Preoperative and Long-Term Postoperative Echocardiographic Evaluation of Chronic Aortic Insufficiency; Optimal Timing for Aortic Valve Replacement

To dtermine the optimal timing for Aortic Valve Replacement in patients of aortic insufficiency is very important, because irreversible myocardial damage can result before symtoms such as dyspnea, syncope and chest pain, appear for the first time. Henry suggested that the echocardiographic index of left ventricular end systolic dimension 55mm could be useful as an indicator of whether to operate or not. But Fioretti, et al., insisted that there was no significant difference postoperatively between those below 55mm and those over 55mm. To determine whether a left ventricular end systolic dimension greater than 55mm is one of the risk factors for AVR in patients with aortic insufficiency, we analyzed the serial echocardiographic examinations of 23 patients who underwent AVR for isolated AI. Group I patients (n=17) had a preoperative left ventricular end systolic dimension less than or equal to 55mm and Group II patients (n=6) had a preoperative left ventricular end systolic dimension greater than than 55mm. 1) left ventricular end systolic dimension decreased in both groups significantly, and there was a statistically significant difference between Group I and Group II at 12 modths after operation. 2) Left ventricular end diastolic dimension also decreased in both groups significantly, and there was a statistically significant difference between Group I and Group II at 12 months after operation. 3) Ejection Fraction was decreased markedly just postoperatively, but it was recovered soon in both groups, and there was no statistically significant differences of the ejection fractions between the two groups postoperatively. 4) SV1+/-RV6 in EKG, as an indicator of LV mass, was also analzed and it revealed significant reduction in both groups postoperatively, but we could not observe statistically significant differences between the two groups from 6 months after the operation. We concluded that the preoperative left ventricular end systolic dimension 55mm could be useful as an index to predict postoperative prognosis and to determine the timing of aortic valve replacement.

Clinical Observation on Antihypertensive Effects of Tripamide(Normonal(R))

The antihypertensive effects of tripamide was studied in 19 cases of essential hypertension. After 4 weeks treatment with daily dosage of Tripamide (Normonal(R)) 15mg, the dosage was adjusted to 30mg in 10 cases. Before and after treatment laboratory tests were performed in 11 cases. The obtained results were as follows: 1) After 4 weeks treatment with daily dosage of Tripamide 15mg, mean systolic and diastolic blood pressure was decreased by 25 mmHg (12.7%) and 9.7 mmHg (8.5%) respectively(p<0.01), and in 58% of the cases, good or fair control of blood pressure was resulted. 2) After final treatment, mean systolic and diastolic blood pressure was decreased by 29.7 mmHg(15.1%) and 15.0 mmHg(120.5%) respectively(p<0.005) and in 79% of the cases, good or fair control of blood pressure was resulted. 3) There was no significant changes in the values of sodium, potassium, BUN, creatinine, uric acid, cholesterol, SGOT, SGPT and calcium after treatment. 4) There was no significant side effect except one case of mild fatigue and tingling sense of extrmities which were subsided spontaneousely.

A Case of Anomalous Origin of Right Pulmonary Artery from the Ascending Aorta

Anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital malfomation. To date, there have been 60 reported cases in the literature. Usually the right pulmonary artery arises form the ascending aorta and other malformations such as patent ductus arteriosus are commonly associated. Early diagnosis is essential because congestive heart failure develops in early life and operation is contraindicated if severe pulmonary vascular changes have occurred. We report a case of anomalous origin of right pulmonary artery from the ascending aorta, which is associated with patent ductus arteriosus and severe pulmonary hypertension. She was diagnosed by digital subtractional angiography and cardiac catheterization.

