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

To determine the effect of percutaneous transluminal coronary angioplasty on the left ventricular diastolic filling in patients with coronary artery disease, diastolic filling was serially examined before, early(within 2 days) and late(5~15 days) after PTCA using pulsed Doppler echocardiography in 14 patients(12 unstable angina; 2 stable angina). The Control group was consisted of 20 normal persons with similar age and sex distribution. The left anterior descending artery was dilated in 10 patients, the right coronary artery in 3 patients, and the circumflex artery in 1 patient. Peak velocity of early diastolic rapid inflow(E), peak velocity of late diastolic inflow (A), A/E ratio, and deceleration time of E wave were measured by pulsed Doppler echocar diography. 1) LVangiogram was performed in 10 patients, and showed normal wall motion in 7 cases and regional hypokinesia in 3 cases. Delta area decreasing rate was 59+/-10%, and LVEDP was 11+/-4 mmHg. 2) A/E ratio was greater in patient group(1.00+/-0.28) than in normal control (0.64+/-0.10) (p<0.05). There was no significant difference in A and E values between two groups. 3) A/E ratio decreased significantly from 1.00+/-0.28(pre-PTCA) to 0.85+/-0.24 (late post-PTCA) (p<0.01), but there was no significant change at early post-PTCA(0.94+/-0.32). Deceleration time also decreased significantly from 213+/-56 msec(pre-PTCA) to 177+/-34 msec (late post-PTCA) (p<0.05), but there was no significant change at early post-PTCA (199+/-34 msec). In conclusion, there was impairment of left ventricular diastolic filling in patients with coronary artery disease which gradually improved after PTCA, and this result probably is related to post-ischemic "stunned" myocardium.
Angina, Unstable ; Angioplasty, Balloon, Coronary ; Arteries ; Coronary Artery Disease* ; Coronary Vessels* ; Deceleration ; Echocardiography, Doppler, Pulsed* ; Humans ; Hypokinesia ; Myocardium ; Sex Distribution

BACKGROUND: Previous studies indicated that there was important correlation between early patency of infarct-related artery, preservation of ventricular function, and improved survival after thrombolytic therapy for acute myocardial infarction. An increased infusion rate of rt-PA has been shown to result in faster thrombolysis and a high patency rate of occluded vessel in myocardial infarction. Therefore, we evaluated the effect of simplified triple bolus injection of rt-PA on early patency of infarct-related artery and evaluated safety and efficacy of triple bolus injection. METHOD: Patients with acute myocardial infarction presenting up to 6 hour from the onset of chest pain were recruited for the study. Aspring(100-200mg) was given immediately. Total dose for 1.5mg/kg of rt-PA(minimum 75mg, maximum 100mg) was administered as triple bolus intravenous injections. The half of total dose was injected initially, the quarter of total dose was injected at 10 minutes after 1st injection and the remainder was injected at 40 minutes after 1st injection. Five thousand units of heparin was given and 1,000-1,500unit/hr was given continuously. Coronary angiogram was performed at 60 minutes and 7-10 days after the first bolus injection. RESULTS: At 60 minutes, eleven of fourteen patients (78.6%) showed TMI grade-3 of patency in infarct-related coronary artery. There were two patients of hemorrhagic complications. One patient developed cerebellar hemorrhage at third day after rt-PA injection, and the other developed bleeding at femoral sheath site. There was no in-hospital mortality and reinfarction. CONCLUSION: In patients with acute myocardial infarction, the simplified triple bolus injection of rt-PA is associated with high early patency(TMI grade-3) in infarct-related coronary artery, with low risk of major bleeding comlications comparable to other studies.
Arteries ; Chest Pain ; Coronary Vessels ; Hemorrhage ; Heparin ; Hospital Mortality ; Humans ; Injections, Intravenous ; Myocardial Infarction* ; Thrombolytic Therapy ; Tissue Plasminogen Activator* ; Ventricular Function

BACKGROUND: Measurements of coronary flow reserve(CFR) and phasic coronary flow profile are useful in assessment of the physiologic significance of coronary lesions. However, alterations in hemodynamic status are known to influence coronary flow reserve. The purpose of this study was to assess the effect of increase in heart rate on maximal pharmacologin coronry flow reserve and phasic flow pattern. METHODS: We investigated 12 patients(9 females and 3 males, mean age : 49+/-12 years) with normal coronary artery and atypical chest pain syndrome for the measurement of CFR and coronary flow profile. CFR and systolic and diastolic coronary flow velocity integral(CFVI) were measured at the proximal portion of left anterior descending artery with 0.018 inch(12MHz) Doppler guide wire before and during intracoronary injection of 12 mcg of adenosine. The heart rate at the baseline ranging from 62 beats/min to 79 beats/min(mean : 70+/-5 beats/min) was increased to 100 beats/min and again to 120 beats/min by right atrial pacing. RESULTS: CFR progressively decreased from 3.0+/-0.5 at baseline to 2.4+/-0.4 during pacing at 100 beats/min and to 2.0+/-0.3 during pacing at 120 beats.min(p<0.001). CFVI/min at baseline was progressively increased(130+/-15% of control value at 100 beats.min, 135+/-30% at 120 beats.min(p<0.01) whereas in adenosine hyperemia remained unchanged(286+/-81% at hyperemia baseline, 296+/-91% at 100 beats/min, 289+/-105% at 120 beats/min, p>0.05). Systolic CFVI/min was increased at baseline(185+/-35% at 120 beats/min, p<0.01) and in adenosine hyperemia(377+/-153% at hyperemia baseline, 457+/-178% at 120 beats/min, p=0.01). Diastolic CFVI/min was increased at baseline(134+/-178% at 120 beats/min, p<0.01), but in adenosine hyperemia, no significant change was observed(278+/-77% at hyperemia baseline and 251+/-77% at 120 beats/min, p>0.05). CONCLUSION: Increase in heart rate induces a substantial reduction in maximal CFR. Thus,heart rate appears to be one of important variable for the measurement of CFR and phasin coronary flow profile.
Adenosine ; Arteries ; Chest Pain ; Coronary Vessels ; Female ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hyperemia ; Male

