Twenty-seven patients with moderate or severe mitral stenosis (MS) were studied by cardiac catheterization and angiography, 2-dimensional (2-D) echocardiography and Doppler echocardiography to assess the ability of Doppler ultrasound to accurately measure mitral valve orifice area and to assess whether mitral regurgitation (MR) affected the calculation. Mitral valve area by Doppler was determined by the pressure half time method. There were good correlation between 2-D & Doppler echocardiography (r=0.84) and between cardiac catheterization & Doppler echocardiography (r=0.83) regardless of the presence of MR. It is concluded that the Doppler echocardiography provides a simple, accurate, useful noninvasive method for the estimation of mitral valve area in patients with MS even in the presence of complicating MR.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Echocardiography ; Echocardiography, Doppler ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Ultrasonography*

In order to obtain a useful parameter for dynamic quantification of mitral stenosis, hemodynamic data in 51 patients with pure mitral stenosis undergoing cardiac catheterization gas been statistically analyzed. As results, cardiac output was significantly correlated with mitral valve area(r=0.63), oxygen delivery(r=0.48), pulmonary vascular resistance(r=-0.46), oxygen delivery index(r=0.40) and mixed venous oxygen saturation(r=0.38), and was not significantly related to pulmonary artery pressures, pulmonary arterial wedge pressure and mitral pressure gradients. Whereas mixed venous oxygen saturation showed a significant correlation with pulmonary vascular resistance(r=-0.69), mean pulmonary artery pressure(r=-0.59), systolic pulmonary artery pressure(r=-0.59), diastolic pulmonary artery pressure(r=-0.59), mitral valve area(r=0.51), pulmonary arterial wedge pressure(r=-0.47), oxygen delivery index(r=-0.45), peak mitral pressure gradient(r=-0.41), oxygen delivery(r=-0.39), cardiac output(r=0.38) and mean mitral pressure gradient(r=-0.33). These results indicate that mixed venous oxygen saturation is a very useful parameter for dynamic quantification of advanced mitral stenosis.
Cardiac Catheterization ; Cardiac Catheters ; Cardiac Output ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Stenosis* ; Oxygen ; Pulmonary Artery ; Pulmonary Wedge Pressure

Assessment of aortic regurgutation(AR) by means of color Doppler echocardiaography is known to be a reliable noninvasive measure of regurgutation, and the laboratories grade AR primarily on the basis of the maximal length of the regurgitant jet of color Doppler flow mapping. This paper describes the influence of the cardiac output upon the regurgitant jet length. Twenty seven adult patients with AR were examined. In 17 with mild AR of 27 patients, the perioperative color Doppler control studies of AR were done because mitral valve was replaced only. The regurgitant fraction and volume obtained by the thermodilution and pulse Doppler method were compared with angiographic and color Doppler esimates of severity of AR. The results show that the length of the regurgitant jet of AR by color Doppler study became larger aith indreasing cardiac output in the same patient and correlated well with regurgitant volume rether than regurgitant fraction. Therefore the regurgutant jet length appreared to be influenced by regurgutant volume which was altered by changing caediac output. In conclusion, a color Doppler study allows noninvasive quantitative estimation of severity of AR, and its use should take into account the cardiac output.
Adult ; Aortic Valve Insufficiency* ; Cardiac Output* ; Humans ; Mitral Valve ; Thermodilution

BACKGROUND: In patients with acute posterior myocardial infarction, the standard 12 leads electrocardiogram is often nondiagnostic, but posterior chest leads(V7 to V9) are expecting to identify those patients with posterior involvement. And so the meaning of posterior chest leads for detecting posterior infarction needs to determine, especially in the elderly with often nondiagnostic routine electrocardiogram. METHODS: We studied eighty-four patients(aged 61+/-10 years, 61 men and 23 women) with acute myocardial infarction who had right coronary or left circumflex artery occlusion angiographically. All patients had technetium-99m pyrophosphate myocardial imaging and 2D echocardiographic imaging within 48 hours after admission to establish the diagnosis of acute posterior infarction. Patients were analyzed to determine on the diagnostic meaning of posterior chest leads and routine electrocardiogram in detecting posterior infarction. RESULTS: The overall sensitivity of posterior chest leads, especially of lead V9 in detecting acute posterior myocardial infarction were 86.3%(69/80) with ST-segment elevation and 87.5%(70/80) with the appearance of pathologic Q waves. The 4 patients with lateral infarction were no changes in post chest leads. Left bundle branch block, artificial pacemaker rhythm, WPW syndrome, old anterior myocardial infarction. hypertrophy of left ventricle with strain pattern, and small infarction were a obstacle to detect posterior involvement with posterior chest leads. There are no significant age-associated differences in elderly patients for detecting posterior involvement with posterior chest leads. CONCLUSION: Posterior chest leads(V7-9), especially lead V9 are a very sensitive and useful tool for diagnosis of posterior infarction, with no age associated differences.
Aged ; Arteries ; Bundle-Branch Block ; Diagnosis* ; Echocardiography ; Electrocardiography* ; Heart Ventricles ; Humans ; Hypertrophy ; Infarction ; Male ; Myocardial Infarction* ; Pacemaker, Artificial ; Thorax* ; Wolff-Parkinson-White Syndrome