Interpretation of 201Tl Myocardial Scan in Ischemic Heart Disease

This study was performed to evaluate the method of quantification of exercise thallium-201(201Tl) myocardial perfusion imaginges(M.P.I.) for the detection of coronary artery disease. Exercise 201 Tl MPI were interpreted objectively, reproducibly, quantitatively and easily by a computer assisted technique-Circumferential profile method. Exercise 201Tl MPI and redistribution images were taken in 32 patients(9 cases of post infarction angina, 13 cases of angina pectoris, 8 cases of atypical chest pain, 1 case of arrhythmial and 1 case of caridac neurosis). The results obtained were as follows: 1) Exercise 201Tl MPI of 3 cases of angina pectoris demonstrated transient perfusion defect in 5 cases, persistent perfusion defect in 2 cases, transient and persistent perfusion defect in 1 cases and no perfusion defect in 5 cases. Exercise 201Tl MPI of 9 case of post-infarction angina revealed persistent perfusion defect in 7 cases and transient and persistent perfusion defect in 2 cases. 201Tl MPI of 8 cases of atypical chest pain showed transient perfusion defect in 1 case and no perfusion defect in 7 cases. There was no perfusion defect in 1 case of arrhythmia and another case of cardiac neurosis. 2) The location of persistent perfusion defects in several views of 201Tl MPI in 9 case of postinfarction angina were consistent with those of infarction area in the electrocardiogram. 3) While visual analysis interpreted three cases to have no perfusion defect and one case to have transient perfusion defect respectively, objective analysis revealed that one of them had transient perfusion defect, another of them had persistent perfusion defect and the other had transient and persistent perfusion defect. 201Tl MPI of three cases could be done easily by circumferential profile method, which were difficult to interprete by subjective visual analysis. The results indicate that Exercise 201Tl MPI interpreted by circumferential profile analysis would be an objective, quantitative and noninvasive method for the detection of ischemic change and location in coronary artery disease.

A Case Report of Expanding Abdominal Aneurysm and Annuloectasia in Marfan Syndrome

Marfan syndrome may be associated with various cardiovascular complications, but expanding abdominal aneurysm is a relatively rare complication. A 32 year old male patient was admitted to S.N.U.H. because of pulsating abdominal mass and back pain. The patient was diagnosed as a case of expanding abdominal aortic aneurysm and annuloectasia of aorta due to Marfan syndrome. Abdominal aneurysm was located from 3 cm below the origin of left renal artery to left common iliac artery. Abdominal aneurysm was operated successfuly. The size of abdominal aneurysm was about 2815cm. The pathological findings of surgically removed abdominal aortic wall showed loss of elastic fibers and fragmentation of fibers in media. A case of expanding abdominal aortic aneurysm due to Marfan's syndrome was reported with a review of literatures.

Exercise Echocardiography in Patients with Chronic Aortic Regurgitation

Supine exercise test was done with bicycle ergometer and echocardiography in 28 patients with chronic aortic regurgitation. Ejection fraction was measured before and immediately after exercise from echocardiography, wall stress and radius/thickness ratio was calculated from echocardiography and systolic blood pressure. 1. There was no difference in left ventricular end systolic and diastolic dimension, ejection fraction at rest, radius/thickness ratio, wall stress between NYHA functional class I, II, III. But work capacity was greater in NYHA class I than in class II, III(39712+/-10778 watt-sec, 23766+/-14280 watt-sec, 11968+/-6052 watt-sec respectively). Ejection fraction after exercise was significantly increased in class I(66.3+/-8.9% at rast vs 71.3+/-10.7% after exercise). 2. Ejection fraction was increased more than 5% in 12 patients(group I) and increased less than 5% or decreased in 16 patients(group II). There was no difference in basal E.F., Ded, Des and postexercise heart rate-blod pressure product between group I and II. But between group I and II, there was significant difference in diastolic redius/thickness ratio(2.55+/-0.30 vs 3.00+/-0.51), mean radius/thickness ratio(1.86+/-0.23 vs 2.18+/-0.30), systolic wall stress(192.3+/-38.6mmHg vs 240.2+/-57.7mmHg), mean wall stress(265.8mmHg vs 334.8+/-68.7mmHg) and work capacity(33848+/-12682 watt-sec vs 19210+/-12342 watt-sce). 3. Work capacity was more than 23800 watt-sec in 16 patients(group A), and less than 23800 watt-sec in 12 patients(group B). There was no difference in ejection fraction at rest, radius/thickness ratio, wall stress, and left ventricular dimension. But ejection fraction after exercise was significantly different between group A and B(68.6+/-14.6% vs 55.8+/-14.2%). 4. In nine patients with end systolic dimension greater than 50 mm ejection fraction was decreased or increased less than 5% in 7 patients. So mean ejection fraction was significantly decreased after exercise(56.8+/-7.5% at rest, 51.0+/-16.3% after exercise).

