BACKGROUND: To evaluate the efficacy of transesophageal echocardiography(TEE) to detect left atrial thrombi(LAT) and to investigate the clinical and echocardiography parameters which related with LAT. METHOD: We performed TEE and TTE simultaneously to 98 consecutive patients who had native mital valve disease or mital prosthesis as usual method. We examined the presence and location of LAT and spontaneous contrast(SC) in TEE and measured left atrial dimension(LAD), ejection fraction(EF), mital valve area(MVA) in TTE. Cardiac rhythm, history of anticoagulation and systemic embolization were also reviewed. We compared such parameters in LAT positive/negative groups and SC positive/negative groups. RESULTS: 1) In TEE, we detected 26 cases of LAT, among them seventeen cases : left atrial appendage(LAA) thrombi, 3 cases : combined LA and LAA thrombi, 6 cases : LA thrombi. In TTE, six cases showed LAT but we couldn't detect LAA thrombi. The difference between two methods was statistically significant(p<0.05). 2) LAT positive group showed larger LAD, lower EF, and higher prevalence of AF, systemic embolization, and LAT than negative groups(p<0.01). 3) SC positive group showed larger LAD, lower EF, higher prevalence of AF, systemic embolization LAT than SC negative groups(p<0.05). 4) In multiple discriminant analysis, the history of systemic embolization was most important factor which can suspect LAT(Wilk's Lambda:0.77152. p<0.0001). SC, EF, presence of AF, LAD, anticoagulation therapy. MVR were also statistically valuable factors in order. The hit ratio of this analysis was 86.84%. CONCLUSION: We can suggest that TEE is very useful method to detect LAT than TTE, and the spontaneous contrast was very important factor which can suggest LAT and systemic embolization in mitral valve disease.
Echocardiography ; Echocardiography, Transesophageal* ; Humans ; Mitral Valve ; Prevalence ; Prostheses and Implants

No abstract available.
Myelitis, Transverse* ; Retrospective Studies*

We report a case of nonsyphilitic isolated coronary ostial stenosis of the left main coronary artery observed by transesophageal echocardiography(TEE) in a 52-year-old woman with angina. The lesion was suspected during coronary angiography and it was not visualized by transthoracic echocradiography. Coronary ostial stenosis, which is potentially lethal as left main coronary artery disease, occurs rarely in the absence of other coronary artery disease. The diagnosis of ostial stenosis has been usually made by the use of coronary angiography, however, it may be difficult to diagnose at angiography if angiographic catheter is positioned across the stenotic lesion, and the unexpected serious complication during coronary angiography in such a patient may happen. The new ultrasonic imaging technique of TEE provides more detailed images of proximal coronary anatomy and coronary blood flow.
Angiography ; Catheters ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Female ; Humans ; Middle Aged ; Ultrasonography

A 67 year old male patients was anesthetized with halothane for a open reduction of the fractured right femur shaft. The patient was admitted to the emergency room after he had cerebra1 contusion and fracture of the femoral shaft by a traffic, accident. Anesthesia was continued for one and a, half hours without any problem. At around one and a half hours of anesthesia, the patient developed cardiac arrest and resuscitation was performed immediately. The patient's life was saved by resuscitation and the operation was completed without any further problem. At the time of the resuscitation, a tension pneumothorax was recognized but anesthesia was continued with immediate, proper management. Closed thoracotomy was performed at the recovery room after anesthesia and the patient recovered from anesthesia without any other problem.
Aged ; Anesthesia ; Anesthesia, General* ; Cardiopulmonary Resuscitation* ; Contusions ; Emergency Service, Hospital ; Femur ; Halothane ; Heart Arrest ; Humans ; Male ; Pneumothorax* ; Recovery Room ; Resuscitation ; Thoracotomy