BACKGROUND: Various observations suggest that variations of autonomic tone participates in arrhythmias, but there is limited information about the influence of the autonomic tone on the development of episodes of paroxysmal atrial tachycardia in the elderly. METHODS: Ambulatory 24-hour Holter electrocardiogram from 40 patients over 60 years old with paroxysmal atrial tachycardia(PAT) were analyzed. Frequency domain heart rate variability(HRV) parameters were determined every 4 minutes over 16 minutes before the onset of PAT and 8 minutes after. HRV indices included total power(TP) (0~0.5Hz), low frequency power(LF) (0.04~0.15Hz), high frequency power(HF) (0.15~0.4Hz), very low frequency power(VLF) (0~0.04 Hz), the ratio of LF/HF(LF/HF), normalized LF(nu LF) (LF/(TP~VLF) X 100) and normalized HF(nu HF) (HF/(TP~VLF) X 100). RESULTS: Thirty-one of 40 patients(77.5%) had a sudden rise in LF/HF within 12 minutes before the onset of PATs. Among these 31 patients, 20 had a rise within 4 minutes, 7 in 4~8 minutes and 4 in 8~12 minutes preceding the PATs. There were 28 patients(90.3%) who had a increase in nu LF, 29 patient(93.5%) who had a decrease in nu HF and 18 patients(58. 1%) who had an acceleration of heart rate among these 31 patients. Ten of 40 patients(l0%) had no changes in HRV through the PATs. CONCLUSION: These findings suggest that a relative rise in sympathetic activity contributed to at least 77.5% in the genesis of the elderly PAT, and thus hope- fully providing a rationale for therapeutic approach involving modification of the sympathetic nervous system in the prevention of PATs.
Acceleration ; Aged ; Arrhythmias, Cardiac ; Autonomic Nervous System ; Electrocardiography ; Heart Rate ; Humans ; Middle Aged ; Sympathetic Nervous System ; Tachycardia ; Tachycardia, Supraventricular*

BACKGROUND: The understanding of degenerative change of aortic valve due to aging process is required for evaluation of aortic valvular disease in the elderly, but no regional study had been completed. METHODS: We have analyzed the data from the asymptomatic, non-cardiac surgical patient above the age of 60 or older by using preoperative 2-D and Doppler echocardiography prospectively. RESULTS: We have observed the thickening of aortic valve in the age of 60 or older with trends of which is noticed earlier in female than in male and increased rapidly as the patient is older. In the group who have thickening of aortic valve. trans-aortic pressure gradient was significantly higher than those who have not. The mean trans-aortic peak pressure gradient of the group who have not thickening of aortic valve was 6.6+/-1.8mmHg. The frequency of aortic stenosis over 60 year-old showed the tendency of increased pattern as the case older, thickening of valve more severe. And the incidence of significant aortic stenosis is 0.6%. Aortic requrgitation in the gae of 60 or older was mainly noticed in the group who have thickening of aortic valve. and the incidence of significant aortic requrgitation is 2.1%. CONCLUSION: In the current study. we found no major difference in the incidence of thickening of aortic valve and significance of hemodynamics above age 60 or older compare to the western data.
Aged* ; Aging ; Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography, Doppler ; Female ; Hemodynamics ; Humans ; Incidence ; Male ; Middle Aged ; Prospective Studies

