Echocardiographic examination was performed before, immediately after, 4-6 months after and 10-12 months after mitral valve replacement(MVR) surgery in 46 patients with mitral valve disease(8 patients with mitral regurgitation, 24 patients with mitral stenosis and 14 patients with mitral stenosufficiency) to evaluate the effects of mitral valve replacement on dimension of left atrium and left ventricle, volume of left ventricle, ejection fraction(EF) and fractional shortening(FS) of left ventricle. The results are as follows : 1) The endsystolic dimension(ESD), enddiastolic dimension(EDD), endsystolic volume(ESV) and enddiastolic volume(EDV) decreased significantly after operation in patients with mitral stenoinsufficiency(MSR), the ESD, EDD, ESV and EDV increased significantly after the operation, but returned to preoperative value 10-12 months after the operation. 2) The EF and FS of left ventrcle after MVR were significantly lower than preoperative value throughout the postoperative period in patients with MR. However in patients with MS or MSR, there were no significant postoperative changes in EF and FS, except transient depression in the patients with MS at the immediate postoperative period. 3) In all patients with mitral valve disease, the left atrial dimension and the ratio of domension of left atrium to the dimension of aorta decreased significantly after MVR. From above results, it is suggested that surgery should be considered seriously for the patients with MR before the ESD, EDD and ESV increase maekedly, even if the EF anf FS are in normal range and the symptoms are not severe, to prevent irreversible depression of myocardial function. It seems that serial echocardiographic examination is very helpful in this respect.
Aorta ; Atrial Natriuretic Factor ; Depression ; Echocardiography* ; Heart Atria ; Heart Ventricles ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Mitral Valve* ; Postoperative Period ; Reference Values

BACKGROUND: Angiotensin convertiong enzyme inhibitors have been shown to exert favorable effects on the left ventricular remodeling process associated with ventricular dilation after coronary occlusion. However, the effects of such therapy on global and regional left ventricular remodeling after coronart artery reperfusion have not been characterized, nor have such effects been assessed after exercise training. METHODS AND RESULTS: Female Sprague-Dawley rats(n=80) were randodmized into 4 groups at 5 days after 45 minutes of left coronary artery occlusion followed by reperfusion. Animals completion the experiment included : Untreated Sedentary group(n=20), Untreated with Swimming Exercise group(n=21), Captopril Treated Sedentary group(n=18) and Captoril Treated with Exercise group(n=21). At 3 weeks after randomization, global and regional morphologic changes of the left ventricle(LV) were examined from mid-ventricular transverse slices which were perfusion-fixed at a constant aortic pressure of 60mmHg and a left ventricular cavity pressure of 10mmHG. At rest and during exercise, compared to untreated rats, the captopril treated animals showed significantly decreased LV weight/tibial length ratio(LV/TL)(p<0.01),increased LV cavity area and dimension(both p<0.01), decreased total myocardial area and noninfarcted area(both p<30.001) and reduced wall thicknesses in the noninfarcted and infarcted regions(both p<0.001). Compared to treated and untreated dsedentary rats, exercise significantly increased LV/TL(p<0.05) and epicardial and endocardial areas in the infarcted zone(both p<0.05) and decreased transmurality(p<0.01). Exercise decreased LV cavity area in the captopril treated groups(42.3+/-10.4 vs. 40.4+/-6.0mm2),whereas exercise increased LV cavity area in the untreated groups(33.5+/-8.9 vs. 39.1+/-6.2mm2)(p<0.05). CONCLUSION: These findings provide evidence in rats for evidence in rats for exaggerated left ventricular dilation and supperssion of compensatory myocardial hypertrophy globally and in the infarct zone with 3 weeks of captopril treatment following coronary artery reperfusion with acute nontransmural myocardial infarction. In addition, the effects of captopril on LV dilation and suppression of global and regional hypertrophic response were partially reversible by swimming exercise.
Angiotensins ; Animals ; Arterial Pressure ; Arteries ; Captopril ; Coronary Occlusion ; Coronary Vessels* ; Enzyme Inhibitors ; Female ; Humans ; Hypertrophy ; Myocardial Infarction ; Myocardial Reperfusion ; Random Allocation ; Rats* ; Rats, Sprague-Dawley ; Reperfusion* ; Swimming ; Ventricular Remodeling*

