A clinical study is done on 234 adult patients with congenital heart disease who visited Dong San Hospital, Keimyung University during the period of January 1982 to May 1987. Among those the number of men is 109 and the female is 125. There are female preponderance in atrial septal defect and patent ductus arteriosus while male in tetralogy of Fallot and pulmonary stenosis. Most of patients are found below 30 years of age and the incidence decrease with age; below 30 years of age, ninty percent of ventricular septal defect, eight-eight percent of tetralogy of Fallot, eighty-four percent of patent ductus arteriosus and seventy-seven percent of atrial septal defect are found. The incidence of congenital heart diseases in adult are as follow; ventricular septal defect 30.8%, atrial septal defect 30.3%, tetralogy of Fallot 17.1%, patent ductus arteriosus 12.8%, pulmonary stenosis 3.4% and miscellaneous congenital diseases 4%. Associated anomalies of major congenital heart diseases are as follows; the most commonly associated anomaly in ventricular septal defect is pulmonary stenosis, and Sinus Valsalva aneurysm with/without rupture or aortic regrugitation is frequently associated in ventricular septal defect. Mitral regurgitation or pulmonary stenosis are frequently as sociated with atrial septal defect. Patent foramen ovale or atrial septal defect and persistent left superior vena cave are associated with tetralogy of Fallot. The lesion of aortic valve is frequent in patient ductus arteriosus.
Adult ; Aneurysm ; Aortic Valve ; Ductus Arteriosus ; Ductus Arteriosus, Patent ; Female ; Foramen Ovale, Patent ; Heart Defects, Congenital ; Heart Diseases* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Incidence ; Male ; Mitral Valve Insufficiency ; Multiple Endocrine Neoplasia Type 1 ; Pulmonary Valve Stenosis ; Rupture ; Tetralogy of Fallot

BACKGROUND: Radiofrequency catheter ablation was introduced the curative method of supraventricular tachycardia in patients with accessory pathways. The success of catheter ablation depends on the accurate localization of accessory pathway and the destruction of accessory pathways. METHOD: We analyzed the local electrograms in 35 patients to be underwent the successful catheter ablation and measured the catheter stability, A/V ratio, AV interval, Accessory pathway potential, and the interval from the onset of RF energy to loss of accessory pathway from local electrograms at the successful ablation sites. RESULTS: The ratio of A wave and V wave range from 0.06 to 6.33 and the mean of A/V ratio is 0.62. The shortest AoVo interval is 20 msec and the longest AoVo interval is 120 msec and the mean of AoVo interval is 58.23 msec. The shortest ApVp interval is 20 msec and the longest ApVp interval is 100 msec and the mean of this interval is 51.88 msec. The incidence of accessory pathway potential among 35 successful ablation sites in 25%. The mean of time from RF energy to loss of accessory pathway is 4.48 sec. CONCLUSION: We concluded that the finding of local electrogram during catheter ablation is very important for shortening of procedure time and the successful procedure.
Catheter Ablation* ; Catheters ; Electrophysiologic Techniques, Cardiac* ; Humans ; Incidence ; Tachycardia, Supraventricular

Pulmonary artery aneurysms are very rare. They are usually associated with congenital cardiac defect. We present one case of pulmonary artery aneurysm associated with patent ductus arterious with the review of the literatures.
Aneurysm* ; Ductus Arteriosus, Patent* ; Pulmonary Artery*

BACKGROUND AND OBJECTIVES: Intracardiac electrocardiographic finding using as a guide for selective catheter ablation in patients with AV nodal reentrant tachycardia (AVNRT) is not specific. Therefore, we evaluated the efficacy and safety of the anatomical approach for catheter ablation in patients with AVNRT. MATERIALS AND METHOD: Among the patients diagnosed as AVNRT by electrophysiologic study, total 66 patients (M:F=26:40) were included in this study. In the right anterior oblique radiographic view, the septal annulus of tricuspid valve, extending from the most posterior region of the annulus adjacent to coronary sinus ostium (posterior) to His bundle recording site (anterior), was divided into posterior (P), mid (M), and anterior (A) sites. Radiofrequency (RF) energies were applied from the posterior part to the anterior part sequentially along the septal annulus of tricuspid valve until successful ablation. RESULTS: Successful anatomical sites were located in posterior (11 patients), mid (48 patients), and anterior (7 patients) sites. The most patients (62 patients) were treated with slow pathway ablation except 4 patients in whom fast pathway was ablated. Probable slow potentials were observed in 8 patients (12%, 3 in posterior sites and 5 in mid sites). Transient complete AV block followed by first degree AV block and delayed complete AV block was occured in one case whose ablation site was A1. And another 3 patients had postablation first degree AV block. CONCLUSION: In patients with AVNRT, the ablated pathway were different according to successful anatomical site. And RF catheter ablation of atrioventricular nodal reentrant circuit guided by anatomical landmark is safe and efficacious.
Atrioventricular Block ; Bundle of His ; Catheter Ablation* ; Catheters* ; Coronary Sinus ; Electrocardiography ; Humans ; Tachycardia, Atrioventricular Nodal Reentry* ; Tricuspid Valve