A Study on HLA Antigens in Patients with Takayasu's Arteritis

To determine the possible participation of genetic factors in the pathogenesis of Takayasu's arteritis and to investigate an association between HLA antigens and the disease, we performed HLA typing in twenty two patients confirmed by clinical findings and aortography, and in fifty normal Koreans as controls. HLA-A, B,C and DR antigens were tested by standard microlymphocytotoxicity method with HLA antisera, which were supplied by UCLA Tissue Typing Laboratory. The results were as follows: 1) Frequent antigens of HLA-A locus in patients were A 2(54.5%), Aw 33(31.8%), Aw 24(27.2%) and A26(13.6%) in decreasing order, and Aw 33 was more frequent in patients than in normal controls(18.0%)(relative risk: 2.1). 2) Frequent antigens of HLA-B locus in patients were Bw61(31.8%), Bw44(31.8%), Bw62(22.7%) and Bw52(13.6%) in decreasing order, and Bw61 was more frequent in patients than in normal controls(10%)(relative risk : 4.2). 3) Frequent antigens of HLA-C locus in patients were Cw3(54.5%), Cw6(50.0%) and Cw1(22.7%) in decreasing order. 4) Frequent antigens of HLA-DR locus in patients were DR6Y(36.4%), DR2(31.8%), DRw9(27.2%), DR4(27.2%) and DR28(22.7%) in decreasinng order. In MT system MT 3 was more frequent in patients(54.5%) than in normal controls(31.6%)(relative risk : 2. 6). However, the difference of HLA antigen frequencies between patients and normal controls was not statistically significant, and the association of specific HLA antigens with Takayasu's arteritis requires further studies to be confirmed.

Clinical Study of Antiarrhythmic Effect of Mexiletine

The antiarrhythmic effect of Mexiletine was evaluated in five patients with recurrent ventricular tachycardia and in twelve patients with frequent premature ventricular contractions. Electrophysiologic study was performed on the the patients with recurrent ventricular tachycardia before and after the administration of Mexiletin(600-800mg/day). The antiarrhythmic effects of Mexiletine in the patients with frequent premature ventricular contraction was assessed by ambulatory electrocardiography. The results were as follows: 1) In all of the five patients with recurrent ventricular tachycardia, sustained ventricular tachycardia was induced by programmed ventricular stimulation. However, on repeated electrophysiologic study performed while receiving Mexiletine, ventricular tachycardia was not induced in four patients and non-sustained ventricular tachycardia was induced in one patients. 2) The number of premature ventricular contraction was decreased markedly in seven patients(58.3%) with frequent premature ventricular contractions. 3) Minimal side effects, mild indigestion and tremor, were recorded in 3 cases(23%) while receiving Mexiletine 600 mg/day. The higher dose was associated with more frequent and severe side effects.

A Case of Holt-Oram Syndrome

We report a case of Holt-Oram syndrome associated with tetralogy of Fallot. Right thumb was digitalized, and left thumb was hypoplastic and dislocated at metacarpopharygeal joint. Thrombocytopenia in peripheral blood and megakaryocytic hypoplasia in bone marrow was accompanied. Brief review was done with emphasis on embryologic pathogenesis.

