Clinical Study of Myocardial Bridge

BACKGROUND AND OBJECTIVES: Myocardial bridge is congenital coronary anomaly and cause myocardial ischemia by milking effect. The general study of myocardial bridge is to be weak, so we examined a clinical study of myocardial bridge. MATERIALS AND METHOD: This study included 36 bridge cases out of 1048 patients who underwent coronary angiography due to chest pain from Jan. 1993 to Jul. 1998. Angiographic film, medical records and interview by telephone were reviewed retrospectively. Total follow-up duration was mean 27 months (1 month to 62 months). RESULTS: Incidence of myocardial bridges diagnosed by angiography was 3.4%. Angiography showed normal in 32, 1 vessel disease in 3 and 2 vessel disease in one patient. Mean reference diameter was 2.97+/-0.36mm, bridge diameter was 2.75+/-0.33mm in diastole, 1.12+/-0.47mm in systole. Myocardial bridge length was 12.50+/-7.44mm, mean % diameter stenosis was 59.26+/-17.7%. Myocardial bridge location was 80.6% in mid LAD and 13.9% in mid & distal LAD and 5.5% in distal LAD. There was no statistically significant correlation with sex, risk factor of coronary heart disease, resting electrocardigraphy, treadmill test, diameter and angulation of coronary artery, clinical symptom in the severity of myocardial bridge. But the severity of myocardial bridge correlated with bridge length(r=.5033). CONCLUSION: Clinical outcomes of bridge patients were relatively good during the mean follow up periods of 27 months. Myocardial bridge was more severe in younger age and longer bridge length.

Efficacy and Safety of Bevantolol HCl in Treating Essential Hypertension

BACKGROUND: Bevantolol HCl was developed as the first antihypertensive agent that has selective beta1 and alpha1 blocking effects with an additional calcium antagonistic activity. It's expected that antihypertensive effect is comparable to other beta-blockers without any significant adverse effect on lipid and glucose metabolism observed in other drugs, and It has less negative inotropic effect due to peripheral vasodilatation mediated through alpha1 and calcium channel blocking effects. To evaluate the antihypertensive effect and safety of bevantolol HCl, we investigated 73 patients with mild to moderately severe essential hypertension. METHODS: Patients who showed either systolic blood pressure 150-209 mmHg or diastolic pressure 95-119 mmHg, were enrolled in this study. Following placebo period of 2weeks, bevantolol HCl was administered in daily dose of 100-200 mg for 12 weeks. RESULTS: Of the 73 patients, 55 patients who were able to receive bevantolol HCl were observed for the safety and 45 patients who completed this study were evaluated for the antihypertensive effect of the drug. 1) Antihypertensive effect: The mean systolic and diastolic blood pressure significantly decreased from 156.7+/-11.7 mmHg to 144.0+/-16.7 mmHg and from 101.6+/-6.4 mmHg to 93.2+/-9.7 mmHg in two weeks of observation in 37/45 patients (82.2%) and was consistently effective for 12 weeks (p<0.01). Blood pressure under 139/89 mmHg was achieved in 20 out of 45 patients (44.4%). The heart rate also declined from 74.9+/-10.5/min to 69.1+/-14.2/min and the effect lasted for 12 weeks (p<0.01). 2) Safety: Mild adverse effects were observed in 27 out of 55 patients. Only one patient developed a significant bradycardia with heart rate of 40/min, which required withdrawal of the drug. No significant changes in the lipid profiles were observed. CONCLUSION: Bevantolol HCl is highly effective and generally well tolerated with an acceptable safety profile in patients with mild to moderately severe essential hypertension.

Two cases of pheochromocytoma associated with acute myocardial infarction / 대한내과학회지

Pheochromocytoma was usually derived from adrenal medulla or chromaffin cells in or about sympathetic ganglia, and manifested several symptoms and signs by producing, storing, secreting catecholamine. This tumor frequently presented various symptoms such as paroxysmal or persistent hypertension, headache, sweating, palpitation. EKG abnormalities, myocarditis, cardiomyopathy, angina pectoris and myocardial infarction have been reported in cardiovascular systems. We experienced two cases of pheochromocytoma associated with myocardial infarction Two patients presented typical cardiac enzyme patterns and regional wall motion abnormalities on ehcocardiography which was compatible with acute myocardial infarction. However, these patients showed normal coronary artery on coronary angiograpy. Urinary excretion of catecholamine metabolites were elevated and pheochromocytoma was found on right adrenal gland. After the removal of pheochromocytoma, urinary excretion of catecholamine metabolities, regional wall motion abnormalities on echocardiography and blood pressure were normalized.

A Case of Infective Bacterial Endocarditis Complicated by Acute Hemorrhagic Pericarditis and Hemoperitoneum by Rupture of Mycotic Aneurysm at Superior Mesenteric Artery

Infective endocarditis is a disease that is characterized by the vegetations. Although cardiac complications remain the leading cause of death, endocarditis is complex, systemic illness with involvement of virtually all the organs. The spectrum and incidence of cardiovasular, neurologic, renal complications also are presented by direct embolism and immune- mediated phenomena. Systemic embolism is the common and serious complications associated with infective endocarditis. Mycotic aneurysm by septic embolization is known complication of bacterial endocarditis, but mycotic aneurysm of superior mesenteric artery is very rare complication and approximately 10 cases has been reported in the literature. Acute hemorrhagic pericarditis is unusual clinical manifestation of bacterial endocarditis and subject to catastrophic hemodynamic compromise secondary to cardiac tamponade. We report a case of bacterial endocarditis in 23 years old male who developed acute hemorrhagic pericarditis and hemoperitoneum due to rupture of mycotic aneurysm in superior mesenteric artery with brief review of lieratures.

