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Anomalous Origin of the Right Coronary Artery From the Main Pulmonary Artery Presenting as Angina Pectoris in an Adult.

Chung Su PARK ; Weon KIM ; Sung Bum HONG ; Sun Ho HWANG ; Wan KIM ; Byung Hee AN

Korean Circulation Journal.2008;38(11):627-629. doi:10.4070/kcj.2008.38.11.627

The anomalous origin of the right coronary artery from the main pulmonary artery has been rarely reported. We report a 63-year-old male with angina pectoris who was shown to have an anomalous origin of the right coronary artery from the main pulmonary artery. The abnormal origin was identified by conventional coronary angiography, but the abnormal course of the artery was precisely delineated by high resolution multi-slice computerized tomography. The patient underwent successful surgical correction of the anomalous vessel with complete resolution of symptoms.
Adult ; Angina Pectoris ; Arteries ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessel Anomalies ; Coronary Vessels ; Glycosaminoglycans ; Humans ; Male ; Middle Aged ; Pulmonary Artery

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Probable Left Atrial Myxoma Presenting as Concurrent Cerebral and Myocardial Infarctions.

Ung JEON ; Young Sin CHO ; Do Hoi KIM ; Sang Ho PARK ; Seung Jin LEE ; Won Yong SHIN ; Dong Kyu JIN ; Se Whan LEE

Korean Circulation Journal.2008;38(11):622-626. doi:10.4070/kcj.2008.38.11.622

Concurrent cerebral and coronary artery embolization is a theoretically possible, but extremely rare complication of an atrial myxoma. We present a paitent with a left atrial mass (a probable myxoma) who presented with concurrent cerebral and myocardial infarctions due to emboli of tumor origin. An 84-year-old woman presented with an acute cerebral infarction of the middle cerebral artery territory. Several hours after admission, she complained of chest pain consistent with a myocardial infarction. Transthoracic and transesophageal echocardiographic studies revealed the presence of a large, mobile, heteroechoic mass with a few daughter nodules in the left atrium, compatible with a myxoma. Coronary angiography disclosed subtotal occlusion of the ramus intermedius branch and visible tumor vascularization adjacent to the right coronary artery. With medical treatment, including anticoagulation, the patient was stabilized and had an uneventful clinical course for the ensuing 6 months since discharge.
Aged, 80 and over ; Cerebral Infarction ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Female ; Heart Atria ; Humans ; Middle Cerebral Artery ; Myocardial Infarction ; Myxoma ; Nuclear Family

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Massive Pulmonary Thromboembolism Associated With Renal Vein Thrombosis While Using Oral Contraceptives.

Gun Hi KANG ; Seung Gu KIM ; Hye Young LEE ; Jun Jae KIM ; Hyun PARK ; Na Na BAIK ; Young Sup BYUN ; Byoung Kwon LEE

Korean Circulation Journal.2008;38(11):618-621. doi:10.4070/kcj.2008.38.11.618

Pulmonary thromboembolism (PTE) originating from a renal vein thrombosis (RVT) is very rare, especially in relatively healthy young women. The patient described herein presented with a syncope-associated massive PTE. She was previously healthy, except for termination of an ectopic pregnancy with methotrexate 4 months before. The only medication she was taking was an oral contraceptive (OC), which was started 3 months before the PTE. She had no family history of venous thromboembolism (VTE) or any other underlying risk factors. We report the case of a woman who had a PTE originating from a RVT associated with OC use after an ectopic pregnancy.
Contraceptives, Oral ; Female ; Humans ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic ; Pulmonary Embolism ; Renal Veins ; Risk Factors ; Thrombosis ; Venous Thromboembolism

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Impact of Drug-Eluting Stents on Clinical Outcomes in Patients With Diffuse Coronary Lesions.

Hyeon Gook LEE ; Kook Jin CHUN ; Kyoung Im CHO ; Dong Won LEE ; Jun Hyuk OH ; Byung Jae AHN ; Seong Ho KIM ; Joon Sang LEE ; Moo Young KIM ; Woo Hyung BAE ; Woo Seog KO ; Joon Hoon JEONG ; Tae Ik KIM ; Han Cheol LEE ; Jun KIM ; June Hong KIM ; Taek Jong HONG ; Yung Woo SHIN

Korean Circulation Journal.2008;38(11):612-617. doi:10.4070/kcj.2008.38.11.612

BACKGROUND AND OBJECTIVES: In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions. SUBJECTS AND METHODS: Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions > or =51 mm in length. RESULTS: The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0+/-18.15% in Group 1, 12.61+/-21.99% in Group 2, and 19.81+/-31.26% in Group 3(p< 0.05). Late lumen loss was 0.17+/-0.50 mm in Group 1, 0.39+/-0.66 mm in Group 2, and 0.59+/-0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm). CONCLUSION: DES implantation is considered safe and effective in the treatment of diffuse lesions. However, lesion length may be associated with an increase in percent diameter stenosis and late lumen loss at 6-month follow-up.
Constriction, Pathologic ; Coronary Angiography ; Coronary Restenosis ; Coronary Stenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Stents

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Atrial Mechanical Function After Maze Procedure for Atrial Fibrillation Concomitant With Mitral Valve Surgery.

