A Clinical Study on the Regional Ejection Fraction and Regional Wall Motion In Acute Myocardial Infarction

Regional left ventricular dysfunction is common in patients with coronary artery disease and accurate analysis of regional dysfunction is of particular interest. For the quantitative assessment of regional dysfunction, we measured regional ejection fraction by radial sector division method in 19 patients with acute myocardial infarction and 13 normal controls who had multigated blood pool scan. And two independent observer analyzed regional wall motion using 5 point grading system in 18 patients undergoing radionuclide ventricular cineangiography. The results obtained were as follows : 1) Regional wall motion scores for the gated blood pool study agreed completely in 72 of 108 segments (66.7%) and agreed within 1 grade in 88 of 108 segments(81.5%) and agreement rate is lowest in the septal area. 2) Global left ventricular ejection fraction was 63.2+/-4.2% in normal controls, 36.6+/-6.8% in extensive anterior wall infarction group and 52.6+/-9.7% in inferior wall infarction group. The value of extensive anterior wall infarction group was significantly lower than that of inferior wall infarction group(p<0.005). 3) Regional left ventricular ejection fraction by radial sector division method in normal control group were as follows : area 1 ; 56.5+/-6.7%, area 2 : 77.9+/-4.8%, area 3 ;84.3+/-5.5%, area 4 : 76.8+/-6.6%, area 5 ; 84.7+/-7.6%, area 6 ; 85.9+/-11.2%, area 7 ; 75.5+/-12.3%, area 8 ; 74.9+/-14.0%, area 9 ; 75.5+/-8.8%, area 10 ; 54.2+/-11.0%, 11 ; 34.5+/-16.3, area 12 ; 37.1+/-18.0%. 4) Mean regional ejection fraction in 7 patients with anterior wall infarction showed significantly lower values in area 4 to area 8, and in area 2 to area 5 in case of inferior wall infarction group. 5) We thought that regional ejection fraction obtained by radial sector division method is valuable index for the management and evaluation of patients with coronary artery disease.

Recurrence of Left Atrial Myxoma

We present a case of recurrent left atrial myxoma which occurred 7 years and 10 months after initial operation despite resection of originaltumor and adjacent atrial septum. This is the first case report of recurrence in Korea. Among the possible causes of recurrence, regrowth from pretumorous focus seems to be the most suggesting one in this case. Histopathologic findings of recurrent myxoma showed increased cellularity with active proliferation and nuclear hyperchromasia. These findings, together with the rapidity of regrowth, suggest that recurrent myxoma may have 'wilder' behavior. Prolonged postoperative observation is important, even if ample resection was done at the initial operation including atrial septum.