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

Profound reduction of anterograde coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite technically successful procedure. We found interesting coronary flow pattern in a patient with acute myocardial infarction, showing angiographic no reflow phenomenon after direct PTCA. The coronary blood flow pattern of the angiographic no-reflow phenomenon in this case was characterized by minimal systolic flow and sharp deceleration of diastolic flow. Coronary flow reserve calculated by the ratio of adenosine induced maximal hyperemic velocity and basal velocity was reduced. The Dopplertipped guide wire was useful for observation of phasic coronary flow pattern of angiographic no-reflow phenomenon.
Adenosine ; Deceleration ; Humans ; Ischemia ; Myocardial Infarction* ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention

Perforation of the interventricular septum complicating acute myocardial infarction is uncommon. The condition was first described anatomically by Latham in 1845 and the first antemortem diagnosis was made by Brunn in 1923. In both cases, bedside catheterization utilizing a flow directed catheter detected a step up of O2 saturation at the ventricular level, compatible with ventricular septal defect, and two dimensional echocardiogram allowed direct visualization and localization of the postmyocardial infarction VSD. Finally cineventriculogram confirmed them.
Catheterization ; Catheters ; Diagnosis ; Heart Septal Defects, Ventricular ; Infarction* ; Myocardial Infarction

Cyclooxygenase (COX) is an enzyme involved in the conversion of arachidonic acid to prostaglandins(PGs), and exists in two forms, COX-1 and COX-2. COX has been reported to be involved in early implantation by secretion of PGs which causes permeability of vessels and reaction of decidual cells around the implantation site. Recently, in mice and sheep studies, COX-1 and COX-2 expression in the endometrium has been reported to be different according to implantation and stages of the estrous cycle, but expression of COX-1 and COX-2 in human endometrium during the menstrual cycle has not yet been established. The purpose of this stuffy was to observe the variances of COX-1 and COX-2 expression by immunohistoehemical staining in endometrial samples obtained from human hysterectomy specimens and biopsies of women of reproductive age according to different stages of the menstrual cycle. Also, we attempted to observe COX-1 and COX-2 expression in the epithelial and stromal cells of the endometrium obtained during the mid-secretory phase, which were cultured separately. COX-2 showed a cyclic pattern of expression according to the different stages of the menstrual cycle and was strongly expressed particularly at the mid-secretory phase which corresponds to the time of implantation. However, COX-1 tended to be increased in the early proliferative, and mid- and late secretory phases, but was also expressed in the whole menstrual cycle showing no particular pattern. In the separately cultured cells COX-1 was expressed in epithilial cells and COX-2 in the stromal cells. The above results suggest that since COX-2 is expressed at the same time as implantation and cultured cells display a specific secretory pattern, COX-2 has inductive endocrine enzyme properties and has an important effect on endometrial cells during implantation. Also, COX-2 expression in endometrial cells may be utilized as a useful marker of endometrial maturation.
Animals ; Arachidonic Acid ; Biopsy ; Cells, Cultured ; Cyclooxygenase 1* ; Endometrium* ; Estrous Cycle ; Female ; Humans* ; Hysterectomy ; Menstrual Cycle ; Mice ; Permeability ; Prostaglandin-Endoperoxide Synthases ; Sheep ; Stromal Cells

BACKGROUND: Previous studies have indicated adenosine triphosphate (ATP) is as potent coronary vasodillator as adenosine (A). We designed this study to compare the vasomotion of coronary artery (CA) between the infusion of ATP and that of A (1). METHOD AND RESULTS: Ten patients with normal CA (6 male and 4 female) age ranging from 41 to 74 years (57+/-11) were studied at LAD and RCA for measurement of coronary flow reserve (CFR), time to maximum effect (Tmax), time to baseline (TBL) in CA during ATP and A infusion. Tmax was achieved earlier with ATP than A, and these results suggest that maximum vasodilation occurs faster with ATP. Side effect profile was similar in 2 patients with mild chest pain with ATP and A. CONCLUSION: Since it has appeared that vasodilatory effect of ATP was comparable to A which has been used in pharmacological stress test in many diagnostic modalities, ATP can be used safely in many clinical setting where A has been used.
Adenosine Triphosphate* ; Adenosine* ; Chest Pain ; Coronary Vessels ; Exercise Test ; Humans ; Male ; Vasodilation

We evaluated the clinical effects of amlodipine in 10 patients(7 male and 3 female) with angina pectoris in terms of the effect on the anginal pain, hemodynamic changes and side effects. The results obtained were as follows; 1) The clinical improvement was obsebed in 8(80.8%) of 10 and 9(88.9%) of 9 patients at 2 and 10 weeks after oral amlodipine. 2) The systolic and diastolic blood pressure was decreased significantly(136.0+/-16.5mmHg vs 117.0+/-10.6mmHg, p<0.01 and 85.0+/-9.7mmHg vs 75.0+/-5.3mmHg, p<0.01 respectively) but the heart rate was indepentent of amlodipine administration. 3) The adverse effects of amlodipine were as headache in 3, facial flushing in 3, palpitation, dizziness, urinary difficulty in 1 respectively and one of them discontinued amlodipine due to severe palpitation and facial flushing.
Amlodipine* ; Angina Pectoris* ; Blood Pressure ; Dizziness ; Flushing ; Headache ; Heart Rate ; Hemodynamics ; Humans ; Male