A Case of Coronary Arteriovenous Fistula Associated with Giant Coronary Artery Aneurysm

Coronary arteriovenous fistula is a more prevalent, hemodynamically significant congenital malformation. Both coronary arteries arise normally from their aortic sinuses, but the branches of fistula communicate directly with cardiac chamber, pulmonary trunk, coronary sinus, superior vena cava, or pulmonary vein. Fistula associated with coronary aneurysm is an uncommon finding. We report a rare case of 76-year-old female patient who had a coronary arteriovenous fistula with giant coronary artery aneurysm. This case is clearly diagnosed by echocardiography, three-dimensional computed tomography (3D-CT), and coronary angiography (CAG).

Predictive Factors for the Recovery of Left Ventricular Dysfunction in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The left ventricular ejection fraction (LVEF) is known to be a significant prognostic factor for patients with acute myocardial infarction (AMI). The aim of this study was to investigate clinical or therapeutic factors associated with the recovery of a low LVEF for patients with AMI. SUBJECTS AND METHODS: From January to December 2004, we enrolled 89 patients (mean age: 62.5+/-10.6 years, 43 males and 26 females) with AMI and who had a LVEF less than 50%. Forty five patients whose LVEF improved more than 10% were classified as group I (mean age: 62.4+/-10.4 years, 34 males and 11 females) and 44 patients whose LVEF was not changed or decreased were classified as group II (mean age: 62.3+/-10.9 years, 29 males and 15 females). The clinical variables, including risk factors and the pain-to-door time, the biochemical markers of myocardial injury, the coronary angiographic findings and the treatment-related variables, were compared between the two groups. RESULTS: The cardiovascular risk factors were not different between the groups. The location of infarction, the success rate of percutaneous coronary intervention and the coronary angiographic lesion morphologies were not different between the groups. However, the pain-to-door time was significantly shorter in group I than in group II (6.0+/-9.5 vs 22.4+/-7.5 hours, respectively, p=0.046). Improved control of risk factors was not associated with the recovery of LV function. The use of beta-blocker, statin, anti-platelet agents, vasodilators and diuretics were not different between the groups. However, the use of angiotensin converting enzyme inhibitor (ACEI) was more common in group I than group II (79.3% vs 47.4%, respectively, p=0.03). CONCLUSION: A shorter pain-to-door time and the use of ACEI were significant predictors of the recovery of LV dysfunction for patients with AMI.

Predictive Factors for the Mortality of Cardiovascular Patients at Coronary Care Unit / 대한구급학회지

BACKGROUND: Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups. RESULTS: The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p<0.05). Predictive factors for mortality by multiple logistic regression analysis were low LVEF (OR 11.4, 2.9-21.4 95%CI, p<0.001), no performance of percutaneous coronary intervention (PCI, OR 10.8, 2.5-17.8 95%CI, p<0.001) and clinical diagnosis of aortic dissection (OR 3.8, 1.3-9.8 95%CI, p=0.021). CONCLUSIONS: The predictive factors for mortality at CCU were low LVEF, no PCI and aortic dissection.

The Clinical Effects of a Combined Agent Including Losartan and Hydrochlorthiazide, Hyzaar(R), in Patients with Ischemic Heart Failure

BACKGROUND AND OBJECTIVES: Angiotensin converting enzyme inhibitor is known to be effective in the prevention of left ventricular remodeling following myocardial infarction. However, little data is available concerning the clinical effects of angiotensin (AT) receptor blocker in ischemic cardiomyopathy. This study evaluated the clinical effects of the concomitant use of losartan with low doses of hydrochlorthiazide in cases of ischemic cardiomyopathy. SUBJECTS AND METHODS: A combined agent of 50 mg of losartan potassium with 12.5 mg of hydrochlorthiazide (HCTZ) was administrated once daily over a 12-week period to 29 patients (M:F=26:3, 61.4+/-8.7 years) who were diagnosed with ischemic heart failure (ejection fraction lower than 50% by echocardiography) at Chonnam National University Hospital. RESULTS: Clinical symptoms of dyspnea in the 29 patients improved from 2.08+/-0.49 to 1.15+/-0.38 as measured by New York Heart Association class. The systolic and diastolic blood pressure did not change significantly following treatment (116.5+/-18.0/77.0+/-11.9 mmHg vs. 118.7+/-15.1/78.1+/-11.1 mmHg). The ejection fraction following administration of Losartan/HCTZ increased from 40.3+/-8.1% to 46.7+/-10.8% (p=0.001). Losartan/HCTZ was well tolerated in all patients without significant adverse effects or laboratory changes. CONCLUSION: A fixed combination of losartan and low dose hydrochlorthiazide is effective in patients with ischemic heart failure.

A Huge Left Ventricular Pseudoaneurysm after Acute Inferior Myocardial Infarction

No abstract available.

Early Outcome of Long Coronary Stent Implantation

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) for long coronary lesion is known to be associated with low success rate,suboptimal outcome,high complication and restenosis rates. Here we report the early clinical and angiographic results of long coronary stent implantations for long coronary lesions. METHOD: We analyzed the clinical,angiographic features and early results after stent implantations in 46 patients who were implanted long coronary stent(> or =20mm in length)among 174 stented patients at Chonnam University Hospital from Jan.through Nov.1996. RESULT: 1) Age was 59+/-7(35-78) years,and sex ratio was 2.5:1(33 male:13 female). clinical diagnosis was as follows; 24 patients with unstable angina, 21 with acute myocardial infarction, 1 with stable angina and 6 with old myocardial infarction. Left ventricular ejection fraction by left venriculogram was 58+/-10(27-87)%. 2) Involved numbers of vessel were single in 27 patients, two in 14 patients, and three in 5 patients. Target stented coronary arteries were 28 left anterior descending arteries, 17 rigtt coronory arteries, and 1 left circumflex artery. Morphologic types of target lesions were type C in 26 patients, type B2 in 20, and diameter stenosis(DS) was 76+/-13%, minimal luminal diameter(MLD) 1.0+/-0.3mm, length 21+/-6(10-38)mm. Indications for stent were 28 denovo lesions, 10 restenoses, 5 suboptimal PTCAs and 3 bailout procedures. Twenty six Microstents 2, 15 Wallstents, 4 Freedom stents, and 1 Wictor stent were used. Stent diameter was 3.2+/-0.3(2.5-5.0)mm and length 30+/-3(20-49)mm, stent diameter/reference diameter(RD) ratio 1.0+/-0.1, and stent minus lesion length 9.0+/-3.7mm. 3) Stents were deployed successfully in all 46 patients. No procedure-related death, myocardial infarction, emergency bypass surgery, and laboratory evidences of acute or subacute stent thrombosis were observed. 4) DS was decreased to 3.5+/-7.5%, MLD was increased to 3.2+/-0.3mm(p<0.0001, respectively). Acute gain was 2.2+/-0.4mm(71.8+/-15.6%,p<0.0001). CONCLUSION: We observed high success rate without major complications in long stent implantations for long coronary arterial lesions. Long-term follow-up should be required to prove long coronary stent as a better treatment modality to reduce acute complications and late restenosis.