDM patients have a two-to fourfold increased risk of coronary heart disease relative to nondiabetic subjects. This excess risk is explained only partially by increased levels of standard risk factors. This study was conducted to assess the relatioship between serum Lp(a) levels and coronary heart disease. Furthermore, whether the Lp(a) level was related with NIDDM or not. METHODS: Total 83 subjects undergoing coronary angiography were evaluated on clinical risk factors and lipid profies with Lp(a). Among them, 24 subjects had normal coronary artery, while the others revealed significant stenosis of coronary arteries more than 50%. RESULTS: The serum Lp(a) levels of the CHD group were significantly higher than control group(37.4 +/- 31.8mg/dl vs 22.6 +/- 12.9mg/dl). Other lipids profile were not significantly dfferent between two groups. Serum Lp(a) levels had no relations to fasting blood sugar level. Multivariate logistic regression analysis of lipid parameters revealed that cholesterol, LDL-cholesterol, and Lp(a) were best discriminator among risk factors for coronary heart disease. But in our study, the serum cholesterol and LDL-cholesterol levels were within normal range. CONCLUSION: This study suggested that Lp(a) level was a significant independent risk factor for coronary heart disease whether there was fasting hyperglycemia or not.
Blood Glucose ; Cholesterol ; Constriction, Pathologic ; Coronary Angiography ; Coronary Disease* ; Coronary Vessels ; Diabetes Mellitus, Type 2* ; Fasting ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Clinical Trial ; Lipoprotein(a)* ; Lipoproteins ; Logistic Models ; Reference Values ; Risk Factors*

BACKGROUND: Despite general agreement as to the safety and immediate success of percutaneous iliac angioplasty, its long-term efficacy remains subjects to debate and percutaneous transluminal angioplasty(PTA) induced dissection in the iliac artery may also lead to urgent surgery although frequency of this complication is not clearly stated in the literature. The relatively early result with the use of the Palmaz balloon-expandable intraluminal stent(BEIS) for treating atherosclerotic iliac artery and PTA-induced iliac artery dissections strongly suggest that Palmaz BEIS has its important role for limitations of PTA.It is generally accepted that indications for stent placement are (a) inadequate immediate postangioplasty response (b) restenosis after previous iliac balloon angioplasty, and (c) total iliac artery occlusion. METHODS: We report the successful implantation of Palmaz BEIS at right common iliac artery in a patients suffered from severe claudication. Previously the patients received PTA two times. First PTA resulted in intimal dissection and restenosis occurred after successful second PTA. RESULTS: After successful implantation of Palmaz BEIS, pressure gradients across the lesion and blood flow pattern were nearly normalized. The patients was discharged without symptom and was in good condition after 4 months follow-up. CONCLUSION: According to our this limited experience and other reports, stent placement in valuable adjunct in the management of iliac artery disease.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic* ; Follow-Up Studies ; Humans ; Iliac Artery* ; Stents*

BACKGROUND: Doppler echocardiography is a non-invasive technique that has been used to evaluate LV diastolic dysfunction. Impaired left ventricular diastolic filling is known to occur in patients with coronary artery disease. Compared with those in normal subjects, Doppler-derived transmitral blood flow velocities have been reported to be reduced during early diastolic filling and to be compensatory elevated subsequent to atrial systole in patinets with coronary artery disease. But stiffness of myocardium normalize the E/A ratio, and normal E/A ratio may reveal increased ventricular filling pressure. We tried to investigate left ventricular filling parameters by Doppler echocardiography in patients with early myocardial infarction, and to compare left ventricular diastolic function regarding infarct location on EKG, one or multivessel disease on coronary angiography, and treatment modality. METHODS: From September 1993 to August 1995, Pulsed wave Doppler echocardiography was performed in patients with early acute myocardial infarction(N=95) and control group(N=20) within 5 days after admission, and parameters of diastolic function was evaluated. RESULTS: Echocardiographic data showed significant differences in mean ejection fraction, mean left ventricular mass, and mean left ventricular mass index between two groups. There was no significant difference in E/A ratio, deceleration time, and isovolumetric relaxation time between two groups. Neither, there was significant difference in each diastolic parameter for infarct related wall on EKG. And there was no significant difference in deceleration time for one or multi vessel disease on coronary angiography, treatment modality(conservative treatment, thrombolytic therapy, or primary PTCA). CONCLUSION: In patients with early acute myocardial infarction, left ventricular diastolic dysfunction was absent. And there was no significant correlation between the presence of diastolic dysfunction and the location of infarct related wall on EKG, or one or multi vessel disease, or treatment modality.
Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease ; Deceleration ; Echocardiography ; Echocardiography, Doppler ; Electrocardiography ; Humans ; Myocardial Infarction* ; Myocardium ; Relaxation ; Systole ; Thrombolytic Therapy