The antiarrhythmic effect of Mexiletine was evaluated in five patients with recurrent ventricular tachycardia and in twelve patients with frequent premature ventricular contractions. Electrophysiologic study was performed on the the patients with recurrent ventricular tachycardia before and after the administration of Mexiletin(600-800mg/day). The antiarrhythmic effects of Mexiletine in the patients with frequent premature ventricular contraction was assessed by ambulatory electrocardiography. The results were as follows: 1) In all of the five patients with recurrent ventricular tachycardia, sustained ventricular tachycardia was induced by programmed ventricular stimulation. However, on repeated electrophysiologic study performed while receiving Mexiletine, ventricular tachycardia was not induced in four patients and non-sustained ventricular tachycardia was induced in one patients. 2) The number of premature ventricular contraction was decreased markedly in seven patients(58.3%) with frequent premature ventricular contractions. 3) Minimal side effects, mild indigestion and tremor, were recorded in 3 cases(23%) while receiving Mexiletine 600 mg/day. The higher dose was associated with more frequent and severe side effects.
Dyspepsia ; Electrocardiography, Ambulatory ; Humans ; Mexiletine* ; Tachycardia, Ventricular ; Tremor ; Ventricular Premature Complexes

A clincal study was made on 383 adult patients with congenital heart disease who visited the Seoul National university Hospital during the period of March, 1961-July, 1979. 1. The incidence of congenital heart disease for the consecutive years was increasing in 1970s, especially in recent two years. 2. The sex incidence of congental heart disease was female 47.0%, male 53.0%, with male preponderance in tetralogy of Fallot, ventricular septal defect, coarctation of aorta, aortopulmonary window and female preponderance in atrial septal defect, patent ductus arteriosus. 3. Age distribution of congenital heart disease showed that 79.1% of all were below 30 years of age but atrial septal defect showed wide distribution below and above 30 years of age. 4. The incidences of each congenital heart disease were atrial septal defect 20.9%, tetralogy of Fallot 20.6%, ventricular septal defect 19.%, patent ductus arteriosus 12.0%, pulmonary stenosis 7.6%, trilogy of Fallot 1.8%, Ebstein's anomaly 1.8%, ventricular septal defect with pulmonary stenosis 1.3%, coarctation of aorta 1.3%, ventricular septal defect with aortic insufficiency 1.0%, transposition of great vessels 1.0%, in order and rare and various combined anomalies. 5. Average duration of illness in congenital heart disease was less than 15 years in majority, but duration from 11 years to 20 years was most common in tetralogy of Fallot. 6. Functional class of congenital heart disease is class II and I in majority, but class III was most common in tetralogy of Fallot. 7. Comparision of precatheterization diagnosis with postcatheterization diagnosis showed concordence in 92.2% and comparison of postcatheterization diagnosis with postoperative diagnosis showed concordence in 95.5% of cases. 8. Electrocardiographic findings in 5 major congenital heart disease were observed as follows; right ventricular hypertrophy 86.3%, right atrial enlargement 16.4% in tetralogy of Fallot, right ventricular hypertrophy 30.9%, incomplete right bundle branch block 27.9% in atrial septal defect, left ventricular hypertrophy 28.8%, right ventricular hypertrophy 10.6%, biventricular hypertrophy 10.6% in ventricular septal defect, left ventricular hypertrophy 63.2% in patent ductus arteriosus and right ventricular hypertrophy 70% in pulmonary stenosis. 9. Postoperative changes in electrocardiographic findings were observed in 36.1% of operated patients, of whom teteralogy of Fallot 61.7%, ventricular septal defect 48.0% were most common. Pstoperative electrocardiographic changes were complete right bundle branch block 58.3%, incomplete right bundle branch block 11.7%, myocardial ischemia 10%, nonspecific ST-T changes 10%, etc. in order.
Adult* ; Age Distribution ; Aortic Coarctation ; Bundle-Branch Block ; Diagnosis ; Ductus Arteriosus, Patent ; Ebstein Anomaly ; Electrocardiography ; Female ; Heart Defects, Congenital ; Heart Diseases* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Myocardial Ischemia ; Pulmonary Valve Stenosis ; Seoul ; Tetralogy of Fallot ; Transposition of Great Vessels ; Trilogy of Fallot

