Follow-up Results of Percutaneous Pulmonic Balloon Valvuloplasty in Adult with Pulmonic Stenosis

Percutaneous pulmonic balloon valvuloplasty(PPV) was performed in 23 patients with moderate to severe degree of pulmonary stenosis(PS) from March, 1986 to May, 1991. The patients were 26.4 years old, range from 15-44, and 13 of them were males. 19 patients of them had valvular stenosis and the other 4 patients had combined combined stenosis with infundibular stenosis. Associated cardiac defects were atrial septal defect(ASD) in 3 patient, patient foramen ovale(PFO) in two patients, and patent ductus arteriosus(PDA) in one patient. Transpulmonic peak systolic pressure gradient(big up tri, openP) decreased from 88.6+/-34.2mmHg to 31.2+/-21.3mmHg after PPV(p0.05). The sum of amplitudy of R wave in V1 and that of S wave in V6 in ECG(R1+S6) represents the degree of rigth ventricular hypertrophy. The ECG was followed-up for 15.3months(6~29months) in 11 patients and R1+S6 at pre PPV and at follow-up were 15.9+/-9.1mm and 9.3+/-4.1mm(p<0.01). In summary PPV can achieve very good short-term and long-term results in relieving moderate to severe pulmonic stenosis in adult.

Clinical and Electrophysiologic Characteristics of Idiopathic Sustained Left Ventricular Tachycardia

Ventricular tachycardias(VTs) usually complicate iscemic heart disease. Cardiomyopathy or other organic heart disease and are aften associated with sudden cardiac death. Ventricular tachycardias with no apparent cardiac abnormalities, however, have been known to have different clinical features comprising a unique clinical entity among other tachycardias. Eleven patients(7men, 4 women) were investigated on their clinical features, electrophysiologic studies and late potentials. 1) The mean age at diagnosis was 23.4+/-6.5 years and the predominating clincal features were palpitation, syncope or congestive heart failure. No death occured over a mean follow up period of 29.2+/-26.5 months. 2) The resting ECGs were within normal limits in 8 patients and showed nonspecific ST-T changes in 3 patients. 3) Ventricular pacing induced sustained ventricular tachycardias in 7 patients and nonsustained VT in 1 aptient. Atrial pacing could provoke sustained VTs in 3 patients. 4) His bundle electrograms(HBE) were obtained in 7 patients during tachycardial. The HV intervals of the induced VTs distributed between 0 to -25msec in 5 patients and there was no definite His potentials in two patients. 5) The coupling interval of premature stimuli and the echo interval(the interval from the stimulus to the initiation of resulting VT) showed inverse relationship in 5 cases. No direct relationship was observed. 6) The termination mode, observed in 7 patients, showed delayed ternmination in 2 patients. 7) Late potentials(LPs) were pisitive in three patients but there was no significant statistical difference between LPs in normal control and those with idiopathic sustained left VTs. 8) Verapamil terminated VTs in 8 patients and slowed the rate of tachycardial in 1 patient. In conclusion, idiopathic sustained left ventricular tachycardias occur in younger age group and have more favorable prognosis. The findings of EPS and LPs suggest microreentry or triggered activity as their basic mechanism and verapamil can be used effectively for their termination.

The Vasomotor Tone In Vasospastic Angina

To evaluate the coronary vasomotor tone in vasospasic angina, we compared the diameters of non-spastic segments of vasospastic group with those of control group. The internal diameters of each segment of three major coronary arteries were measured on the basal coronary angiogram, and nitroglycerin administration after provocation with ergonovine or acetylcholine. The vasospastic angina group consisted of 26 patients(20 males, 6 females, mean age of 54 years) and control group consisted of 25 patients (7 males, 18 females, mean age of 55 years). The basal coronary arterial diameters in vasospastic angina group were smaller than those in control group(p<0.05) except the distal segment of right coronary artery. The percent dilation ratio in vasospastic angina group was greater than that in control group(p<0.05). In vasospastic angina group there was no significant difference in the degree of constriction after provocation with ergonovine or acetylcholine between proximal and distal segment. These observations suggest that in vasospastic angina, basal coronary arterial tone is increased in the entire coronary arterial tree and the localized spasm may reflect local hyperrespon siveness.