A Case of Hereditary Antithrombin III Deficiency Manifested by Myocardial Infarction and Deep Vein Thrombosis

Antithrombin III deficiency is an autosomal dominant disorder, which is manifested by recurrent venous thromboembolisms, such as: deep vein thrombosis and/or pulmonary embolism, but arterial embolisms are very rare. We report a case of a patient with hereditary antithrombin III deficiency, manifested by myocardial infarction and deep vein thrombosis.

Current Opinion in Viral Myocarditis and Dilated Cardiomyopathy: New Paradigms for Congestive Heart Failure

No abstract available.

Correlation of Parameters of Superior Vena Caval Flow with Transtricuspid Flow Pattern

BACKGROUND: Pulmonary venous flow velocity pattern (PVFVP) is widely used to assess LV diastolic function. It is known that the parameters of PVFVP have a significant correlation with the ratio of peak early diastolic filling velocity (E) to peak filling velocity at atrial contraciton (A) measured in the transmitral flow. However, the correlations between parameters of superior vena caval flow (SVCF) and transtricuspid E/A ratio have not been reported. Therefore the present investigation was performed to elucidate these correlations. METHODS: Fifty patients (26 men, mean age 63.1+/-11.1 years), who did not have significant tricuspid valvular disease and restrictive filling pattern on tricuspid and superior vena caval doppler, were included in this study. SVCF was recorded with the transducer positioned at subxiphoid area and the sample volume placed 2 cm within the superior vena cava. Blood flow across the tricuspid valve was obtained from standard four chamber view or modified parasternal four chamber view with the sample volume placed on leaflet tips. Recording was made during midexpiratory apnea. The following doppler parameters were measured: transtricuspid E and A velocity, E/A ratio: systolic (S) and diastolic (D) peak velocities and time velocity integrals (TVI), S/D velocity ratio, S/D TVI ratio, atrial reversal peak velocity (ArV) and TVI (ArTVI) in SVCF. RESULTS: 1) In SVCF, S velocity (63.7+/-11.8 cm/s vs 73.4+/-13.6 cm/sec, p1. And D TVI (7.1+/-3.0 cm vs 5.2+/-3.1 cm, p1. 2) As E/A ratio increased, diastolic TVI (r=0.315, p<0.05) and D/S TVI ratio (r=0.448, p<0.001) increased, and ArTVI (r=-0.376, p<0.01) and ArV (r=-0.416, p<0.01) decreased. 3) As E peak velocity increased, SVCF D peak velocity increased (r=0.305, p<0.05). CONCLUSIONS: Tricusupid E/A ratio has positive correlations with D TVI and D/S TVI ratio, and negative correlations with ArTVI and ArV. But there were no correlations in S velocity, D velocity, and S/D velocity ratio as the relation of mitral E/A ratio with PVFVP.

Correlation of the Time Interval from the Peak of Mitral E Wave to the Peak of Pulmonary Venous D Wave with Mitral Doppler Indexes

BACKGROUND: Pulmonary venous diastolic flow follows the pattern of mitral flow and is dependent on the pressure difference between the pulmonary vein and the left atrium (LA). The magnitude of the decrease in LA pressure in early diastole depends on both the volume of the blood leaving the LA and the stiffness of the left ventricle (LV) and the LA. Relaxation process is known to govern early diastolic compliance. We hypothesized that in patients with decreased early diastolic compliance due to LV relaxation abnormality, there may be rapid rise in LV and LA pressure, resulting in early peak of pulmonary venous D wave as early LV diastolic filling progress. This study was undertaken to define this hypothesis and to examine the relation of the time interval between E wave peak and D wave peak to mitral doppler indexes. METHOD: Patients with significant mitral or aortic valvular disease, or patients with LV ejection fraction below 60%, or patients who have pseudonormal or restrictive LV filling pattern on mitral and pulmonary venous Doppler, were excluded from this study. Mitral Doppler indexes including peak E velocity, peak A velocity, E wave acceleration time (EAT) and deceleration time (EDT) were measured. E/A ratio was calculated. The isovolumic relaxation time from aortic valve closure (Ac) to the onset of E wave , the time interval from Ac to the peak of E wave (AcE), the time interval from Ac to the peak of D wave, and the diastolic time from Ac to R of electrocardiogram (AcR) were measured by the pulsed wave Doppler and phonocardiography. The time interval from the peak of E wave to the peak of D wave (ED) was calculated by the subtraction of AcE from AcD. RESULTS: 1) ED is significantly shorter in patients with E/A or =1 (58.9+/-27.4 msec versus 74.7+/-17.2 msec, p<0.05). 2) ED correlated with IVRT (r=-0.400, p<0.01), AcR (r=0.414, p<0.01), but not with E/A ratio, EDT, or EAT. 3) Multivariate linear regression analysis with all the previously mentioned variables showed that IVRT, AcR, and EAT were independent determinants of the ED. CONCLUSION: This study demonstrates that the ED is shortened in patients who are regarded as having LV relaxation abnormality and that ED is affected by IVRT, AcR, and EAT.