A clincal study was made on 383 adult patients with congenital heart disease who visited the Seoul National university Hospital during the period of March, 1961-July, 1979. 1. The incidence of congenital heart disease for the consecutive years was increasing in 1970s, especially in recent two years. 2. The sex incidence of congental heart disease was female 47.0%, male 53.0%, with male preponderance in tetralogy of Fallot, ventricular septal defect, coarctation of aorta, aortopulmonary window and female preponderance in atrial septal defect, patent ductus arteriosus. 3. Age distribution of congenital heart disease showed that 79.1% of all were below 30 years of age but atrial septal defect showed wide distribution below and above 30 years of age. 4. The incidences of each congenital heart disease were atrial septal defect 20.9%, tetralogy of Fallot 20.6%, ventricular septal defect 19.%, patent ductus arteriosus 12.0%, pulmonary stenosis 7.6%, trilogy of Fallot 1.8%, Ebstein's anomaly 1.8%, ventricular septal defect with pulmonary stenosis 1.3%, coarctation of aorta 1.3%, ventricular septal defect with aortic insufficiency 1.0%, transposition of great vessels 1.0%, in order and rare and various combined anomalies. 5. Average duration of illness in congenital heart disease was less than 15 years in majority, but duration from 11 years to 20 years was most common in tetralogy of Fallot. 6. Functional class of congenital heart disease is class II and I in majority, but class III was most common in tetralogy of Fallot. 7. Comparision of precatheterization diagnosis with postcatheterization diagnosis showed concordence in 92.2% and comparison of postcatheterization diagnosis with postoperative diagnosis showed concordence in 95.5% of cases. 8. Electrocardiographic findings in 5 major congenital heart disease were observed as follows; right ventricular hypertrophy 86.3%, right atrial enlargement 16.4% in tetralogy of Fallot, right ventricular hypertrophy 30.9%, incomplete right bundle branch block 27.9% in atrial septal defect, left ventricular hypertrophy 28.8%, right ventricular hypertrophy 10.6%, biventricular hypertrophy 10.6% in ventricular septal defect, left ventricular hypertrophy 63.2% in patent ductus arteriosus and right ventricular hypertrophy 70% in pulmonary stenosis. 9. Postoperative changes in electrocardiographic findings were observed in 36.1% of operated patients, of whom teteralogy of Fallot 61.7%, ventricular septal defect 48.0% were most common. Pstoperative electrocardiographic changes were complete right bundle branch block 58.3%, incomplete right bundle branch block 11.7%, myocardial ischemia 10%, nonspecific ST-T changes 10%, etc. in order.
Adult* ; Age Distribution ; Aortic Coarctation ; Bundle-Branch Block ; Diagnosis ; Ductus Arteriosus, Patent ; Ebstein Anomaly ; Electrocardiography ; Female ; Heart Defects, Congenital ; Heart Diseases* ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Hypertrophy ; Hypertrophy, Left Ventricular ; Hypertrophy, Right Ventricular ; Incidence ; Male ; Myocardial Ischemia ; Pulmonary Valve Stenosis ; Seoul ; Tetralogy of Fallot ; Transposition of Great Vessels ; Trilogy of Fallot

