Changes of pulmonary function in patients with mitral stenosis after percutaneous mitral balloon valvuloplasty

BACKGROUND: The patients with mitral stenosis are generally accompanied with impaired pulmonary function. The aim of this study was to evaluate the changes of pulmonary function after percutaneous mitral balloon valvuloplasty (PMV) in that patients. METHODS: PMV was performed in 36 patients with mitral stenosis in Pusan National University Hospital and hemodynamic, echocardiographic and pulmonary function test data before and after PMV were analyzed. RESULT: After PMV, NYHA functional class was improved from 2.2+/-0.6 to 1.2+/-0.4 (p<0.001). The mean left atrial pressure and mean pulmonary arterial pressure significantly decreased from 14.5+/-6.2 mmHg to 5.7+/-4.4 mmHg(p<0.001) and from 25.3+/-10.9 mmHg to 15.5+/-7.4 mmHg (p<0.001), respectively. Cardiac output was slightly decreased from 5.34+/-1.31 L/min to 5.28+/-1.25 L/min (p=0.50). Mean mitral pressure gradient decreased from 13.5+/-5.8 mmHg to 4.4+/-2.1 mmHg (p<0.001) and mitral valvular area significantly increased from 0.86+/-0.19 cm2 to 1.71+/-0.28 cm2 (p<0.001). In pulmonary function test, only MVV and PEF was significantly improved from 77.2+/-23.8% to 88.4+/-27.9% (p<0.01) and 87.1+/-26.8% to 97.5+/-26.4% (p<0.01), respectively. But, VC, FEV1, FEF25-75% and FVC were not changed significantly. In exercise treadmil test, exercise duration was significantly improved from 482.0+/-266.2 sec to 718.0+/-287.5 sec (p<0.001). CONCLUSION: We observed the results of better hemodynamic changes and exercise capacity after PMV. But, there was no significant improvement in pulmonary function after PMV. In our opinion, irreversible pulmonary changes and hemodynamic effect on pulmonary function should be considered.

Influence of left ventricular hypertrophy on ventricular arrhythmias in hypertensive patients / 대한내과학회지

OBJECTIVES:Left ventricular hypertrophy(LVH) increases the risk of sudden death in hypertensive patients and this is known due to ventricular arrhythmias. Thus, author studied the relationship between LVH as a hypertensive target organ damage and ventricular arrhythmias. METHODS: 24-hour ambulatory electrocardiographic monitoring, measurement of microalbumin in 24-hour urine and fundoscopic examination were performed on 100 hypertensives (50 patients without LVH and 50 patients with LVH on EKG) who admitted Pusan National University Hospital. RESULTS: In patients with LVH, ventricular extrasystoles occurred more frequently than without LVH(p<0.05) and ventricular couplet and ventricular tachycardia were more common but statistically not different. Microalbuminuria and hypertensive retinopathy were more severe in patients with LVH than without LVH(p<0.05 and p<0.01, respectively). CONCLUSION: Of the ventricular arrhythmias, ventricular extrasystole but not ventricular couplet and ventricular tachycardia occurred more frequently in patients with LVH than without LVH. Thus, prospective study with long-term follow up should be done to establish the relationship between hypertensive LVH and cardiovascular mortality, especially sudden death. And, further study should be done to make the relationship between reduction in LVH with antihypertensive therapy and reduction in LVH-associated ventricular arrhythmias.

The Significance of a Crochetage Pattern on R Wave in Electrocardiographic Inferior Limb Leads in Atrial Septal Defect

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.

Etiologies and prognostic factors of chronic cor pulmonale / 결핵

BACKGROUND: The aims of this study were to assess the etiologies, survival and prognositic factors of patients with chronic cor pulmonale visited Pusan National University Hospital. METHODS: This study included 103 patients with chronic cor pulmonale. There were 67 men and 36 women. The diagnosis of chronic cor pulmonale was primarily based on the presence of underlying lung disorder and echocardiographic finding of enlarged or hypertrophied right ventricle. Other clinical data including patients' symptoms and signs, findings of arterial blood gas analysis, hematologic and biochemical laboratory and pulmonary function test were assessed. RESULTS: The most common underlying lung disorder was pulmonary tuberculosis (59.2%) and chronic obstructive pulmonary disease was the next (28.2%). The survival rate was 57% in one year, 45% in two years, and 34% in three years. The prognostic factors were maximal voluntary ventilation(MVV), forced vital capacity(FVC), FEV1, serum Na, vital capacity(VC), serum albumin and peak expiratory flow(PEF) in univariate analysis. And in multivariate analysis, serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant. CONCLUSION: Pulmonary tuberculosis was the most important underlying lung disorder in chronic cor pulmonale. The survival rate was 57% in one year, 45% in two years, and 34% in three years. Serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant prognostic factors.

