BACKGROUND AND OBJECTIVES: The purposes of this study are 1) to investigate the relationship between resting baseline Pd/Pa, determined by the ratio of the pressures proximal (Pa) and distal (Pd) to the target lesion before, inducing hyperemia and fractional flow reserve (FFR) and 2) to identify a resting baseline Pd/Pa range that might reliably preclude the need for hyperemic induction. SUBJECTS AND METHODS: A total of 622 pressure wire data sets obtained from intermediate stenotic lesions were analyzed. RESULTS: There was a good linear relationship between resting baseline Pd/Pa and FFR (r=0.746, p<0.001). Receiver-operating characteristic curves of the resting baseline Pd/Pa with FFR < or =0.80 as the reference variable showed an area under the curve of 0.89 (95% confidence intervals 0.863-0.914, p<0.001) with a diagnostic accuracy of 82.3% when the resting baseline Pd/Pa was < or =0.92. These results showed that certain cutoff values can reliably predict FFR, whether positive or negative. The resting baseline Pd/Pa >0.95 (n=257, 41.3%) had a negative predictive value (NPV) of 98.1% and a sensitivity of 97.3%. the resting baseline Pd/Pa < or =0.88 (n=65, 10.5%) had a positive predictive value (PPV) of 96.2% and a specificity of 99.8%. These were consistent regardless of coronary vessel, lesion location, lesion length, or degree of stenosis. CONCLUSION: In intermediate lesions, the resting baseline Pd/Pa was linearly related to FFR. A certain range of the resting baseline Pd/Pa values had an excellent NPV with high sensitivity or excellent PPV with high specificity for determining the lesion significance.
Coronary Vessels ; Fractional Flow Reserve, Myocardial ; Glycosaminoglycans ; Hyperemia ; Sensitivity and Specificity

The combination of coronary arteriovenous fistula to the coronary sinus (CS), dilatation of the entire length of coronary artery, coronary aneurysm and persistent left superior vena cava (PLSVC) is very rare. We present the case of a 63-year-old female admitted for dyspnea on exertion, orthopnea, and facial edema. Echocardiography detected a giant coronary artery with shunt flow, dilated CS and PLSVC and a coronary angiography reaffirmed these findings. The calculated ratio of pulmonary blood flow to systemic blood flow by cardiac catheterization was 1.53. After multidisciplinary review considering old age, hypoactivity due to underlying Parkinsonism and relatively small amount of shunt flow, medical therapy was chosen. The patient remained asymptomatic for 10 months after discharge without intervention.
Aneurysm ; Arteriovenous Fistula ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Aneurysm ; Coronary Angiography ; Coronary Sinus ; Coronary Vessels ; Dilatation ; Dyspnea ; Echocardiography ; Edema ; Female ; Fistula ; Humans ; Middle Aged ; Parkinsonian Disorders ; Vena Cava, Superior

Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.
Acute Coronary Syndrome ; Cardiomyopathies ; Hemodynamics ; Hospital Mortality ; Influenza, Human ; Pandemics ; Pneumonia, Viral ; Public Health ; Swine

PURPOSE: The aim of this study was to report the efficacy of the first dorsal metacarpal artery island flap for soft tissue defect of the thumb. MATERIAL AND METHODS: We performed the first dorsal metacarpal artery island flap for soft tissue defect of the thumb in 14 cases since 1992 to 2008. There were dorsal defect in 9 cases, volar defect in 2 cases and lateral defect in 3 cases. The cases are limited by defect size under 2.5 cm in width. We checked a vessel diameter in the flap pedicle, a mobile pedicle length in operative field. Evaluation results was based on flap quality, donor site quality, two-point sensory discrimination, scar contractures, total active movement of the thumb and donor digit. RESULTS: The flap quality was well vascularized and survived in 12 cases (success rate : 86%). Diameter of vessels in flap was estimated within 0.5 mm by operational findings. Dorsal vein was irregular and complicated. Average of the pedicle length was 3.2 cm. Sensory function were preserved in all cases after long term follow up, but the cases we could measure two-point discrimination were 9 cases and average was 5.3 mm. Donor sites were dermatized using skin graft and 2 cases were complained limitation of motion at joints of index finger. CONCLUSION: The failure rate of flap were about 14%. We considered that it need to prepare under operational microscopy because vessels distributed into flap are small and complex. Problems of donor site are not negligible. However it was regarded as a useful island flap which could preserve sensory function in case of soft tissue defect of thumb when it applied to appropriate cases and operated by skilled procedure.
Arteries ; Cicatrix ; Contracture ; Discrimination (Psychology) ; Fingers ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Joints ; Microscopy ; Sensation ; Skin ; Thumb ; Tissue Donors ; Transplants ; Veins