Alzheimer's disease(AD) is associated with a characteristic neuropathology. The major hallmarks of AD are senile plaques(SPs) and neurofibrillary tangles(NFTs). beta-amyloid protein(Abeta) is derived from the proteolysis of amyloid precursor protein(APP) and then converted to SPs. Mature SPs produce cytotoxicity through direct toxic effects and activation of microglia and complement. NFTs are composed of paired helical filaments(PHFs) including abnormally phosphorylated form of the microtubule-associated protein(MAP) tau and increased tau level in cerebrospinal fluid may be observed in most AD. The aggregation of Abeta and tau formation are thought to be a final common pathway of AD. Acetycholine, dopamine, serotonin, GABA and their receptors are associated with AD. Especially, decreased nicotinic acetylcholine receptors(nAChRs) in AD are reported. Genetic lesions associated with AD are mutations in the structural genes for the APP located on chromosome 21, presenilin(PSN)1 located on chromosome 14 and PSN2 located on chromosome 1. Also, trisomy 21, Apo-E gene located on chromosome 19, PMF locus, low density lipoprotein receptor-related protein and alpha-macroglobulin increase risk of AD. In this article, we will review about the neurobioloby of AD and some newly developed research areas.
Acetylcholine ; Alzheimer Disease* ; Amyloid ; Amyloid beta-Peptides ; Apolipoproteins E ; Cerebrospinal Fluid ; Chromosomes, Human, Pair 1 ; Chromosomes, Human, Pair 14 ; Chromosomes, Human, Pair 19 ; Chromosomes, Human, Pair 21 ; Complement System Proteins ; Dopamine ; Down Syndrome ; gamma-Aminobutyric Acid ; Genetics ; Lipoproteins ; Microglia ; Neurobiology* ; Proteolysis ; Serotonin

Clinical EPS was performed in 16 normal adults without evidence of conduction disease on the surface standard 12 lead electrocardiogram in order to provide normal electrophysiological values of the sinus node function and AV conduction. EPS was also performed in 15 patients with sick sinus syndrome and 10 patients with AV conduction disturbance to evaluate the clinical usefulness of EPS in detecting sinus node dysfunction and AV conduction disturbance. The results were as follows. 1) The results of sinus node function test in the normal group were m-SNRT 853+/-198msec(range 800-1,560msec), c-SNRT 230+/-66msec(range 120-370msec), and %m -SNRT/SCL 127+/-11%(range 114-149%). 2) In 15 patients with SSS, the M-SNRT were ranged from 1,270 to 12,330msec and 10 patients(66%) had significantly increased m-SNRT exceeding 1,560msec. The c-SNRT were ranged from 230 to 10,730msec and 13 patients(83%) had significantly increased c-SNRT exceeding 370msec. The % m-SNRT/SCL were ranged from 136 to 770% and 12 patients(80%) had significantly increased % m-SNRT/SCL exceeding 150%. 3) The SACT in normal group were 84+/-14msec(range 70-105msec) measured by continuous atrial pacing method and 80+/-19 msec(range 60-115msec) measured by atrial extrastimulation method. 4) In SSS, the SACT measured by continuous atrial pacing method was ranged from 80 to 1,050msec and 11/12 patients(92%) had significantly increased SACT exceeding 112 msec. The SACT measured by atrial extrastimulation method was ranged from 90 to 310msec and 7/8 patients(88%) had significantly increased SACT exceeding 118 msec. 5) C-SNRT, % m-SNRT/SCL, and SACT were more useful in detecting sinus node dysfunction than m-SNRT. 6) The AV conduction intervals in normal group were PA interval 17+/-6(range 5-25msec), AH interval 96+/-18 msec(range 70-135msec), and HV interval 46+/-7msec(range 35-55msec). 7) Rapid atrial pacing induced Wenckebach type second degree AV block proximal to H at pacing rate of 90 to 190/min in 14/16 normal adults. 2 patients maintained intact AV conduction upto maximum pacing rate of 200/min. 8) His bundle electrogram showed the site of AV block in 9 of 10 patients with AV conduction disturbances. The sites of AV block were AV nodal area 1 case, intraHis bundle 4 cases, and infraHis bundle 4 cases. 9) EPS provided a good supportive information that was useful in selecting pacemaker therapy in a patient with chronic bifascicular block who revealed prolonged HV interval and infraHis bundle block at a pacing rate of 70min. 10) The refractory periods of AV conduction system in normal group were AERP 274+/-54msec (range 170-410msec), AVN-FRp 467+/-74msec(range 285-600msec), AVN-ERP 341+76msec(range 190-460), and V-ERP 280+/-25msec(range 240-320msec).
Adult ; Atrioventricular Block ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Humans ; Sick Sinus Syndrome ; Sinoatrial Node*