A Case of Forestier's Disease with Dyspnea / 결핵

Forestier's disease, also known as diffuse idiopathic skeletal hyperstosis(DISH), is a peculiar type of senile ankylosing hyperostosis of the spine characterized by flowing ossification of the anterior and right lateral aspect of the vertebral column, particularly in the thoracic region Although these patients are typically asymptomatic, there is documentation of a number of extraspinal manifestations including dysphagia, respiratory distress, dysphonia and cervial myelopathy. We report a case of Forestier's disease presenting with dyspnea in a 57-year old man, who have chronic cervical pain and bronchiectasis. Forestier's disease was diagnosed by cervical spine X-ray, neck CT. The patient was treated with oral steroid and then improved.

Relation Between Pulmonary Hypertension and Mitral Stenosis Severity in Patients Undergoing Balloon Mitral Commissurotomy

BACKGROUND: In patients with mitral stenosis, the degree of pulmonary hypertension is expected to be related to the severity of mitral valve obstruction. However, some patients with severe mitral stenosis do not develop reactive pulmonary hypertension. MATERIALS AND METHODS: We evaluated 34 patients with symptomatic mitral stenosis undergoing percutaneous mitral valvuloplasty by clinical, echocardiographic, and invasive hemodynamic(cardiac cathrterization) data. Prevalvuloplasty data were available in 34 subjects[mean age 38+/-9 year ; women 74% ; NYHA class 1 (6 patients), class 2 (17 patients), class 3 (7 patients), class 4 (4 patients) ; in electrocardiography, NSR(23 patients), Atrial fibrillation(11 patients)]. RESULTS: 1) The pulmonary vascular bed gradient was significantly correlated with pulmonary vascular resistance(r=0.91), mean pulmonary artery pressure(r=0.82), transmitral mean pressure gradient(r=0.64) and mitral valve area(r=-0.48). The pulmonary vascular resistance was significantly correlated with mena pulmonary artery pressure(r=0.77), transmiral mean pressure gradient(r=0.61) and mitral valve area(r=-0.54), NYHA functional classification(r=0.36). However, the pulmonary vascular bed gradient and pulmonary vascular resistance was not significantly correlated with age, sex, cardiac output, the severity of mitral regurgitation and mean left atrial pressure. 2) The mean pulmonary artery pressure was significantly correlated with mean left atrial pressure(r=0.80), transmitral mean pressure gradient(r=0.72) and mitral valve area(r=-0.47). 3) When patients were divided into those with a pulmonary vascular bed gradient > 12mmHg and

A Case of Bartter-like Syndrome in a Patient of Drug-induced Interstitial Nephritis Associated with Rheumatoid Arthritis / 대한신장학회잡지

A 59-year-old female patient with rheumatoid arthritis showed hypokalemic metabolic alkalosis, normotensive hyperreninemic hyperaldosteronism and high urinary prostaglandin level. She was thought to have Bartter's syndrome. But, her kidney biopsy specimen showed chronic interstitial nephritis. She have used acetaminophen containing analgesics for recent three years. So we thought her disease was caused by drug. But, in this case, clinical manifestations are correspond with Bartter's syndrome and we have witnessed a successful respond to kalium replacement, angiotensin converting enzyme inhibitor, prostaglandin inhibitor and spironolactone administration.

A Study on Serum Magnesium Concentration in the Management of Congestive Heart Failure / 대한내과학회지

OBJECTIVES: There are many interesting reports suggesting that magnesium(Mg) deficiency is deleterious in patients with congestive heart failure (CHF). It is paradoxical that the most important cause of Mg deficiency in these persons is maybe use of therapeutics including diuretics. Authors investigated the trend of serum and 24 hour urine Mg with other relating electrolytes in Mg homeostasis prospectively, in the management of CHF. And we assessd the effects of medications and many variables in .CHF on serum Mg, and the usefulness of serum Mg representing the body content. METHODS: Fifty three patients who were diagnosed as CHF by clinical finding and echocardiogaphy were prescribed conventional doses of diuretics as furosemide 40mg and spironolactone 50mg daily, with or without angiotensin converting enzyme(ACE) inhibitor and digitalis. And then, serial serum and 24 hour urine Mg, sodium, potassium and calcium were obtained at admission, 2nd day, 5th day, and discharge. RESULTS: The patients group with chronic CHF, which was defined as long-term use of diuretics over 6 months, showed higher prevalence of low level of serum Mg concentration than the group with acute one(11 of 28, 39% vs. 2 of 25. 8%, P< 0.01). Of those two groups, the latter showed upward trend of serum Mg from admission to discharge, but the former showed no change. In 24 hour urine Mg excretion, the amount of the patients with CHF was larger than that of control group. In the chronic CHF group, the effect of digitalis on decreasing serum Mg was evident. Serum Mg of acute CHF group correlated with serum BUN(r=0.5609). Whereas, that of chronic group with ejection fraction(r=-0.4742) and plasma renin activity(r=-0.3791), with serum potassium(r=0.4673) and creatinine(0.5846). Serum Mg may be useful indicator of Mg homeostasis, especially in chronic CHF patients. CONCLUSION: Because patients with chronic CHF were prone to deficiency of Mg in the management, maintaining the adequate serum Mg through long- term replacement seems very important in decreasing the morbidity and mortality of these persons.