Bong Gun SONG ; Soo Jin CHO ; Sang Yeub LEE ; Jung Hyuk KIM ; Seung Min CHOI ; Yong Hwan PARK ; Jin Oh CHOI ; Sang Chol LEE ; Young Keun ON ; Seung Woo PARK ; June Soo KIM ; PyoWon PARK

Korean Circulation Journal.2008;38(11):606-611. doi:10.4070/kcj.2008.38.11.606

BACKGROUND AND OBJECTIVES: The maze procedure is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). We compared the left atrial mechanical function (LAMF) of patients whose rhythm was converted to SR after maze procedure with that of patients whose rhythm was not converted to SR and determined if preoperative left atrial volume index (LAVI) and immediate postoperative LAMF could predict conversion of AF to SR. SUBJECTS AND METHODS: We prospectively evaluated 80 patients with AF treated with the maze procedure between March 2005 and February 2007. LAMF was assessed by looking at left atrial ejection volume (LAEV) and ejection fraction (LAEF) during echocardiography before, 2 weeks after, and 6 months after the procedure. RESULTS: Of the 80 enrolled patients, 71 were converted to SR after the maze procedure (SR group), and 9 were not converted to SR (AF group). There were no significant differences in age, sex, hypertension, diabetes mellitus, renal failure, stroke, thyroid dysfunction, or smoking history between the groups. Pre-operative LAVI (p=0.010) was a predictor of conversion of AF to SR. LAEF gradually increased in the SR group during follow-up, but not in the AF group. CONCLUSION: LAMF recovered in the SR group after the maze procedure, irrespective of clinical presentation and initial LAMF. Preoperative LAVI predicted SR conversion.
Atrial Fibrillation ; Atrial Function, Left ; Diabetes Mellitus ; Echocardiography ; Follow-Up Studies ; Humans ; Hypertension ; Mitral Valve ; Prospective Studies ; Renal Insufficiency ; Smoke ; Smoking ; Stroke ; Thoracic Surgery ; Thyroid Gland

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Prevalence of Atrial Fibrillation in Middle-Aged People in Korea: The Korean Genome and Epidemiology Study.

Kwang Soo LEE ; Sun Ja CHOI ; Sung Hee PARK ; Hyung Lae KIM ; Haesook MIN ; Hyun Young PARK

Korean Circulation Journal.2008;38(11):601-605. doi:10.4070/kcj.2008.38.11.601

BACKGROUND AND OBJECTIVES: The prevalence of atrial fibrillation (AF), the most common sustained arrhythmia, is expected to rise with the aging population, but very few studies have reported on the prevalence and risk factors of AF in Korea. SUBJECTS AND METHODS: We analyzed 10,012 Korean adults (4,750 men and 5,262 women), 40-69 years old, who were enrolled in the Korean Genome and Epidemiology Study. AF was diagnosed by single electrocardiogram recording in a baseline survey (2001-2003). RESULTS: The estimated prevalence of AF was 0.4% {95% confidence interval (CI), 0.28-0.52} in adults 40-69 years old, and increased to 1.0% in individuals 60-69 years old. The prevalence rate for men (0.6%) was higher than for women (0.2%) across all age groups. In multiple logistic regression analysis, AF was significantly associated with old age {odds ratio (OR), 8.15; 95% CI, 3.06-21.71}, male gender (OR, 4.04; 95% CI, 1.90-8.61), diabetes mellitus (OR, 2.15; 95% CI, 1.05-4.44), and congestive heart failure (OR, 14.11; 95% CI, 2.56-77.70). Obesity, however, did not show an association with AF. CONCLUSION: The prevalence of AF in Korean adults aged 40-69 years is approximately 0.4%, lower than that in Western populations. Age, male gender, diabetes, and heart failure are associated with AF. Further research in a larger population is necessary to verify for our results.
Adult ; Aged ; Aging ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Surveys and Questionnaires ; Diabetes Mellitus ; Electrocardiography ; Female ; Genome ; Heart Failure ; Humans ; Korea ; Logistic Models ; Male ; Obesity ; Prevalence ; Risk Factors

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Transient Left Ventricular Dysfunction After Percutaneous Patent Ductus Arteriosus Closure in Children.

