Effects of Spontaneous Recanalization of Left Ventricular Function after Acute Myocardial Infarction

We studied the incidence of spontaneous infarct related artery recanalization and it's effect on LV function in 120 patients with acute myocardial infarction by angiography within 1 month after onset of acute MI between Nov. 1983 to Sep. 1988. The total occlusion rate of the infarct related artery in 34 cases catheterized from 1st day to 7th day was 55.8%, that of 33 cases from 8th day to 14th day 51.5%, that of 32 cases from 15th day to 21th day 40.7% and that of 21 cases from 21th day to 30th day was 47.7%. These results suggest that spontaneous recanalization of infarct related artery has mainly occurred within 24 hours after acute MI. LV ejection fraction among those patients who showed spontaneous recanalization(n=59) was not significantly superior to those with persistent occlusion of the infarct related artery. Both anterior and inferior MI patients showed no difference in LV function as regard to whether they showed recanalization or persistent occlusion. Although early spontaneous reperfusion of the infarct related artery is not uncommon in acute MI, LV function was not influnced by the spontaneous recanalization at least until 1 month after MI.

Echophonocardiographic Study in Patients Undergoing Percutaneous Mitral Balloon Valvuloplasty(PMV)

Percutaneous mitral ballon valvuloplasty(PMV) is an effective nonsurgical procedure for patients with mitral stenosis. PMV was performed in 13 patients(mean age, 41 years) with mitral stenosis. All patients underwent echophonocardiography(Echophono) before and after PMV. Two dilatation balloons were used in which the diameters approximately equaled the mitral valve annulus diameter as determined. After PMV, the mean mitral valve pressure gradient decreased(22.3+/-1.89mmHg to 5.2+/-2.6mmHg), the mean left atrial pressure decreased(21.3+/-5.1mmHg to 9.0+/-4.5mmHg) and the mitral valve area increased from 0.8+/-0.3cm2 to 1.7+/-0.6cm2. The Echophono data are correlated with clinical and hemodynamic changes produced by PMV. PMV resulted in echophono changes consistent with decresed severity of mitral stenosis ; shortening of Q-S1, from 88+/-14 to 73+/-11 mses(p<0.01) and (Q-S1)-(S2-OS), from 0.9+/-1.7 to -2.1+/-1.6(p<0.001) ; prolongation of S2-OS from 80+/-15 to 103+/-14 msec(p<0.001) and increase of EF slope from 14.7+/-5.4 to 26.7+/-8.1 mm/sec(p<0.001). Compared with pre-PMV, post-PMV Echophono showed significant decrease in the severity of mitral stenosis. Thus Echophono is a simple, low cost method helpful in evaluation and follow-up patients undergoing PMV.

Coronary Thrombolysis with Intravenous Recombinant Tissue-Type Plasminogen Activator(rt-PA)

Eleven patients with acute myocardial infarction were treated with recombinant tissue-type plasminogen acrivator(rt-PA). The incidence of coronary thrombolysis, reocclusion and effect on the fibrinolytic system were studied. Dose of 1.25mg/kg up to 100mg of rt-PA was given intravenously for3 hours. Six of 7 patients(85.7%) on whom coronary angiography was performed within 90 min of initiation of therapy showed recanalization of the infarct-related artery and two of 3 patients at 24hrs. Reocclusion was demonstrated in one of 7 patients on whom repeat coronary angioplasty was performed at 15+/-5days. Blood fibrinogen level was higher than 100mg/dl after rt-PA infusion. One patients died during left ventriculography and there were no major bleeding complications. Thus intravenous rt-PA achieves high rate of recanalization without eliciting clinically significant fibrinogenolysis.

A Case of Main Pulmonary Artery Aneurysm Associated with Patent Ductus Arteriosus

Pulmonary artery aneurysms are extremely rare. Even though their etiology or mechanism remain uncertain, congetial anenrysms follow the congenital heart defects which elevate the pulmonary artery pressure or increase the pulmonary blood flow and acquired aneurysms are developed by syphilis, mycotic change and atherosclerosis. Pulmonary artery aneurysms involve the artery trunk rupture and exanguination if untreated, there has been an emphasis in the need for surgical intervention whenever the diagnosis is made regardless of the presence or absence of symptoms. Here we report a case of patient ductus arterious associated with main pulmonary artery aneurysm in 39 year old female patient with review of literatures.

Mitral Regurgitation after Percutaneous Balloon Mitral Valvuloplasty(PMV): Results and Relationships to Valve Morphology

To evaluate the change in valvular morphology and occurence and severity of mitral regurgitation produced by PMV, 45 patients(33 women and 12 men,mean age 38+/-10 years) were studied using two-dimensional(2-D) and Doppler echocaediography before and 1-2 days after this procedure. Mitral valve area after PMV increased in all patients, from 0.9+/-0.2 to 1.8+/-0.4cm2(P<0.0001). In valve area estimation, the correlation between Gorlin`s method and 2-Dechocardiography was better(r=0.61, p<0.0001) than that between Gorlin`s method and Doppler pressure halftime(r=0.38, P<0.01) before valvuloplasty, but after the procedure Gorlin`s and 2-D image valve area correlated less well(r=0.33, P<0.05) than Gorlin`s-Doppler pressure halftime correlation(r=0.46, P<0.002). Before PMV, 37 patients had no mitral regurgutation, 7 had grade 1 and 1 had grade 2 mitral regurgutation. After PMV, new mitral regurgutation occurred in 14 patients, increased in severity in 5 patients and so mitral regurgutation newly developed or increased in severity in 19(42%) patients. There were no differences between the patients with and those without an increase in mitral regurgutation after PMV, in age, sex, caediac rhythm, initial mitral valve area, increase in mitral valve area and fluoroscopic calcification. However, morphologic characteristics especially mobility(P<0.01) and thickening(P<0.05) of mitral leaflets were better pressured, and EBDA/BSA(effective balloon dilating area/body surface area) was significantly smaller(P<0.02) in patients without an increase in mitral regurgutation. Thus, an increase in mitral regurgutation after PMV might be related to the features of valve morphology especially and thickand EBDA/BSA.