Immediate Results of AVE Micro-II Stent

BACKGROUND: Several kinds of stents have shown their safety and efficacy to treat acute or subacute closure after balloon angioplasty as well as to reduce restenosis rate. However, one of the limitations of stents is difficult to deploy especially in tortuos vessels, lesions at a bend, and distal to previously deployed stents. The Micro stent II, which was one of the most recently developed stents, ia a rapid-exchage balloon expandable stainless steel stent with a zigzag design connected with a continuous single weld in each 3mm segments. It scores over excellent trackability and optimum radio-opacity. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report our experiences with Micro-II stent implanatation in the first 76 patients at Tonsei cardiovascular center to assess its safety and efficacy in patients with complex coronary anatomy and clinical results in the first months. METHODS: Between January 1996 and July 1996, eighty-six Micro-II stent were implanted in the coronary arteries of 76 patients(male 65.8%, age 59+/-10 year). Forty-five patients had unstable angina, the others had stable angina(17pts), acute myocardial infarction(14pts). RESULTS: 1) Indication of stenting was de novo 51(59.3%), suboptimal result 25(29.1%), restenosis 1(1.2%) and 9(10.4%) of lesions were stented in bail out situation. 2) Single stent were implanted in 76(88.4%)lesions, overlapping stent in 10(11.6%)lesions. Among overlapping stents, the second stent with Micro-II stent and with another kind of stent were 4.6%, 7.0%, respectively. 3) Procedure related complication including a subacute closure was occurred in 1(1.2%) patient who had distal dissection and 45% residual stenosis. In 12(14%) lesions, preistent dissection has been noticed after stent impantation. 4) Angiographic success(defined as a residual stenosis of <30% without major dissection) was achieved in 82 of 86 attempts(95.3%). The procedual success rate(defined as a residual stenosis of <30% without occurrence of major clinical events within 4 weeks after procesure) was 96.1%(73/76 patients). Angiographic success and procedural success rate in calcified lesion were 100% and 100%, respectively. Angiographic success and procedural success rate in more than 45` angulated lesion were 97% and 100%, respectively. 5) The mean minimal luminal diameter of the target lesions was increased from 0.42+/-0.40mm before stent implantation to 2.93+/-0.50mm(p<0.001). The percentage of diameter stenosis was reduced from 86.49+/-13.04% to 1.40+/-7.11%(p<0.001) after stent implantation. CONCLUSION: Coronary stenting with AVE Micro-II stent can be safety performed and is particularly beneficial in tortuous and calcified arteries. There was a high tendency for peristent dissection which need to special consideration to avoid. Follow-up data is needed to assess mid and term patency. Coronary artery disease . AVE Micro-II stent . Immediate results.

Electrophysiologic Characteristics of Successfully Ablated Midseptal Accessory Pathway

BACKGROUND: Catheter ablation using radiofrequency energy has been established as the most important mode of treatment in patients with accessory pathway. However the ablation of midseptal accessory pathways had been recognized as being more difficult to ablate than other located pathway because of the low incidence and the difficult localization of ablation site. This paper describes the electrophysiologic characteristics of successfully ablated midseptal accessory pathway using radiofrequency energy. METHOD: Routine electrophysiologic studies were performed in 13 patients with midseptal accessorypathway. Guided by the recording of VA interval, the ablation catheter was positioned in all patients in an area bounded anteriorly by the tip electrode of the His bundle catheter and posteriorly by the coronary sinus ostium. Local electrograms during orthodromic atrioventricular reentrant tachycardia or right ventricular apical pacing were compared for 13 patients with midseptal accessory pathway and consequent 13 patients with posteroseptal accessory pathway. RESULT: 13 patients with midseptal accessory pathway; eight with constant Wolff-Parfinson-White syndrome, one with intermittent Wolff-Parkinson-White syndrome and four with concealed bypass track underwent attempts at ablation of their pathway using radiofrequency energy. 11 accessory pathways were successfully ablated without complication during the firstsession. A second attempt at ablation was made in two patients with success(one; recurred case, the other one; failed case at the first session). In the surface 12-Lead ECG, all eight patientswith constant Wolff-Pakinsin-White syndrome had not shownen Qrs complex at lead 3. Two patient with midseptal accessory pathway had transient left bundle branch block during orthodromic tachycardia. The VA interval during left bundle branch block was not change compared to that during narrow complex tachycardia in both. In all patients with midseptal accessory pathway, the VA interval in his bundle electrogram were almost similar to that in the coronary sinus ostial electrogram, which was not observed in the patients with posteroseptal accessory pathway. CONCLUSION: We suggest that VA interval during orthodromic tachycardia and right ventricular apcial pacing is the most reliable market for identifying midseptal accessory pathway, especially distinguishing from posteroseptal accessory pathway.

A Case of Diseeminated Cryptococcosis

No abstract available.

A Case of Potter Syndrome Type I

No abstract available.