BACKGROUND: Improvements in catheter equipments and increasing experience of the operators have brought about a broadening of the indications and applications of percutaneous transluminal coronary angioplasty(PTCA). In particular, coronary angioplasty has been employed in total occlusions.We evaluated the initial success rate and safety of PTCA total occulsive coronary artery disease. METHODS: To assess the success rate and safety of PTCA total coronary artery occlusion, the data of 24 patients(male 19, female 5, mean age 55+/-9 years), in whom PTCA for total occlusion were performed, were examined. RESULTS: Primary success rate of procedure was 66.7%(16 out of 24 lesions).The success rate according to the duration of total occlusions was 8 out of 11(72.7%) with occlusions<4 weeks duration and 3 out of 7(42.9%) with occlusions>4 weeks duration(p=0.07). There was no difference in success rate according to vassel dilate(left anterior descending 75.0%, right coronary 44.4%) and length of occluded lesion(0.93%+/-0.47%cm, p=0.35). Eight procedural failures included inability to cross the lesion with a guide wire in 6 and inability to dilate the lesion in 2, but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Even though the recanalization of occluded coronary arteries has a lower initial success rate than angioplasty for stenotic arteries, PTCA in total occlusion can be performed as a safe and effective therapeutic modality in selective patients.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arteries ; Catheters ; Coronary Artery Disease ; Coronary Vessels* ; Death ; Emergencies ; Female ; Humans

BACKGROUND: Indications and applications of percutaneous transluminal coronary angioplasty(PTCA) have been broaden recent years. We evaluated the initial success rate and safety of PTCA in mulitiple lesions and vessels. METHODS: To assess the success rate and safety of PTCA In mulitiple lesions and vessels, the data of 60 lesions from 28 patients(male 23, female 5, mean age 56+/-12 years), in whom PTCA for multiple lesions and vessels were performed, were examined. Initial results and complications were compared in 37 lesions undergoing multivessel and 23 lesions undergoing multilesion PTCA. RESULTS: Overall primary success rate of procedure was 82%(49 out of 60 lesions). Angioplasty was attempted in mean 2.1 stenotic lesions per patient. Primary success rate per lesion was 84%(31 of 37) among those who underwent multivessel and 78%(18 of 23) among those who underwent multilesion PTCA(p>0.05). Success rate according to the combination of dilated vessels was 85.7%(12 of 14) in left anterior descending(LAD) and left circumflex(LCX), 83.3%(10 of 12) in LAD and right coronary artery(RCA), 100.0%(4 of 4) in LAD and diagonal branch, RCA and LCX in 75.0%(3 of 4), and 66.7%(2 of 3) in LAD, LCX and diagonal branch. Eleven failures(18.3%) included inability to pass the guide wire cross the lesion or inability to locate the balloon catheter in 5(8,3%), abrupt closure in 2(3,3%), coronary spasm in 1(1.7%) and major branch occlusion in 3(5.0%), but there was no emergency coronary bypass surgery or cardiac death. CONCLUSION: Coronary angioplasty in selected patients with multivessel and multilesion coronary artery disease might be useful and have relatively good initial results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angioplasty* ; Catheters ; Coronary Artery Disease ; Death ; Emergencies ; Female ; Humans ; Spasm

"Dual LAD" was defined as the early bifurcation of the proximal LAD into two vessels : a short LAD which remained in the anterior interventricular sulcus and does not reach the apex, and a long LAD which leaves the anterior interventricular sulcus only to return to the distal sulcus and continue to the apex. Recognition of "Dual LAD" is essential to prevent errors of interpretation of the coronary arteriogram and for planning of optimal surgical therapy. We report 2 cases of "Dual LAD" with the review of the literatures.
Coronary Vessels*

To evaluate the diagnostic value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography, sensitity, specificity and predicitive value of thallium-201 stress myocardial scintigraphic imaging were compared to simultaneously recorded 12 lead electrocardiography in 17 normal subjects and 30 patients with coronary artery disease who proved by coronary arteriography. The following results were obtained. 1) The mean age was 49.5+/-10.7 years(mean+/-SD)in subjects with normal coronary arteries and 53.1+/-8.8 years in patients with stenotic coronary arteries. 2) Fourteen patients had one-vessel disease, 10 two-vessel disease and 6 three-vessel disease. 3) Sensitivity of thallium myocardial scintigraphic imaging was higher than that of stress electrocardiography(86.7% vs 76.7%). 4) Specificity of both tests was same(70.6% vs 70.6%). 5) Sensitivity of thllium-201 stress myocardial scintigraphic imaging and stress electrocardigraphy in relation to the extent of coronary artery disease showed 78.6% vs 64.3% in one vessel disease, 90% vs 80% in two-vessel disease and 100% vs 100% in three-vessel disease. 6) Predictive value of thallium-201 stress myocardial scintigraphic imaging and stress electrocardiography revealed 83.9% vs 82% in the postive test and 75% vs 63.2% in the negative test. In conclusion, even though thallium-201 stress myocardial scintigraphic imaging was superior to stress electrocardiography in diagnosing coronary artery disease, scintigraphic defects were noted in 5 subjects with normal coronary arteries which could mislead to erroneous diagnosis of coronary artery disease. This point should be taken into consideration in the interpretation of thallium-201 stress myocardial scintigraphic imaging.
Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Electrocardiography* ; Humans ; Sensitivity and Specificity ; Thallium