The traditional diagnostic methods available for diagnosis of acute myocardial infarction such as electrocardiogram and serum enzyme analysis have well known linitations in clinical application and identifying the acute myocardial infarction. Therefore it does seem important to develop additional noninvasive means of identifying the presence of myocardial necrosis which may be used in conjunction with standard techniquens for infarct recognition. The purpose of this study was to define the diagnostic usefulness of myocardial infarct imaging with technetium-99m stannous pyrophosphate(Tc-99mPYP) which is introduced in clinical application recently. The study was performed in 41 patients with chest pain thought to be due to acute myocardial infarction and with nondiagnostic electrocardiogram by serial determinations of serum creatine kinase -MB (CK-MB) isoenzyme and lactic dehydrogenase(LDH) isoenzyme-1/-2 ratio accompanying with Tc-99m PYP myocardial imaging. The results are as follows: 1) Of the studied 41 patients, none showed false positive and 3 false negative Tc-99mPYP myocardial scintigraphic finding in the diagnosis of acute moycardial infarction. On the other hand, serum Ck-MB isoenzyme and LDH-1/-2 ratio showed 10 and 1 false positive, and none and 4 false negative findings, respectively. 2) The 3 patients who couldn't be identified by Tc-99mPYP myocardial imaging technique had subendocardial infarction in all. 3) Of the 10 patients wih false positive elevation in serum Ck-MB isoenzyme determinations, 5 patients were postcardiotomy syndrome, 1 after cardiopulmonary resuscitation due to cardiac arrest, 1 after cardioversion, 1 unstable angina, 1 after coronary bypass surgery and 1 after carotid endarterectomy. In all of these patients, serum CK-MB isoenzyme levels were within 5-10% of total serum CK level. In conclusion, Tc-99mPYP myocardial imaging technique appears to be very specific and high sensitive diagnostic tool for detecting acute myocardial infarction as compared with serum enzyme analysis. Tc-99mPYP myocardial scintigraphy in addition to serum CK-MB isoenzyme determination which it is useless as an isolated finding due to the poor specificity may be extremely valuable in confirming the diagnosis of myocardial infarction, especially in the cases with nondiagnostic electrocardiogram.
Angina, Unstable ; Cardiopulmonary Resuscitation ; Chest Pain ; Creatine Kinase ; Diagnosis ; Electric Countershock ; Electrocardiography* ; Endarterectomy, Carotid ; Hand ; Heart Arrest ; Humans ; Infarction ; Myocardial Infarction* ; Myocardial Perfusion Imaging ; Necrosis ; Sensitivity and Specificity

BACKGROUND: The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be correlated with the presence or absence of coronary atherosclerotic disease(CAD), but no studies to date have used carotid B-mode ultrasound to compare the extent of atherosclerotic disease in the two arterial circulation. The aim of the present study was to examine the association between carotid artery and coronary artery atherosclerosis. METHODS: Four hundred fifty four consecutive elderly patients(220 men, 234 women) greater than 60 years of age who underwent coronary angiography for suspected CAD were evaluated by B-mode ultra- sound imaging of the both common carotid, proximal internal carotid and carotid bifurcation for measure- ment of atherosclerostic plaque. The severity of coronary atherosclerosis was judged by a consensus inter- pretation of coronary angiogram. CAD was defined as 50% or greater diameter stenosis of coronary artery. RESULTS: The presence of CAD was less than 10% in the elderly patients with less than 15% diameter stenosis of carotid artery, and was in the all elderly patient with 35% or greater diameter stenosis of carotid artery atherosclrosis. The predictability of 15% or greater carotid stenosis for CAD were 97.9% sensitivity, 54.6% specificity, 85.7% positive predictive value and 91.7% negative predictive valve and of 20% or greater were 92.1%, 70.4%, 89.9% and 78.6%, respectively. CONCLUSION: Carotid B-mode ultrasound is non-invasive, safe, and useful, and measurement of carotid artery plaque burden by B-mode ultrasonography expects to be rapidly being adopted as a reliable surro- gate for coronary artery atherosclerosis.
Aged* ; Atherosclerosis ; Carotid Arteries ; Carotid Artery Diseases ; Carotid Stenosis ; Consensus ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels ; Humans ; Male ; Sensitivity and Specificity ; Ultrasonography

No abstract available.
Aged* ; Humans ; Hypertension*

In order to determine the meaning of tricuspid stenosis(TS) in rhematic valvular heart disease(RVHD), 310 consecutive patients with RVHD were assessed by Doppler and 2-dimensional(2D) echocardiography. The frequency of 2D echocardiographic TS(diastolic doming of anterior tricuspid leaflet and thickened tricuspid leaflets) was 8.4%, and all patients with 2D echocardiographic TS had the mean tricuspid pressure gradient(MTPG) of 1mmHg or more compared to normal control of less than 1mmHg with Doppler echocardiography. The frequency of clinically significant hemodynamic TS(MTPG>2mmHg) and of servere hemodynamic TS(MTPG>5mmHg) in RVHD were 3.5% and 0.6% respectively. Rheumatic TS was accompanied by tricuspid regurgitation in the frequency of 92.3% and did not occurs in pure mitral regurgitation. Rhematic TS occurs with high frequency in advanced rheumatic valvular stenosis, and the frequency of rheumatic TS in severe rheumatic mitral stenosis and mitral stenosis coexing with aortic stenosis were 20.8% and 23.9% respectively. The results indicates that TS in RVHD is little practical meaning but is unable to disregard especially in the cases of advanced rhematic valvular stenosis, and there is need to recognize of TS in RVHD.
Aortic Valve Stenosis ; Constriction, Pathologic* ; Echocardiography* ; Echocardiography, Doppler ; Heart ; Hemodynamics ; Humans ; Mitral Valve Insufficiency ; Mitral Valve Stenosis ; Tricuspid Valve Insufficiency