BACKGROUND: Although percutaneous transluminal coronary angioplasty(PTCA), first reported in 1977, represents a major advance in cardiovascular therapeutics, acute closure and restenosis are major limitations of PTCA. The focus of this report is to describe the procedural results and short-term follow-up obtained at Yonsei Cardiovascular center. METHODS: We implanted 12 balloon expandable Palmaz-Schatz stents in 12 patients with significant stenosis of coronary artery. Five patients presented as candidates for primary stenting and the remainder presented with restenosis. Clinically, there were unstable angina in 4, stable angina in 5, old myocardial infarction with stable angina in 2, and old myocardial infarction in 1. The stented vessels were the right coronary artery in 4 and left anterior descending artery in 8. All patients received a single stent. The sizes of stents were 3.0mm in 9, 3.5mm in 2, and 4mm in 1. The lesion morphology according to AHA/ACC classification were type A in 1, type B in 10, and type C in 1. The extent of coronary artery disease was 1-vessel in 4, 2-vessel in 6 and 3-vessel in 2. RESULTS: Successful delivery was accomplished in all patients and complications including acute and subacute thrombosis bleeding requiring transfusion, myocardial infarction, and death were absent. Vessel patency after mean follow-up of 7 month showed restenosis in 4 out of 7 patients : 50% in 1, 60% in 1., 0% in 1 and total obstruction in 1 patient. PTCA was done in the patient with 80% restenosis successfully. CONCLUSION: Balloon-expandable intracoronary stenting is a feasible method for treating the acute complication of balloon angioplasty. It seemed to reduce the rate of restenosis for single stent implantation, but long-term results and indications should be evaluated more extensively.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Classification ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies* ; Hemorrhage ; Humans ; Myocardial Infarction ; Stents* ; Thrombosis

BACKGROUND: Recently the percutaneous transradial approach for coronary angiography, transluminal coronary angioplasty or coronary stention were reported but there was no report in Korea. So we tested the safety and efficacy of the transradial appreach for coronary angiography in Korean. METHODS: Eleven patients(male 9, female 2, mean age 59.3 yeal old)with chest pain underwent percutaneous transradial coronary angiography with 5 french multipurpose catheter. We evaluated clinical efficacy and observed complication of percutaneous transradial coronary angiography by physical examination and DOpple ultrasonography of puncture site of radial artery. RESULTS: Right coronary angiography and left ventriculography were performed successfully in all cases, but left coronary angiogrphy was failed in three cases. In another three cases, the patient complained of arm pain which was aggravated during manipulation of the catheter. After the procedure, it took 10.3 minutes to stop the bleeding at the puncture site, Clinically significant complications were not observed after the procedure. The patients were not restricted to bed at all since the completion of the procedure. CONCLUSION: In our limited dexperience, percutaneous transradial coronary angiography could be performend on the outpatient basis without significant complications.
Angioplasty ; Arm ; Catheters ; Chest Pain ; Coronary Angiography* ; Female ; Hemorrhage ; Humans ; Korea ; Outpatients ; Physical Examination ; Punctures ; Radial Artery ; Ultrasonography

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.
Anemia ; Blood Transfusion* ; Drug Therapy ; Extremities ; Femur* ; Humans ; Limb Salvage* ; Osteosarcoma* ; Prognosis

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.
Cardiomyopathies* ; Catecholamines ; Child, Preschool ; Extracorporeal Membrane Oxygenation* ; Female ; Humans ; Hypertension ; Myocarditis ; Neuroblastoma*

