Incidence of eNOS gene mutationin Korean patients with coronary artery spasm

BACKGROUND: Coronary artery spasm is an important mechanism in producing myocardial ischemia. But the exact mechanism of the spasm is not well known. We investigated the mutation of endothelial nitric oxide synthase (eNOS) that produce nitric oxide and relationship between eNOS mutation and coronary artery spasm. MATERIALS AND METHODS: Blood were drawn from the patients with angiographically proven coronary artery spasm and normal controls. DNA were extracted and polymerase chain reaction and restriction analysis with Nae I were performed to find T-786--

Incidence of eNOS gene mutationin Korean patients with coronary artery spasm

BACKGROUND: Coronary artery spasm is an important mechanism in producing myocardial ischemia. But the exact mechanism of the spasm is not well known. We investigated the mutation of endothelial nitric oxide synthase (eNOS) that produce nitric oxide and relationship between eNOS mutation and coronary artery spasm. MATERIALS AND METHODS: Blood were drawn from the patients with angiographically proven coronary artery spasm and normal controls. DNA were extracted and polymerase chain reaction and restriction analysis with Nae I were performed to find T-786--

A Case Report of Infective Endocarditis that Caused by Gemella Haemolysans in a Patient with Ventricular Septal Defect

Infective endocarditis is the infectious disease that produces vegetation on endocardium. Acute bacterial endocarditis is most frequently caused by Staphylococcus aureus, occurs on a normal heart valve, and subacute endocarditis usually caused by Streptococcus viridans occurs on damaged valves. Gemella haemolysans are gram-positive cocci that is placed in the family Streptococcaceae. As opportunistic pathogen, Gemella haemolysans are able to cause severe localized and generalized infections and it is known that this organism very rarely causes infective endocarditis. The paucity of reports concerning Gemella haemolysans is probably related to the difficulties associated with their identification. Several laboratory tests to prevent misinterpretation of this organism are now suggested. We have experienced a case of infective endocarditis that is caused by Gemella haemolysans in 37 year old male patient with ventricular septal defect. Gemella haemolysans were detected by blood culture and he was treated with intravenous vancomycin with gentamicin and ceftriaxone, and also underwent cardiac surgery. This is the first case of Gemella haemolysans endocarditis of ventricular septal defect in Korea.

A Case of Histologically Confirmed Coxsackiviral Myocarditis Supported by a Left Ventricular Assist Device

Enteroviruses are the most common agents of myocarditis and have been implicates in the pathogenesis of dilated cardiopmyopathy. There are still discrepancies in the association of enterovirus and myocardial disease, partially due to lack of data on detection of virus antigen or viral culture in the tissue. For the treatment of fulminant myocarditis, aggressive hemodynamic support is warranted because of its excellent long-term prognosis. This 16 year-old girl was admitted because of anterior chest pain for a day. She had flu-like symptoms such as fever, sore throat and cough at 2 weeks ago. Electrocardiogram showed sinus tachycardia and ST segment elevations in lead II, III, aVF and V1-V4. Troponin T was positive and creatinine phosphokinase was elevated (1323 IU/L) at emergency room. On emergency echocardiogram, inferior wall motion was decreased and the ejection fraction (EF) was 70%. Coronary angiogram showed no thrombus and no significant stenosis in coronary artery, and spasm was not induced with ergonovine. Conventional treatment for congestive heart failure with digoxin (0.25 mg daily) and furosemide (20 mg t.i.d) was started under the impression of myocarditis. On the first hospital day, pulmonary edema and signs of shock were developed. The whole left ventricular(LV) wall motion were markedly decreased and EF was less than 20% on echocardiogram. Despite of intra-aortic balloon pump (IABP) for 4 hours, shock and pulmonary edema was progressed. Mechanical circulatory support was started with left ventricular assist device (LVAD, Bio-pump, Medtronic Bio-Medicus, USA). At the time of operation, central venous pressure was 24cmH20, systolic blood pressure was 75mmHg, left atrium(LA) and LV was dilated and the whole wall of LV showed almost akinesia , and LA appendage was biopsied. After 126 hours of LVAD, LV wall motion was restored and EF was 79% on echocardiogram. LVAD was removed 10 days after operation and she was discharged on 23 days of hospitalization without any heart failure symptoms. Immunohistochemistry of LA showed enteroviral VP1 capsid protein (primary antibody; NoVo Castra Laboratory, UK) over the entire LA wall. Her serum neutralized coxsackievirus B3 (CVB3, H3 variant of Woodruff strain) in neutralization test using horse anti-CVB3 (Nancy strain) antibody (ATCC, V030-501-560) as a positive control. The titer of neutralization Ab in her serum of 21 days increased more than 4 times than that of 2 days.