A Clinical Observation on the Antihypertensive Effects of Long-acting Propranolol(Inderal LA(R))

The antihypertensive effects of single daily dose of long-acting propranolol(Inderal LA(R)) were observed in 29 cases of essential hypertension, and the results were as follows; 1) Age distribution of the cases was from 39 years to 72 years with the mean age of 51.3. And there were 13 female and 16 male patients. 2) Mean value of the hypotensive effects in systolic and diastolic blood pressure were 22.9 mmHg, and 11.5 mmHg, respectively. 3) The results of the antihypertensive effects were as follows; good 31.0%, fair 34.5%, poor 20.7%, and failure 13.8%. 4) The decrement of heart rate with long-acting propranolol was 9.3 per minute in average. 5) 1 case of nausea and 2 cases of lassitude were noted, but these symptoms were subsided spontaneously with continous medication.

A Clinical Study on the Therapeutic Effect of Diltiazem(Herben(R)) in Angina Pectoris

Diltiazem(Herben(R)) was orally administered in a daily dose of 180mg over 8 weeks to 15 patients with angina pectoris requiring minimum 5 tablets of nitroglycerin per week. The symptom of angina pectoris was scored according to frequency and character of anginal attacks and the number of nitroglycerin tablets used was recorded during the Diltiazem therapy. We noted significant decrease of the score of anginal attack and the number of nitroglycerin tablets used during the course of Diltiazem therapy. No significant change in blood pressure, heart rate and the product of systolic blood pressure and heart rate was noted during the course of Diltiazem therapy. It is possibel that Diltiazem improved ischemic heart disease by slightly decreasing myocardial oxygen demand and increasing blood flow to the ischemic areas by dilatation of coronary arteries and collateral vessels. There was no abnormal change in laboratory findings during the Diltiazem treatment. These findings suggest that Diltiazem(Herben(R)) is a favorable and safe antianginal agent useful for longterm treatment of anginal pectoris.

Effect of Pantethine in the Treatment of Hyperlipidemia

After pantethine in doses of 540 mg per day was administered for 8 weeks in 20 patients with hyperlipidemia, the serum levels of total cholesterol, triglyceride and HDL-cholesterol were compared with the pretreatment level. The serum level of total cholesterol decreased to 240+/-52 mg%[mean+/-standard deviation] after 4 weeks and 223+/-41 mg% after 8 weeks from the pretreatment level of 293+/-38 mg%(p<0.01). The serum triglyceride level also decreased to 254+/-109 mg% after 4 weeks and 239+/-114 mg% after 8 weeks from the pretreatment level of 375+/-126 mg%(p<0.01). But, there was no significant change in the serum levels of HDL-cholesterol before and after treatment (56+/-27 mg% beforAfter pantethine in doses of 540 mg per day was administered for 8 weeks in 20 patients with hyperlipidemia, the serum levels of total cholesterol, triglyceride and HDL-cholesterol were compared with the pretreatment level. The serum level of total cholesterol decreased to 240+/-52 mg%[mean+/-standard deviation] after 4 weeks and 223+/-41 mg% after 8 weeks from the pretreatment level of 293+/-38 mg%(p<0.01). The serum triglyceride level also decreased to 254+/-109 mg% after 4 weeks and 239+/-114 mg% after 8 weeks from the pretreatment level of 375+/-126 mg%(p<0.01). But, there was no significant change in the serum levels of HDL-cholesterol before and after treatment (56+/-27 mg% before treatment, 56+/-18 mg% after 4 weeks and 59+/-22 mg% after 8 weeks). Pantethine was well tolerated in most patients.

A Case Report of Coronary Arteriovenous Fistula

We report a case of coronary arteriovenous fistula in a female adult confirmed by aortography. The fistulous communication was between right coronary artery and right ventricle. This is the first case report of adult patient with coronary arteriovenous fistula in Korea.

A Clinical Observation on the Antihypertensive Effects of labetalol(Trandate(R))

The antihypertensive effect of labetalol was evaluated in 25 cases of essential hypertension. 1. Age distribution was from 38 to 71 years. Thirteen cases were female and 12 cases were male. 2. The daily effective doses were ranged from 300 to 600mg. Total duration of medication were from 1 week to 12 weeks(mean 5 wks). 3. The 10 cases of 25 showed good antihypertensive effect, and 9(36%) showed fair. In 76% of the cases showed effective antihypertensive effect. 4. Two cases were suffered from side effects, such as mild orthostatic hypotension and dizziness.