The penetrating atherosclerotic ulcer of the aorta resulting from the atherosclerosis of the aortic wall can clinically mimic type III aortic dissection, since both diseases produce the ulceration and dissection of aortic wall. However, their imaging features and pathophsiologies are distinctly different from each other. Familial hypercholesterolemia(FH) menifests overt hyperlipidemia that can results in premature atherosclerosis of the aorta as well as the coronary artery. We report a clinically and radiologically evident case of perntrating atherosclerotic ulcer of the descending thoracic aorta which was developed in a 36-year-oldd heterozygote FH male.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Coronary Vessels ; Heterozygote* ; Humans ; Hyperlipidemias ; Hyperlipoproteinemia Type II* ; Male ; Ulcer*

Diltiazem(Herben(R)) was orally administered in a daily dose of 180mg over 8 weeks to 15 patients with angina pectoris requiring minimum 5 tablets of nitroglycerin per week. The symptom of angina pectoris was scored according to frequency and character of anginal attacks and the number of nitroglycerin tablets used was recorded during the Diltiazem therapy. We noted significant decrease of the score of anginal attack and the number of nitroglycerin tablets used during the course of Diltiazem therapy. No significant change in blood pressure, heart rate and the product of systolic blood pressure and heart rate was noted during the course of Diltiazem therapy. It is possibel that Diltiazem improved ischemic heart disease by slightly decreasing myocardial oxygen demand and increasing blood flow to the ischemic areas by dilatation of coronary arteries and collateral vessels. There was no abnormal change in laboratory findings during the Diltiazem treatment. These findings suggest that Diltiazem(Herben(R)) is a favorable and safe antianginal agent useful for longterm treatment of anginal pectoris.
Angina Pectoris* ; Blood Pressure ; Coronary Vessels ; Dilatation ; Diltiazem ; Heart Rate ; Humans ; Myocardial Ischemia ; Nitroglycerin ; Oxygen ; Tablets

To determine the possible participation of genetic factors in the pathogenesis of Takayasu's arteritis and to investigate an association between HLA antigens and the disease, we performed HLA typing in twenty two patients confirmed by clinical findings and aortography, and in fifty normal Koreans as controls. HLA-A, B,C and DR antigens were tested by standard microlymphocytotoxicity method with HLA antisera, which were supplied by UCLA Tissue Typing Laboratory. The results were as follows: 1) Frequent antigens of HLA-A locus in patients were A 2(54.5%), Aw 33(31.8%), Aw 24(27.2%) and A26(13.6%) in decreasing order, and Aw 33 was more frequent in patients than in normal controls(18.0%)(relative risk: 2.1). 2) Frequent antigens of HLA-B locus in patients were Bw61(31.8%), Bw44(31.8%), Bw62(22.7%) and Bw52(13.6%) in decreasing order, and Bw61 was more frequent in patients than in normal controls(10%)(relative risk : 4.2). 3) Frequent antigens of HLA-C locus in patients were Cw3(54.5%), Cw6(50.0%) and Cw1(22.7%) in decreasing order. 4) Frequent antigens of HLA-DR locus in patients were DR6Y(36.4%), DR2(31.8%), DRw9(27.2%), DR4(27.2%) and DR28(22.7%) in decreasinng order. In MT system MT 3 was more frequent in patients(54.5%) than in normal controls(31.6%)(relative risk : 2. 6). However, the difference of HLA antigen frequencies between patients and normal controls was not statistically significant, and the association of specific HLA antigens with Takayasu's arteritis requires further studies to be confirmed.
Aortography ; Histocompatibility Testing ; HLA Antigens* ; HLA-A Antigens ; HLA-B Antigens ; HLA-C Antigens ; HLA-DR Antigens ; Humans ; Immune Sera ; Takayasu Arteritis*