Positivity of Chlamydia Pneumoniae Antibody and It's Significance in Atherosclerosis

BACKGROUND: The relationship between infection of microorganism and atherosclerosis has been studied because the pathophysiology after infection is similar to those of cell injury and/or lipid theory. Although there are many reports which described the relationships between the infection of chalamydia pneumoniae and the atherosclerosis. In Korea, even the prevalence of chlamydia infection has not been studied yet. This study was purposed on the prevalence of chlamydia infection and it's correlation to atherosclerosis. METHODS: 235 subjects were enrolled and age and sex adjusted subjects were divided into two groups, normal controls (n=43), atherosclerosis (AS, n=90) group:coronary artery disease (CAD, n=61) and cerebrovascular disease (CVD, n=29). Serum total cholesterol (TC), triglyceride (TG), HDL-cholesterol (HDL-C) were measured, LDL-cholesterol (LDL-C) was calculated. Serum IgG chlamydia antibody were measured by ELISA method. RESULTS: TG was significantly higher in AS (162.51+/-100.04 mg/dL vs 122.91+/-63.31 mg/dL, mean+/-SD, p=0.019), and HDL-C was significantly higher in controls (47.30+/-9.88 mg/dL vs 39.38+/-8.29 mg/dL, p0.01). Levels of LDL-C and TC were not statistical significant. Serum IgG chlamydia antibody was positive in 29.8% (70/235), 30% (27/90) in AS group and 28% in controls and there was no statistical significance between groups (p=0.804). CONCLUSION: In conclusion, there was no significant differences in positivity of IgG chlamydia antibody in AS compared with that of controls. Overall positivity of chlamydia antibody was lower in Korea than in other country. It is still controversial whether Chlamydia pneumoniae is a primary etiologic agent of atherosclerosis or not. This study could not demonstrate the relationship between chlamydia infection and atherosclerosis in Korea. The effectiveness and indications of antichlamydial antibiotics for prevention of cardiovascular complications in atherosclerosis and overall chlamydia infection in general population will be needed in large scale trials.

Incidence of Lipoprotein Lipase Gene Polymorphism and Correlation with Severity of Coronary Artery Disease in Korean

BACKGROUND: Lipoprotein lipase(LPL) is a key enzyme in the metabolism of serum triglyceride(TG) which is utilized in the peripheral tissue as free fatty acid and stored in adipose tissue. LPL gene consists of 10 exons which encode 475 amino acids and more than 9 LPL gene polymorphisms have been reported. LPL gene polymorphism is related to lipids level and the severity of atherosclerosis in coronary artery disease. In Korea, LPL polymorphism has not been reported yet. The purpose of this study is to konw the incidences of LPL gene polymorphism and it's relationship with blood lipids level and the severity of atherosclerosis. METHODS: Subjects were divided into three groups; normal controls(n=50), coronary artery disease(CAD, n=51) and cerebrovascular disease(CVD, n=52). The PCR- amplified genomic DNA from peripheral white blood cell was analyzed with restriction fragment length polymorphism(RFLP) by two different restriction enzymes(Pvu II, Hind III). RESULTS: Total cholesterol(TC) was higher in CVD than in controls and CAD (203+/-60mg/dl vs 188+/-37, 167+/-42, p<0.01). Triglyceride(TG) was also elevated in CAD(166+/-65mg/dl vs 122+/-62 in controls, p<0.05). HDL cholesterol(HDL-C) was higher in controls than in CVD and CAD(49+/-9mg/dl vs 36+/-10, 44+/-9, p<0.05). The incidence of Hind III RFLP and Pvu II RFLP was not different among groups. There was no correlation between LPL gene RFLP and lipid profile. There was no correlation between LPL gene RFLP and severity of coronary arterial stenosis. The incidence of Hind III RFLP (-/-) homozygotes was lower in Korean than in other country(5% vs 7-10%). The incidence of Pvu II RFLP (-/-) homozygotes was lower in Korean than in other country(10.3% vs 18-29%). CONCLUSIONS: The LPL gene mutations in intron 6 and 8 have no direct effects on the lipid profiles and the severity of coronary artery disease. Although LPL is a key enzyme in TG metabolism, two mutations in this study could not change the activity of LPL, nor were a marker linked to other site of mutation(s). The mutation(s) in exon which encode amino acid for enzyme activity should be detected to dissect the pathphysiologic mechanism in the atherogenesis.