OBJECTIVES: Hypertension provokes left ventricular diastolic dysfunction due to decreased elasticity of the ventricular myocardium at first. It has been proposed that the Doppler echocardiography might provide information concerning diastole because of its ability to measure the blood flow velocities across the mitral valve noninvasively. But Doppler mitral velocity may be "normalized" in hypertensive patients in different conditions. The purpose of this study is to evaluate diastolic function in hypertensive hearts using Doppler echocardiography of the pulmonary venous flow in conjunction with mitral flow velocity pattern. METHODS: We measured the mitral flow velocity curves and the pulmonary flow velocity curves in fifty hypertensive patients(mean age : 56.3+/-10.0, man : 19, woman : 31) nad forty healthy adults(mean age : 51.6+/-12.5, man : 14, woman : 26) from March 1995 to December 1995 by using the SONO 1000 of Hewlett Packerd. RESULTS: 1) The mitral flow velocity pattern in 50 hypertensive patients was characterized by the decrease in the peak early diastolic filling velocity(E : 0.59+/-0.12m/sec) and the ratio of E to peak filling velocity(A : 1.00+/-0.46m/sec). Isovolumetric relaxation time and deceleration time were 127.2+/-33.3msec, 258.9+/-40.9msec respectively. They were longer than normotensive patients(P < 0.05). 2) The pulmonary venous flow velocity pattern in hypertensive patients was characterized by the decreased peak diastolic forward velocity(D : 33.7+/-9.8cm/sec) and the ratio of peak systolic forward velocity(S) to D(S/D : 1.60+/-0.5)(P < 0.05). 3) There was no relation between the flow velocity integral parameters and the peak flow velocity parameters of pulmonary venous flow pattern in hypertensive patients. 4) The dofference in the pulmonary venous duration and the mitral A wave duration at atrial contraction (DA-DR) was 20.9+/-29.4 msec in hypertensive patients. DA-DR in normatensive patients was 24.3+/-32.9msec. DA-DR was not significant in hypertensive patients compared with that of the healthy subjects (P < 0.05) CONCLUSION: Analysis of pulmonary venous flow velocity pattern in conjunction with mitral flow velocity pattern in hypertensive patients provides more accurate assessment of left ventricular diastolic function.
Blood Flow Velocity ; Deceleration ; Diastole ; Echocardiography, Doppler ; Elasticity ; Female ; Heart* ; Humans ; Hypertension ; Mitral Valve ; Myocardium ; NAD ; Relaxation

Dermatomyositis is a disease of unknown etiology characterized by inflammation and degeneration of skeletal muscles and cutaneous abnormalities. Cardiac involvement in dermatomyositis-polymyositis is thought to be rare. In recent year, however, there has been an increasing number of reports on cardiac abnormalities in adult dermatomyositis and polymyositis due to development of noninvasive diagnostic techniques. Categorically, these abnormalities have included electrocardiographic changes, cardiac arrhythmias, congestive heart failure, coronary artery disease, and pericarditis. A 56-year-old woman was admittied to the Ewha womans University Hospital with dyspnea and palpitation. She was diagnosed as having dermatomyositis and followed up our department of Dermatology. Electrocardiogram showed a paroxysmal supraventricular tachycardia at as rate of 195/min. The patient was treated with 240mg/day verapamil p.o, 60mg/day prednisone p.o, there was marked improvement of symptoms. Systematic study of cardiac function utilizing echocardiography, Holter monitoring, thallium-201-scan, and gated blood pool studies were conducted in five newly diagnosed patients with dematomyositis-polymyositis. A significant elevation of serum CPK-MB is indicative of cardiac involvement. Cardiac involvement is a serious prognostic sign. We report a case with the review of the literature.
Adult ; Arrhythmias, Cardiac ; Coronary Artery Disease ; Dermatology ; Dermatomyositis* ; Dyspnea ; Echocardiography ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Heart Failure ; Humans ; Inflammation ; Middle Aged ; Muscle, Skeletal ; Pericarditis ; Polymyositis ; Prednisone ; Prognosis ; Tachycardia, Supraventricular* ; Verapamil