Ruptured sinus of valsalva aneurysms : Clinical features and surgical results / 대한내과학회지

BACKGROUND: Aneurysms of sinus Valsalva are rare anomalies thought to be primarily congenital in origin. To evaluate the clinical features and surgical results associated with ruptured aneurysm of sinus of Valsalva, we reviewed the clinical characteristics and follow up results of the patients. METHODS: From January, 1991, through June 2001, 33 patients with ruptured aneurysm of sinus of Valsalva underwent surgical correction from the above five university hospitals. The patients included 24 men and 9 women, with a mean age of 32+/-13 years. We reviewed symptoms, physical examination findings, ECG findings, the coexistent cardiac anomalies, echocardiographic findings, surgical results in 33 patients. RESULTS: Patterns of fistula tract were right coronary sinus-right ventricle in 24 patients (73%), noncoronary sinus- right atrium in 3 patients (9%), noncoronary sinus - right ventricle in 3 patients (9%), right coronary sinus - right atrium in 2 patients (6%) and right coronary sinus - right ventricle and right atrium in 1 patient (3%). Combined cardiac anomalies were VSD (20 cases; 61%), ASD (1 case; 3%) and PDA (1 case; 3%). But, only 12 cases of VSD (60%) were diagnosed with preoperative transthoracic echocardiography. The aneurysmal sacs were excised in all patients and the defects were closed with a patch in 21 patients (64%) and without patch in 12 patients (36%). No recurrence was observed during follow-up periods (68+/-38 months) for all survivors and there was no late complications or symptoms. CONCLUSION: In sinus of Valsalva aneurysm patients, combined cardiac anomalies, especially VSD, are common. Careful preoperative echocardiography should be performed to detect combined anomalies. And, surgical results are excellent without recurrence.

Antioxidant Vitamin Supplementation and Levels of Circulating Cellular Adhesion Molecules / 대한임상병리학회지

BACKGROUND: The oxidative modification of lipids and the endothelial expression of adhesion molecules are key events in the pathogenesis of atherosclerosis. The appropriate antioxidants that protected and slowed the progression of the disease were reported. We measured the antioxidant enzyme activities and the levels of soluble cellular adhesion molecules in order to evaluate whether antioxidant vitamin supplementation affected the oxidative changes and the expression of cellular adhesion molecules. METHODS: Seventy-seven patients participated in a randomized, double blind, placebo-controlled trial. The test group (38 patients) was given antioxidant vitamin doses including a daily dose of vitamin C 500 mg, beta-carotene 15 mg, vitamin E 400 IUs, and selenium 50 microgram, The control group (44 patients) received placeboes for three months. We measured the vitamin serum levels, intercellular adhesion molecules-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and activities of erythrocyte enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPX) before and at 3 months after supplementation. RESULTS: After supplementation, the serum vitamin levels increased significantly (P<0.05) and the activity of the erythrocyte SOD significantly increased by 0.85 unit/mg hemoglobin (P<0.05) in the test group. Soluble ICAM-1, VCAM-1 and E-selectin levels did not change significantly in the test group after supplementation. CONCLUSIONS: These results suggest that the antioxidant vitamin supplementation may affect erythrocyte SOD activity, but not soluble cellular adhesion molecule levels.

The Echocardiographic Finding of Alcoholic Cardiomyopathy after Cessation of Alcohol

BACKGROUND AND PURPOSE OF THE RESEARCH: It is believed that a long-term drinking will be one of the causes of congestive cardiomyopathy (CM). It is also possible for diagnosis of alcoholic cardiomyopathy in the majority of the patients diagnosed as idiopathic dilated cardiomyopathy if the history of mass alcoholic drinking is taken into consideration or proper blood test is conducted. This study is to confirm whether there is an improvement in the clinical result and cardiac function as has so far been known the case in the patients suspected of alcoholic. METHODS: Among 39 patients with dilated CM who were diagnosed by echocardiographic criteria and clinical evaluation, 11 patients who drank more than 77 g of alcoholic everyday for more than 10 years were defined as alcoholic CM. The changes of their clinical manifestations and m-mode echocardiographic findings in the patients with alcoholic CM were compared before and after treatment. RESULTS: All studied patients were male with the mean age of 52.6+8.0 and the mean follow up period was 38.6 months. Of the 11 patients, 3 patients could not completely free themselves from drinking. Their symptoms on first visit ranged in such order as dyspnea (63.6%), tachycardia (54.5%), and generalized edema (27.3%). Following the treatment, dyspnea and tachycardia showed a statistically significant improvement. Echocardio-graphic parameters, ie, LV diastolic dimension (6.7+/-0.6 cm before treatment and 6.3+/-1.2 cm after treatment), LV systolic dimension (5.6+/-0.7 cm before treatment and 5.2+/-1.4 cm after treatment) and E point septal separation (13.6+/-9.6 mm before treatment and 10.9+/-6.6 mm after treatment) decreased after treatment without a significant meanings in a statistical view point. Their ejection fraction (29.6+/-6% before treatment and 34.5+/-11.1% after treatment) increased after treatment. CONCLUSION: Cardiac symptoms of congestive heart failure and echo-cardiographic parameters in patients with alcoholic CM were improved after abstinence from alcoholic ingestion and medical treatment.