A Case of Supraaortic Ridge and Subaortic Membrane Manifestated as Aortic Regurgitation

Supraaortic stenosis is a localized or diffuse congenital narrowing of the ascending aorta at the levels of superior margin of the sinus of Valsalva, just above coronary arteries. Hemodynamically, it is a usually manifestated as aortic stenosis especially when it combined with subaortic membrane. And there is no case report of supraaortic stenosis combined with subaortic membrane which has aortic valvular reurgitation due to secondary change of dilated sinus of Valsalva by supraaortic ridge. We have experienced a case of aortic regurgitation associated with supraaortic ridge combined with subvalvular aortic membrane.

A Case Report of Balloon Angioplasty for Coarctation of Aorta in Adult

For the treatment of coarction of aorta, surgical intervention has been known as a standard therapy.During last decade balloon angioplasty for coarctation of the aorta has been reported as a successful and safe procedure in about 300 cases. This angioplasty was done mainly in infants and children, and little cases in adults and adolescents. A 22 year-old adult with coarctation of aorta have recieved balloon angioplasty. He visited to emergency room due to severe headache and the blood presure of arm was 240/130mmHg at emergency room. The blood pressure at ward was 168/92mmHg in upper extremities, 104/82mmHg in lower extrimities. His aortogram showed coarctation of thoracic aorta below left subclavian artery. The pressure gradient beween ascending aorta and right femoral artery was decreased from 60mmHg to 0mmHg after balloon dilatation (2 times, balloon diameter 18mm). There were no significant complications. The follow-up magnetic resonance image in 4 month after balloon angioplasty showed no evidence of restenosis or saccular aneurysm. Initial hypertension turned to normal blood pressure in 4 months after balloon angioplasty. This adult case of successful balloon angioplasty for coarctation of aorta is the first case reported in Korea.

Analysis of Time Delay to Affect Thrombolytic Therapy in Patients with Acute Myocardial Infarction

BACKGROUND: Early reperfusion therapy with thrombolytic agents or primary PTCA is most important to salvage ischemic myocardium in acute myocardial infarction(AMI). Timely reperfusion of jeopardized myocardium clearly improves hemodynamics, decreases infarct size and improves survival. The extent of protection appears to be directly related to the rapidity of reperfusion after onset of coronary occlusion. Although the intravenous thrombolysis is a feasible therapy in the patients with evolving AMI, the benifit of thrombolytic therapy decreases because of the time delay after onset of symptom. This study was perfomed to analyze the factors time delay between onset of symptom and the thrombolytic therapy with retrospective and prospective questionaire in the patients with AMI. METHOD: Eighty one patients with AMI were included in this study who came to the emergency room(ER) of Chungnam National University Hospital(CNUH) from Feburary 1995 to October 1996. Delay between door and thrombolytic therapy was defined as hospital time delay. RESULTS: Thrombolytic therapy(rt-PA or urokinase iv) was done in 60 patients(74.1%) and mean prehopital time delay was significantly decreased in the patients with thrombolytic therpapy when compared with those without thormbolytic threapy(462+/-90 vs 1375+/-473 minutes, p=0.005). There were no singificant factors for prehospital time delay such as age, sex, redsidence, ER near residence, transfer time to ER near residence, family status, family history of AMI, severity of chest pain, presence of risk factors of cardiovascular disease(CVD), previous CVD, degree of education, history of other disease and routine check, transfer methods. The only 8 patients(9.8%) knew about AMI and 7 patients among these patient came to ER earlier and received thrombolytic therapy. From 57 referred patients, 40 patients(70.2%) received reperfusion therapy and only 30 patients(52.6%) had recored EKG in the referred hospital. In the analysis of hospital delay from patient's arrival to the thrombolytic therapy, the arrival time at weekdays and weekend had no differences, but hospital delay were significantly prolonged when patients arrived at ER in the night. CONCLUSION: Since prehospital time delay is a most important factor of time delay for the effective thrombolytic therapy in AMI, the pubic education program and effective transport system are needed. And routine record of EKG in patient with chest pain in the local hospital is very helpful to start effective thromolytic therapy at ER. The well designed prospective study with more patinets in our local region is essential to get more accurate information about transport system and to improve survival rate in patients with AMI.