A Case of Renal Hypertension with Unilateral Renal Artery Stenosis and Contralateral Hypoplastic Kidney

Hypertension may be due to either vascular (renal artery stenosis) or nonvascular (urologic) causes in hypertensives with unilateral small kidneys. Generally, the occurrence of hypertension in association with difference in kidney size suggests the presence of prolonged renal artery stenosis. This condition can result in decreased volume of the poststenotic kidney. Another cause of small kidneys is unilateral renal agenesis, renal dysplasia with or without reflux, tubular obstruction, and hydronephrosis. Hypertension can be attributed to abnormal-sized kidneys. Nephrectomy of the small kidney or correction of the stenotic artery normalizes blood pressure. De Jong and associates reported 8 cases of young women thought to have hypertension caused by unilateral renal parenchymal disease. Renal angiography, however, disclosed significant renal artery stenosis in the contralateral kidney of all 8 patients. Revascularization of the kidney with stenotic lesions cured the hypertension. The data suggests that in patients suspected of having hypertension caused by unilateral renal parenchymal disease, not only should renal venous renins be determined, but nephrectomy should not be peformed as well until renal angiography has been performed to exclude contralateral renal artery stenosis. We report a case of unilateral renal artery stenosis with contralateral hypoplastic kidney in a 22 year old woman; hypertension was corrected by successful anastomosis of the stenotic artery without nephrectomy of the contralateral small kidney.

Intraoperative Low-dose Dobutamine Echocardiography Predicts the Post-pump Response of Dysfunctioning Myocardial Segments to Coronary Artery Bypass Grafting

BACKGROUND: Low dose dobutamine echocardiography has recently been introduced for use in identification of viable myocardium in patients with acute myocardial infarction and prediction of the response of dysfunctioning myocardial segments to coronary angioplasty. The aim of this study was to evaluate wheter tihs test could be used to predict the early response of dysfunctioning myocardial segements to coronary artery bypass grafting(CABG). METHODS: We studied in 23 patients with multi-vessel disease during CABG. Myocardial segments were monitored by intraoperative transesophageal echocardiography(TEE) in the transgastric short-axis view at papillary muscle level. The left ventricle was divided into five segments and sixty eight myocardial segments in 23 patients were analyzed. Percentage of systolic wall thickening(PSWT) was calculated in each segment for three times: at basline(early after pericardiectomy);before bypass during dobutamine infusion(3-5ug/kg/min);and after seperation from cardiopulmonary bypass. Segments showing baseline PSWT >_30% were considered normal and those _10% during dobutamine infusion were considered responders and those 30%(normal) and 44(68%) had PSWT _10%(from 12.3+/-7.2% to 33.5+/-11.8%, p<0.01 ; responder segments), and 23(52.3%) showed increase in PSWT < 10%(from 14.7+/-6.5% to 17.4+/-7.4%, p=NS ; nonresponder segments). After CABG, responder segments showed a significant increase in PSWT in comparison with baseline values(from 12.3+/-7.2% to 32.1 +/-11.0%,p<0.01). Segments not responded to dobutamine showed no significant changes in PSWT after CABG(from 14.7+/-6.5% to 16.0+/-8.2%, p=NS). Twenty-four normal segments (PSWT 41.9+/-6.2%) showed a slight but significant reduction in PSWT both during dobutamine infusion(38.7+/-6.9%;p<0.05) and after CABG(38.9+/-6.3%, p<0.05), suggesting that compensatory hyperfunction was present at baseline. Estimation of clinical accruacy of low dose dobutamine TEE yieded to 69% sensitivity, 93.9% specificity, 95.2% positive predictive value, 60.9% negavive predictive value, and 77.3% overall accuracy. In both responders and nonresponders of dysfunctioning segments, there was a correlation between PSWT during dobutamine infusion and that after CABG(r=0.61, r=0.63, respectively). CONCLUSION: Low dose dobutamine TEE test well predicts the early response of dysfunctioning myocardial segments to CABG.

Comparison of Coronary Angiographic Findings between Patients with and Those without Stable Angina Pectoris Prior to Acute Myocardial Infarction

BACKGROUND: Many investigators found that there were more severe and extensive atherosclerosis in patients with stable angina pectoris than those with unheralded acute myocardial infarction(AMI). But coronary angiographic findings in patients with or without stable angina pectoris(SAP) prior to acute myocardial infarction are somewhat controversial. And in many articles that compared the coronary angiographic findings between patients with and those without angina prior to acute myocardial infarction, the definition of angina and significant coronary artery stenosis were not uniform. So, coronary angiographic finding were compared between patients with and those without stable anginal pectoris prior to AMI according to scoring system suggested by Bogarty. METHOD: Coronary angiography was performed in 141 patients with AMI. Angiographic findings of patients with SAP prior to AMI were compared to those without SAP prior to AMI. Risk factors of coronary artery disease were also compared. RESULTS: 1) Numbers of the patients with SAP were 34(24%) and those without SAP were 107(76%). 2) Numbers of stenosed vessels, Numbers of tenosed lesions, extent index and percent of diffuse pattern were higher in SAP group(p<0.05). 3) Numbers of diseased vessels and occluded lesions were not different between two groups(Pvalue was 0.07 and 0.5, respectively). 4) patients with SAP were older than those without SAP(p = 0.03). 5) Sex ratio and prevalence of hypertension, diabetes and smoking were not different between two groups. 6) Lipid profiles were not different between two groups. CONCLUSION: Patients with SAP prior to AMI had more severe and extensive atherosclerosis than those without stable angina pectoris prior to AMI.