Induced hypotension is a well established adjunct to anesthesia which provides improved operating conditions for a wide variety of surgical procedures without significantly increasing the risk to the patient. Since introduction of hypotensive anesthesia in 1964 by Gardner, there has been a wide choice of methods for inducing hypotension during anesthesia, most of which are based on the concept of arteriolar dilatation. Hypotensive anesthesia was attempted on ten patients for total hip replacements which were done at Gospel Hospital, from Feb. to Oct. in 1979. The patients selected did not have a liver problem, and this was determined by SGOT and SGPT, and without a limit of age or sex. The hypotension was induced with 2~3% halothane, 50% N2O and 50%, O2and the blood pressure averaged for systolic pressure 71. 22 mmHg and for diastolic pressure 50. 09 mmHg, The average duration of the induced hypotension was 57. 0 minutes and the blood loss during operation was 300 ml on average. During the hypotensive anesthesia, the urine output decreased by 27. 0% and during the recovery period from hypotension urine output increased by 20%. On our experience, we can conclude that hypotensive anesthesia provides good operative conditions and can be performed without damage to vital organs and can reduce blood loss during operation.
Alanine Transaminase ; Anesthesia* ; Arthroplasty, Replacement, Hip* ; Aspartate Aminotransferases ; Blood Pressure ; Dilatation ; Halothane ; Humans ; Hypotension ; Liver

No abstract available.
Child* ; Dehydration* ; Humans

BACKGROUND: Although a number of indices of diastolic function based on transmitral flow have been proposed, no single factor seems to be adequate for seperating patients with normal from with abnormal diastolic functions. Pulsed Doppler echocardiography of pulmonary venous flow(PVF) is another non-invasive method to evaluate left ventricular diastolic performance. The purpose of this study is to evaluate the normal PVF pattern by TEE. METHOD: We performed pulsed-wave Doppler studies of the PVF and of the mitral flow by transesophageal-(TEE) and transthoracic echocardiography(TTE) in a healthy young adults. RESULTS: In TEE, all sublects showed four phases of the PVE pattern ; two antewgrade systolic phase(early and late : SE and SL), one antewgrade diastolic phase(D) and one retrograde diastolic phase(A). In TTE, there were three phases of the PVF pattern ; two antewgrade phase(systolic, diastolic) and one retrograde diastolic phase but we couldn't find out early systolic phase flow. Peak velocity of each phase of PVF was as follows:SE was 48.9+/-14.1cm/sec, SL was 56.3+/-16.1cm/sec, D was 52.6+/-14.9cm/sec. The timing of SL flow was correlated significantly with that of peak aortic flow(r=0.42, p=<0.01), while the timing of D flow and that of A flow were correlated significntly with timing of mitral E peak and A peak, respectively(r=0.84, p<0.01 ; r=0.80, p<0.01). CONCLUSIONS: In the young normal subject, PVF showed four phase of flow pattern and could be easily obtained by TEE. Furthermore it may be used for evaluation of left ventricular function.
Echocardiography, Doppler, Pulsed ; Echocardiography, Transesophageal* ; Humans ; Ventricular Function, Left ; Young Adult*

No abstract available.
Durapatite* ; Dust* ; Rabbits* ; Transplants*

Thirty-seven cases of cardiac neurosis were treated with propranolol (Inderal(R)) and following results were obtained. 1) Symptoms, such as palpitation, dyspnea, chest tightness and chest pain were disappeared or improved in all cases. 2) Heart rate reduced significantly after treatment from 99.8 per minutes to 74.8 per minutes. 3) Systolic blood pressure reduced significantly after treatment from 147.6 mmHg to 131.4 mmHg. but diastolic blood pressure were not reduced significantly. These results indicated that propranolol is recommendable medicine for improving cardiac symptoms and tachycardia in cardiac neurosis.
Blood Pressure ; Chest Pain ; Dyspnea ; Heart Rate ; Neurocirculatory Asthenia* ; Propranolol* ; Tachycardia ; Thorax

No abstract available.