Yeo Hyang KIM ; Hee Joung CHOI ; Yongkeun CHO ; Sang Bum LEE ; Myung Chul HYUN

Korean Circulation Journal.2008;38(11):596-600. doi:10.4070/kcj.2008.38.11.596

BACKGROUND AND OBJECTIVES: The goal of this study was to assess changes in left ventricular (LV) function and to identify pre-closure factors associated with LV dysfunction {fractional shortening (FS) below 29%} after transcatheter patent ductus arteriosus (PDA) closure. SUBJECTS AND METHODS: Forty-three pediatric patients with PDAs underwent cardiac catheterization for hemodynamic studies and intervention. Doppler echocardiography was performed at pre-closure, post-closure, and follow-up. RESULTS: S' and A' of the septum and mitral annulus were significantly decreased at post-closure and follow-up, respectively. In five of eight patients with Qp/Qs ratios over 1.60 and Pp/Ps ratios over 0.32 at pre-closure, the FS was decreased below 29% at post-closure. Qp/Qs ratio over 1.60 and Pp/Ps ratio over 0.32 at pre-closure had a sensitivity of 86% and a specificity of 84% for predicting FS to be below 29% at post-closure. CONCLUSION: Larger amounts of pre-closure left-to-right shunting and higher pulmonary artery pressure were associated with an increased likelihood of FS <29% after closure. The results of this study suggest that serial assessments of ventricular function are needed after PDA occlusion in patients with high Qp/Qs and Pp/Ps ratios.
Cardiac Catheterization ; Cardiac Catheters ; Child ; Ductus Arteriosus, Patent ; Echocardiography, Doppler ; Follow-Up Studies ; Hemodynamics ; Humans ; Pulmonary Artery ; Sensitivity and Specificity ; Ventricular Dysfunction ; Ventricular Dysfunction, Left ; Ventricular Function

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Young Soo LEE ; Seong Wook HAN ; Yoon Nyun KIM ; Chang Wook NAM ; Hyung Sub KIM ; Kee Sik KIM ; Robert W RHO

Korean Circulation Journal.2008;38(11):590-595. doi:10.4070/kcj.2008.38.11.590

BACKGROUND AND OBJECTIVES: Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.
Bundle-Branch Block ; Heart Ventricles ; Humans ; Sprains and Strains

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An Overview of Myocardial Bridging With a Focus on Multidetector CT Coronary Angiographic Findings.

Sung Min KO

Korean Circulation Journal.2008;38(11):583-589. doi:10.4070/kcj.2008.38.11.583

Myocardial bridging (MB) is a common anatomical variant rather than a congenital anomaly, and it is usually considered benign. It is generally confined to the mid-portion of the left anterior descending coronary artery. Atherosclerotic plaques are often located in the segment proximal to the bridged segment, although the tunneled segment is typically spared. Conventional coronary angiography is the gold standard for detection, but it is invasive and may not be sensitive enough to detect a thin bridge. The prevalence of MB reported in multidetector CT (MDCT) coronary angiographic series has ranged from 3.5% to 30.5% in patients with chest pain or with suspected or known coronary artery disease. Today, MDCT coronary angiography is an alternative noninvasive imaging tool that allows for easy and accurate evaluation of MB.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Myocardial Bridging ; Plaque, Atherosclerotic ; Prevalence

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Transesophageal Echocardiographic Evaluation of Atherosclerosis.

Masami NISHINO ; Jun TANOUCHI

Korean Circulation Journal.2008;38(11):573-582. doi:10.4070/kcj.2008.38.11.573

Transesophageal echocardiography (TEE) is a promising method for evaluating thoracic aortic atherosclerosis and coronary atherosclerosis. The highest impact of TEE as a clinical tool is in searching for cardiac embolic sources in patients with stroke and atrial fibrillation and in conducting detailed evaluations in patients with valvular disease, especially those with mitral valvular disease. However, it is also clinically useful in the evaluation of thoracic aortic atherosclerosis and coronary atherosclerosis. TEE is capable of evaluating thoracic aortic atherosis (intima- media complex thickness) and sclerosis (stiffness parameter beta) simultaneously. In addition, TEE can evaluate coronary atherosclerosis by non-invasively revealing narrowing or occlusion of the coronary arteries and providing information about coronary flow reserve. TEE imaging has improved with the advent of harmonic imaging, multiplane probes, contrast agents, and three-dimensional TEE. Future technology, including integrated backscatter (IBS), tissue Doppler, and strain imaging, will lead to further improvements in TEE. Thoracic aortic atherosclerosis and coronary atherosclerosis assessment should be performed in any patient undergoing TEE.
Aorta, Thoracic ; Atherosclerosis ; Atrial Fibrillation ; Contrast Media ; Coronary Artery Disease ; Coronary Vessels ; Echocardiography, Transesophageal ; Humans ; Sclerosis ; Sprains and Strains ; Stroke

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