BACKGROUND: We performed this study to evaluate the long-term clinical prognosis, the effects of anti-anginal medicines on angina, and the factors on recurrence of angina in patients with angina and insignificant coronary artery stenosis (CAS). METHODS: The study population was consisted of 372 patients with angina and normal or minimal (less than 50 % stenosed) CAS out of 2475 consecutive patients who were performed coronary angiogram for 3.5 years. We reviewed the medical record of the study population. RESULTS: Myocardial infarction was developed in 2 cases (0.5%), recurrence of angina 59 cases (16%), and no death during mean 19 months follow-up period out of 372 patients. Patients with normal coronary artery (n=66) were younger (mean 54 yrs vs 59 yrs, p<0.001), had less incidence of diabetes (5% vs 13%, p<0.01), hypertension (19% vs 29%, p<0.05), recurrent angina (15% vs 18%, not significant), and myocardial infarction (0.4% vs 0.9%, not significant) than patients with minimal lesion (n=06). Anti-anginal medicine did not show benefits in relieving recurrent angina. Furthermore, in case of taking nitrates in patients with normal coronary artery, there was more frequent recurrence of angina (23% vs 13%, p<0.01) than not taking nitrates. There were no affecting factors to the recurrent angina among age, sex, ischemic changes on electrocardiogram, smoking, hypertension, diabetes, and hyperlipidemia. CONCLUSION: The long-term clinical outcomes in patients with insignificant CAS were good. Although there were no definite factors for recurrence of chest pain, administration of nitrates may cause more frequent angina in patients with normal coronary angiography.
Chest Pain ; Coronary Angiography ; Coronary Stenosis* ; Coronary Vessels* ; Electrocardiography ; Follow-Up Studies ; Humans ; Hyperlipidemias ; Hypertension ; Incidence ; Medical Records ; Myocardial Infarction ; Nitrates ; Prognosis ; Recurrence ; Smoke ; Smoking

BACKGROUND: Patients with sinus rhythm, the left atrial appendage(LAA) appeared as a vigorously contracting structure and the blood flow patterns of LAA showed biphasic configuration. However, patients with AF rhythm the blood flow showed irregular or no configuration in doppler echocardiographic study. The purpose of this study is to evaluate relationship between the blood flow patterns of LAA with the presence of spontaneous contrast(SC) and thrombi in LAA. METHODS: We performed TEE and TTE simultaneously to 58 consecutive patients who had native mitral valve disease or mitral prosthesis. Spontaneous contrast(SC) and the presence and location of LAA thrombi were evaluated during TEE and left atrial dimension(LAD) & ejection fraction(EF) were evaluated during TTE. We divided the whole subjects into three groups according to the blood flow patterns ; regular pattern(Group 1), irregular pattern(Group 2), no flow pattern(Group 3). RESULTS: 1) Blood flow within the left atrial appendage is divided with three groups among of them, atrial fibrillation have two blood flow patterns. 2) Peak prositive & negative flow velocity within LAA in AF rhythm groups were slower than normal sinus rhythm group.(p<0.01) 3) Left atrial dimension in group 3 is significantly larger than others groups.(p<0.01) 4) Spontaneous contrast(SC) with LAA could be detected in 2(6.8%) of the 29 patients of group 1, 6(31.5%) of the 19 patients of group 2, 10(100%) of the 10 patients of group 3. Incidence of SC within LAA in group 3 is significantly higher than others groups. 5) LAA thrombi could be detected in 1(3.4%) of the 29 patients of group 1, 1(5.2%) of the 19 patients of group 2, 3(30%) of the 10 patients of group 3. Incidence of LAA thrombi is significangly higher than other groups. CONCLUSIONS: We can suggest that blood flow within LAA is divided into three groups according to the blood flow patterns, and spontaneous contrast and thrombi in LAA were closely related with the blood flow pattern.
Atrial Appendage ; Atrial Fibrillation ; Echocardiography ; Humans ; Incidence ; Mitral Valve ; Prostheses and Implants

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*

OBJECTIVES: Radiofrequency(RF) ablation is an effective and low risk curative treatment for supraventricular arrhythmias. Catheter ablation produced cardiac lesions primarily through formation of coagulation necrosis. We evaluated the degree of myocardial injury after RF catheter ablation by means of serial measurement of myocardial enzyme. METHODS: Fifty-one patients with symptomatic supraventricular tachycardia were included. There were 32 men and 19 women(mean age. 39.5+/-15.4 years)All patients underwent electrophysiologic study to detect accessary pathway and ablation with radiofreguency current. A mean of 18.3+/-14.2 radiofrequency pulses were delivered. The pulses were at a power of 50 to 60 Volts for a duration of 20 to 30 seconds. Unipolar method and a 6F or 7F catheter with a 4 mm tip electrode was used. LDH, CPK and Ck-MB as a kind of cardiac enzyme were measured before and after ablation. RESULTS: 1) The concentration of LDH and CPK were elecated at 8 hours and 16 hours after ablation (p<0.05). 2) The concentration of CK-MB was elevated at 8 hours, 16 hours, 24 hours and 72 hours after ablation(p<0.05). 3) There was no correlation between the number of applications and amounts of radiofrequency current and rise in LDH, CPK, CK-MB concentration. CONCLUSION: The concentration of LDH, CPK and CK-MB were elevated after ablation but they were within normal limits. RF catheter ablation produced myocardial damage inevitably but were within normal limits. RF catheter ablation produced myocardial damage inevitably but minimally, then RF ablation is an effective and safe therapeutic modality for patients with symptomatic tachyarrhythmias.
Arrhythmias, Cardiac ; Catheter Ablation* ; Catheters ; Electrodes ; Humans ; Male ; Necrosis ; Tachycardia ; Tachycardia, Supraventricular*

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

Traumatic ventricular septal defect secondary to nonpenetrating chest trauma is very rare. We present one case of nonpenetrating traumatic ventricular septal defect with the review of the literatures.
Heart Septal Defects, Ventricular* ; Thorax*