Patients with hypertrophic cardiography often complain of chest pain and have electrocardioagrams suggesting myocardial damage or ischemia. Some of three patients have associated coronary arterial atherosclerosis. Transmural myocardial infarction may occur in patients with hypertrophic cardiomyopathy in the absence of significant atherosclerosis of the extramural coronary arteries, about which several pathophysiologic exlpanations were discussed. Presented here, a case of 49-year-old man with hypertrophic cardiomyopathy accompanied with myocardial infarction and angiographically normal coronary arteries is reported. Asymmetric septal hypertrophy, characteristic morphologic abnormality of hypertrophic cardiomyopathy, was progressed to dilated cardiomyopathy after the occurrence myocardial infarction.
Atherosclerosis ; Cardiomyopathy, Dilated ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Coronary Vessels ; Humans ; Ischemia ; Middle Aged ; Myocardial Infarction*

We studied 70 cases of transmural myocardial infarction with first attack to look into the coronary anatomy of the infarct-related artery in the time course of infarction and evaluate the left ventricular wall motion according to patency of the infarct-related artery. The following result were obtained. 1) Among 70 cases with transmural myocardial infarction, 47(67.1%) had anterior infarction and 23 (32.9%) inferior infarction. Mean age of the total cases was 52.1+/-10.6 and M:F ratio was 7.8:1. 2) 28 cases were single vessel disease(40.0%), 19 cases were two vessel disease(27.1%), 18 cases werew three vessel disease(25.8%) and 5 cases had insignificant coronary stenosis (7.3%) with 4 cases of normal coronary artery. 3) The total occlusion rate of the infarct-related artery in 70 cases was 48.6%. The total occlusion rate of the 8 cases catheterized within 1 day was 87.5%, that of the 17 cases from 2nd to 15th day 52.9% that of the 23 cases from 16th day to 2nd month 39.1%, that of the 15 cases from 3rd to 12th month 40.0% and that 7 cases from 2nd and 6th year 42.8%. These results suggest that the natural resolution of the infarct-related artery has almost happened within 2 weeks. 4) The left ventricular ejection fraction was higher and the left ventricular end-diastolic pressure was lower in the group with incomplete occulsion of infarct-related artery than in those with complete occulsion, and left ventricular wall motion was better in the group with incomplete occulsion of the infarct-related artery than in those with complete occulsion.
Arteries* ; Catheters ; Coronary Stenosis ; Coronary Vessels ; Infarction ; Myocardial Infarction* ; Stroke Volume

No abstract available.
Carcinoma, Transitional Cell* ; Humans* ; P-Glycoprotein* ; Urinary Bladder*

BACKGROUND: Since the nonsurgical treatment of mitral stenosis using a single balloon has been introduced by Inoue et al. in 1984. percutaneous mitral valvuloplasty has became an accepted therapeutic modality for selected patients with mitral stenosis. Zeibag et al. demonstrated the double balloon technique showed a better outcome than the single balloon in obtainning the optimal mitral valve area. On the other hand, there are several reports that single balloon technique was comparable with the double balloon technique. Therefore, there are still controversies in efficacy, benefit and complications between balloon techniques. METHOD: To compare the efficacy and complications of percutaneous mitral valvuloplasty with the double balloon or the Inoue balloon technique, 40 patients were studied consecutively by random method in selecting the balloon technique. RESULTS: In all cases, percutaneous mitral valvulopasty was performed successfully. Optimal outcome defined as mitral valve area larger than 1.5cm2 was obtained in 12 cases out of 16(75%) in double balloon group and 15 out of 24(63%) in Inoue balloon group(p=NS). Mitral valve area was significantly increased after valvulopasty in both technique but there was no different between both groups(Mean+/-SD ; 0.9+/-0.3 to 1.7+/-0.2 vs 0.9+/-0.2 to 1.9+/-0.2cm2). There were also hemodynamic improvement significantly in mean mitral gradient(MG). pulmonary artery pressure (PAP) and left atrial pressure(LAP) after PMV but there were no difference between groups (18+/-8 to 7+/-2 vs 21+/-13 to 9+/-4 mmHg for MG. 29+/-12 to 22+/-9 vs 28+/-9 to 18+/-5mmHg for PAP and 22+/-8 to 11+/-5 vs 21+/-6 to 11+/-4 for LAP respectively). Mitral requrgitation greater than grade 2 occurred in 2 cases of the double balloon group and one case of the Inoue balloon group(p=NS). New development of atrial shunt was found in 3 cases in both groups. CONCLUSIONS: The double and Inoue balloon techniques were quite comparable in immediate outcome and complications.
Hand ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Prospective Studies* ; Pulmonary Artery

We evaluated the hypolipidemic effect and adverse reaction of Lovastatin, HMG-CoA reductase inhibitor 20 to 40mg once-daily in the evening, in 20 patients with primary hypercholesterolemia for 12 weeks and the following results were obtained. 1) Lovastatin significantly reduced the total cholesterol(from 264.8+/-12.9mg/dl to 195.3+/-31.3mg/dl) by 26.3%, TG(from 191.1+/-41.5mg/dl to 156.2+/-52.9mg/dl) by 18.3%, LDL-C(from 177.0+/-12.4mg/dl to 121.3+/-19.6mg/dl) by 31.5% and increased th HDL-C (from 39.8+/-4.2mg/dl to 41.6+/-5.0mg/dl) by 4.5% at the end of 12th week. 2) The adverse reaction during the period of study were limited to diarrhea and nausea in one patient, dryness of skin and itching in one patient, and no patients was withdrawn form therapy. In this study, Lovastatin was well toterated and effective agent for the treatment of hypercholesterolemia without serious side effects.
Diarrhea ; Humans ; Hypercholesterolemia* ; Lovastatin ; Nausea ; Oxidoreductases ; Pruritus ; Skin

No abstract available.
Mitral Valve*