Clinical Observation on Antihypertensive Effects of Atenolol(Tenormin(R))

The antihypertensive effects of once-daily 50mg dose of atenolol(Tenormin(R)) were observed in 28 cases of essential hypertension, and the results were as follows. 1. Mean drop in systolic and diastolic pressure were 19mmHg and 16mmHg respectively. 2. In 85.7% of the cases good or fair control of blood pressure was resulted. 3. Transient indigestion and fatigue were complained by 3 patients, but subsided spontaneously with continuous treament.

Clinical Observation on Antihypertenisive Effect of Carteolol Hydrochloride

The antihypertensive effect of carteolol hydrochloride was observed in 20 cases of essential hypertension, and following results were obtained. 1. Mean drops in systolic and diastolic blood pressure by carteolol hydrochloride were 13mmHg and 9mmHg. The results of antihypertensive therapy revealed good control in 25%, fair control in 35%, poor in 20% and failure in 20% of the cases. 2. After the administration of carteolol hydrochloride, no drop in average heart rate was observed. 3. The side effect of carteolol was mild indigestion in two cases.

Clinical Study on Congenital Heart Diseases in Korean Adult

A clincal study was made on 383 adult patients with congenital heart disease who visited the Seoul National university Hospital during the period of March, 1961-July, 1979. 1. The incidence of congenital heart disease for the consecutive years was increasing in 1970s, especially in recent two years. 2. The sex incidence of congental heart disease was female 47.0%, male 53.0%, with male preponderance in tetralogy of Fallot, ventricular septal defect, coarctation of aorta, aortopulmonary window and female preponderance in atrial septal defect, patent ductus arteriosus. 3. Age distribution of congenital heart disease showed that 79.1% of all were below 30 years of age but atrial septal defect showed wide distribution below and above 30 years of age. 4. The incidences of each congenital heart disease were atrial septal defect 20.9%, tetralogy of Fallot 20.6%, ventricular septal defect 19.%, patent ductus arteriosus 12.0%, pulmonary stenosis 7.6%, trilogy of Fallot 1.8%, Ebstein's anomaly 1.8%, ventricular septal defect with pulmonary stenosis 1.3%, coarctation of aorta 1.3%, ventricular septal defect with aortic insufficiency 1.0%, transposition of great vessels 1.0%, in order and rare and various combined anomalies. 5. Average duration of illness in congenital heart disease was less than 15 years in majority, but duration from 11 years to 20 years was most common in tetralogy of Fallot. 6. Functional class of congenital heart disease is class II and I in majority, but class III was most common in tetralogy of Fallot. 7. Comparision of precatheterization diagnosis with postcatheterization diagnosis showed concordence in 92.2% and comparison of postcatheterization diagnosis with postoperative diagnosis showed concordence in 95.5% of cases. 8. Electrocardiographic findings in 5 major congenital heart disease were observed as follows; right ventricular hypertrophy 86.3%, right atrial enlargement 16.4% in tetralogy of Fallot, right ventricular hypertrophy 30.9%, incomplete right bundle branch block 27.9% in atrial septal defect, left ventricular hypertrophy 28.8%, right ventricular hypertrophy 10.6%, biventricular hypertrophy 10.6% in ventricular septal defect, left ventricular hypertrophy 63.2% in patent ductus arteriosus and right ventricular hypertrophy 70% in pulmonary stenosis. 9. Postoperative changes in electrocardiographic findings were observed in 36.1% of operated patients, of whom teteralogy of Fallot 61.7%, ventricular septal defect 48.0% were most common. Pstoperative electrocardiographic changes were complete right bundle branch block 58.3%, incomplete right bundle branch block 11.7%, myocardial ischemia 10%, nonspecific ST-T changes 10%, etc. in order.