We performed three cases of extraanatomic bypass graft for treating adult coarctation. Two cases of left subclavian artery to descending aorta bypass graft were done via left thoracotomy for treating 2 patients who had extensive aortic occlusive disease. One case of ascending aorta to descending aorta bypass graft and aortic valve replacement was done via median sternotomy for a patient who had combined arch hypoplasia and aortic valve regurgitation. One patient was reoperated on for aneurysm rupture of an anastomosis site four months after the first operation and two patients have had no specific problems during and after their operations.
Adult ; Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Valve ; Humans ; Rupture ; Sternotomy ; Subclavian Artery ; Thoracotomy ; Transplants

PURPOSE: The clinical manifestations of Behcet's arthritis are similar to those of rheumatoid arthritis, and they need to be differentiated. The objective of this study was to evaluate the past history, diagnosis, treatments and clinical findings of Behcet's arthritis. MATERIALS AND METHODS: Among 1,602 cases with Behcet's disease, 87 cases with Behcet's arthritis were enrolled in this study between January 1990 and December 2000. A thorough review of each case was done by examining the patients' medical charts and personal interview. The clinical manifestation, the existence of morning stiffness and laboratory studies including ESR, CRP, AS, and RF were investigated. The Shimizu classification was used as diagnostic criteria. RESULTS: There was no preponderance of gender and the most prevalent age group was in their 3rd and 4th decades. The most common involved site was the knee joint (60 of 87 cases), and multiple site involvement was common (56.0%). Clinically, symptoms such as pain, tenderness and joint swelling were common. According to the Shimizu classification, the incomplete type was the most common (67.8%). The symptoms improved after conservative treatment, but 12 cases (21.0%) recurred within one year. Arthroscopic synovectomy was performed in 2 cases, but these cases showed no improvement. CONCLUSION: Behcet's arthritis should be differentiated from rheumatoid arthritis, and conservative treatment showed good clinical results.
Arthritis ; Arthritis, Rheumatoid ; Humans ; Joints ; Knee Joint

BACKGROUND AND OBJECTIVES: Patients with metabolic syndrome (MS) have an increased risk of cardiovascular events. However, only limited studies are available on the effect of MS on restenosis and on the clinical outcome of patients undergoing percutaneous coronary intervention (PCI). The aim of this study is to assess the role of MS in the development of restenosis, and risk of a 6-month major adverse cardiac event (MACE) and a 12-month MACE, as well as the difference of outcome between the use of bare metal stents (BMSs) and the use of drug eluting stents (DESs). SUBJECTS AND METHODS: This is a one center, retrospective study. The study population comprised 151 patients undergoing percutaneous coronary intervention (PCI) with BMSs and 200 patients undergoing PCI with DESs. The study population was classified into two groups of patients with MS and patients without MS. RESULTS: The baseline clinical characteristics were similar in the two groups (with or without MS) except for hypertension, diabetes, body mass index, triglyceride level and high-density lipoprotein level. The frequency of in-stent restenosis of the patients that were implanted with BMSs or DESs was not different between two groups, based on a 6 month follow-up quantitative coronary angiographic analysis (BMSs: 30% vs 22.2%, p= 0.352; DES: 3.3% vs 2.2%, p=0.76; for patients with and without MS, respectively). The percent of patients with a 6-month MACE for patients implanted with BMSs was not statistically different for patients with or without MS (30% vs 22.2%, p=0.352) but the percent of patients with a 12-month MACE showed a statistically significant higher level for the MS group (38.6% vs 23.5%, p=0.044). The percent of patients with a 6-month MACE for patients implanted with DESs was also not statistically different between two groups (5.8% vs 1.7%, p= 0.123). CONCLUSION: Patients with MS undergoing BMSs or DESs implantation do not show higher levels of in-stent restenosis and levels of a 6-month MACE. The number of 12-month MACEs of patients implanted with BMSs is statistically higher, but the number of 6-month MACEs of patients implanted with DESs is not different for the MS group. We conclude that MS is not risk factor of in-stent restenosis in PCI but MS may influence the long-term clinical outcome in patients undergoing PCI.
Body Mass Index ; Coronary Restenosis ; Drug-Eluting Stents ; Follow-Up Studies ; Humans ; Hypertension ; Lipoproteins ; Percutaneous Coronary Intervention* ; Retrospective Studies ; Risk Factors ; Stents ; Triglycerides