Comparison of Coronary Angiographic Findings between Patients with and Those without Stable Angina Pectoris Prior to Acute Myocardial Infarction

BACKGROUND: Many investigators found that there were more severe and extensive atherosclerosis in patients with stable angina pectoris than those with unheralded acute myocardial infarction(AMI). But coronary angiographic findings in patients with or without stable angina pectoris(SAP) prior to acute myocardial infarction are somewhat controversial. And in many articles that compared the coronary angiographic findings between patients with and those without angina prior to acute myocardial infarction, the definition of angina and significant coronary artery stenosis were not uniform. So, coronary angiographic finding were compared between patients with and those without stable anginal pectoris prior to AMI according to scoring system suggested by Bogarty. METHOD: Coronary angiography was performed in 141 patients with AMI. Angiographic findings of patients with SAP prior to AMI were compared to those without SAP prior to AMI. Risk factors of coronary artery disease were also compared. RESULTS: 1) Numbers of the patients with SAP were 34(24%) and those without SAP were 107(76%). 2) Numbers of stenosed vessels, Numbers of tenosed lesions, extent index and percent of diffuse pattern were higher in SAP group(p<0.05). 3) Numbers of diseased vessels and occluded lesions were not different between two groups(Pvalue was 0.07 and 0.5, respectively). 4) patients with SAP were older than those without SAP(p = 0.03). 5) Sex ratio and prevalence of hypertension, diabetes and smoking were not different between two groups. 6) Lipid profiles were not different between two groups. CONCLUSION: Patients with SAP prior to AMI had more severe and extensive atherosclerosis than those without stable angina pectoris prior to AMI.

A Case of Incessant Ventricular Tachycardia Abolished after Endomyocardial Biopsy

Ventricular tachycardia is an important tachyarrhythmia which is encountered commonly in clinical field. The accompanying manifestations could be variable just from palpitation to sudden cardiac death. The classification of this arrhythmia has not completly settled yet, but in a broad way this arrhythmia is classified according to the prescence or abscence or underlying heart disease, especially coronary artery disease. Recently, therapeutic modalities for this arrhythmia have been changed a lot from classical antiarrhythmic drugs to radiofrequency ablation or ICD implantation although there are still some problems to overcome. We experienced a case of 34-year-old female having an incessant ventricular tacycardia which was abolished after endomyocardial biopsy performed to differentiate underlying myocardial pathology.

A Primary Cardiac Angiosarcoma

Primary tumors of the heart are rare and the most are benign. Malignant tumors constitute less than 25% of primary cardiac tumors and angiosarcomas are the most commonly reported histologic type. At least 160 cases have been reported in the world, but no previous report in Korea. We reported a case of primary cardiac angiosarcoma located in right atrium.

Transesophageal Echocardiographic Findings in 3 Cases of Takayasu's Arteritis

BACKGROUND: Takayasu's arteritis is a chronic non-specific inflammatory disease of arteries and it is known that aorta and its major branches are most commonly invoved. Its etiology is still unknown but the basic process is marked intimal proliferation, fibrosis and fibrous scarring with degeneration of the elastic fibers of the media. The proliferative and cicatrical process leads to luminal narrowing, stenosis, localized aneurysm, postsenotic dilatation and calcification in the involved arterial wall. Little attention has been paid to the diagnostic value of transesophageal echocardiography(TEE) in Takayasu's arteritis. METHODS: We evaluated transesophageal echocardiographic findings of aortic lesions in 3 cases of Takayasu's arteritis. RESULTS: The transesophageal echocardiographic findings of aortic lesions in Takayasu's arteritis characteristically showed relatively long sehmental luminal narrowing caused by marked intimal proliferation and contracture fo aortic wasll. The morphology of intimal thickening was characteristically circumferential, concentric and the size of the aorta itself was decreased by contracture as compared with atherosclerotic changes involving aorta. Besides these findings were consistent with angiographic findings. The common types of Takayasu's arteritis which we will meet clinically are known as type I or III. Indeed, 3 cases described in this paper are all type 3 patients. According to that fact, most of Takayasu's arterits may have aortic lesions that could be easily accessible by TEE and the degree of deformity of the aorta can be evaluated using TEE. CONCLUSION: The transesophageal echocardiography may be a valuable diagnostic tool for the evaluation of aortic wall and luminal status in the patients with Takayasu's arteritis.

Effect of mitral regurgitation on pulmonary venous flow pattern derived from transesophageal echocardiography

No abstract available.

Effect of mitral regurgitation on pulmonary venous flow pattern derived from transesophageal echocardiography

No abstract available.