Clinical Study on Congenital Heart Diseases in Korean Adult

A clincal study was made on 383 adult patients with congenital heart disease who visited the Seoul National university Hospital during the period of March, 1961-July, 1979. 1. The incidence of congenital heart disease for the consecutive years was increasing in 1970s, especially in recent two years. 2. The sex incidence of congental heart disease was female 47.0%, male 53.0%, with male preponderance in tetralogy of Fallot, ventricular septal defect, coarctation of aorta, aortopulmonary window and female preponderance in atrial septal defect, patent ductus arteriosus. 3. Age distribution of congenital heart disease showed that 79.1% of all were below 30 years of age but atrial septal defect showed wide distribution below and above 30 years of age. 4. The incidences of each congenital heart disease were atrial septal defect 20.9%, tetralogy of Fallot 20.6%, ventricular septal defect 19.%, patent ductus arteriosus 12.0%, pulmonary stenosis 7.6%, trilogy of Fallot 1.8%, Ebstein's anomaly 1.8%, ventricular septal defect with pulmonary stenosis 1.3%, coarctation of aorta 1.3%, ventricular septal defect with aortic insufficiency 1.0%, transposition of great vessels 1.0%, in order and rare and various combined anomalies. 5. Average duration of illness in congenital heart disease was less than 15 years in majority, but duration from 11 years to 20 years was most common in tetralogy of Fallot. 6. Functional class of congenital heart disease is class II and I in majority, but class III was most common in tetralogy of Fallot. 7. Comparision of precatheterization diagnosis with postcatheterization diagnosis showed concordence in 92.2% and comparison of postcatheterization diagnosis with postoperative diagnosis showed concordence in 95.5% of cases. 8. Electrocardiographic findings in 5 major congenital heart disease were observed as follows; right ventricular hypertrophy 86.3%, right atrial enlargement 16.4% in tetralogy of Fallot, right ventricular hypertrophy 30.9%, incomplete right bundle branch block 27.9% in atrial septal defect, left ventricular hypertrophy 28.8%, right ventricular hypertrophy 10.6%, biventricular hypertrophy 10.6% in ventricular septal defect, left ventricular hypertrophy 63.2% in patent ductus arteriosus and right ventricular hypertrophy 70% in pulmonary stenosis. 9. Postoperative changes in electrocardiographic findings were observed in 36.1% of operated patients, of whom teteralogy of Fallot 61.7%, ventricular septal defect 48.0% were most common. Pstoperative electrocardiographic changes were complete right bundle branch block 58.3%, incomplete right bundle branch block 11.7%, myocardial ischemia 10%, nonspecific ST-T changes 10%, etc. in order.

Clinical Observation on Antihypertensive Effect of Acebutolol Hydrochloride(Sectral(R))

The antihypertensive effect of acebutolol was observed in 26 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral acebutolol was 21mmHg and 11mmHg. The results of antihypertensive therapy revealed good control in 30.8%, fair control in 34.6%, poor in 11.5% and failure in 23.1% of the cases. In 65.4% of the cases, good or fair control of hypertension which means drop of diastolic pressure to the level of less than 100mmHg was observed. 2) Mean drop in heart rate was 7/min. 3) Average daily dose was 508+/-171.9mg. 4) The side effect of oral acebutolol was mild gastrointestinal discomfort in two cases.

Clinical Observation on Antihypertensive Effect of Acebutolol Hydrochloride(Sectral(R))

The antihypertensive effect of acebutolol was observed in 26 cases of essential hypertension, and following results were obtained. 1) Mean decrease in systolic and diastolic blood pressure by oral acebutolol was 21mmHg and 11mmHg. The results of antihypertensive therapy revealed good control in 30.8%, fair control in 34.6%, poor in 11.5% and failure in 23.1% of the cases. In 65.4% of the cases, good or fair control of hypertension which means drop of diastolic pressure to the level of less than 100mmHg was observed. 2) Mean drop in heart rate was 7/min. 3) Average daily dose was 508+/-171.9mg. 4) The side effect of oral acebutolol was mild gastrointestinal discomfort in two cases.