BACKGROUND: The aim of this study is to assess the clinical results of various procedures in congenital aortic stenosis. MATERIAL AND METHOD: From August 1987 to June 2004, 53 patients of congenital aortic stenosis underwent procedures such as percutaneous balloon valvuloplasty, aortic valvuloplasty, Ross procedure, and aortic valve replacement. The mean age of initial procedures was 8.2+/-6.0 years. Percutaneous balloon valvuloplasty was performed in sixteen patients, aortic valvuloplasty in thirty two patients, Ross procedure in nineteen patients, and aortic valve replacement in fourteen patients. The mean follow duration was 80.6+/-60 (0~207) months. RESULT: There was 15.1% (8/53) of early mortality and no late mortality. The six patients with critical aortic stenosis were died of left ventricular dysfunction in early series (before 1 year; 4 cases) and two patients died after the Ross procedure and aortic valve replacement respectively. After percutaneous balloon valvuloplasty, most patients needed reoperations (14/16). Thirteen patients needed reoperation, after aortic valvuloplasty. After Ross procedure, two patients needed reoperation due to aortic regurgitation caused by progressive aortic root dilatation. The actuarial survival rate after Ross procedure at 7 years was 90.5%. CONCLUSION: In young children before the age of one, percutaneous balloon valvuloplasty was considered as the safe initial palliative procedure. But children over one year-old, aortic valvuloplasty were the effective procedure. Ross procedure can be preformed safely with good results.
Aortic Valve ; Aortic Valve Insufficiency ; Aortic Valve Stenosis* ; Balloon Valvuloplasty ; Child ; Dilatation ; Humans ; Mortality ; Reoperation ; Survival Rate ; Ventricular Dysfunction, Left

Patients with isolated congenitally corrected transposition of the great arteries (CCTGA) comprise 1% of all CCTGA patients. They are usually asymptomatic until functional abnormalities such as atrioventricular block or systemic atrioventricular valve regurgitation become complicated. We report here a case of a 33 year-old man with isolated CCTGA and complete AV block that underwent implantation of a permanent pacemaker using endocardial leads. During a 12 month follow-up period, no symptoms developed and lead-related parameters have been stable.
Adult ; Arteries* ; Atrioventricular Block* ; Follow-Up Studies ; Humans ; Pacemaker, Artificial ; Transposition of Great Vessels

PURPOSE: The purpose of this study was to evaluate the radiological results of quadriceps-sparing total knee arthroplasty. MATERIALS AND METHODS: 50 consecutive total knee arthroplasties with a quadriceps-sparing surgical technique and 50 consecutive total knee arthroplasties with conventional surgical techniques were performed. The same surgeon performed all the operations with the same type of prosthesis (Nexgen LPS-flex Total Knee System). We compared the differences between these groups in terms of preoperative and postoperative femorotibial angles, tibial component alignment angles, tibial component inclinations, and ratios of size of the tibia component to tibial cutting size. RESULTS: There were no differences in preoperative femorotibal angles, tibial component alignment angles, tibial component inclinations, ratios of sizes of tibia tray to tibial cutting size, and blood loss between the two groups (p>0.05). The average ranges of motion and HSS scores at 8 weeks postoperatively in the quadriceps-sparing total knee arthroplasty group were greater than those in the conventional surgical technique (p<0.05). The mean postoperative femorotibial angle in the quadriceps-sparing total knee arthroplasty group was a valgus of 6.9+/-1.3 degrees compared with a valgus of 7.7+/-1.4 degrees in the standard arthroplasty group (p<0.05). CONCLUSION: A quadriceps-sparing total knee arthroplasty offers predictable results in terms of radiological comparison with the conventional arthroplasty technique. But this technique has the tendency of producing a decreased valgus angle at the distal femur.
Arthroplasty* ; Femur ; Knee* ; Prostheses and Implants ; Tibia