Clinical Significance of Choroidal Thickness in Eyes with Ocular Ischemic Syndrome

Purpose@#To determine the clinical significance of choroidal thickness and evaluate changes in choroidal thickness over time in eyes affected by ocular ischemic syndrome (OIS). @*Methods@#Medical records of 16 patients diagnosed with OIS between November 2017 and August 2019 were retrospectively reviewed. In every nine areas of the Early Treatment Diabetic Retinopathy Study grid, we compared the differences in choroidal thickness between the eyes with OIS and unaffected eyes, and its change in the OIS eyes during the follow-up period using swept-source optical coherence tomography. We analyzed the best-corrected visual acuity, intraocular pressure, fluorescein angiography (FAG) parameters, systemic diseases, and the duration of symptoms. Correlation between FAG parameters and the choroidal thickness value ratio in the OIS eyes and the unaffected eyes, and changes in the choroidal thickness in the OIS eyes during follow-up were investigated. @*Results@#Median age of the subjects was 67.5 years. In the OIS eyes, all FAG parameters were delayed at the initial examination. Best-corrected visual acuity and intraocular pressure were significantly different between the OIS and unaffected eyes. While the choroidal thickness in every nine areas of Early Treatment Diabetic Retinopathy Study in the OIS eyes was lesser than the unaffected eyes, the choroidal thickness of inner temporal, outer nasal, and outer temporal area showed statistically significant difference. During follow-up, changes in choroidal thickness of OIS eyes as well as correlation between the FAG parameters and the choroidal thickness value ratio between the OIS eyes and the unaffected eyes were not found to be statistically significant. @*Conclusions@#The choroidal thickness of the eyes with OIS was significantly less compared with the unaffected eyes. We inferred that choroidal thinning takes place in the early phase of the disease as the changes in choroidal thickness during the follow-up period were not significant.

Preservative-free Triamcinolone Acetonide-assisted Visualization of the Internal Limiting Membrane

Purpose@#To evaluate and compare the degree of visualization of the vitreous and internal limiting membrane (ILM) during pars plana vitrectomy (PPV) using preservative-free triamcinolone acetonide (PF-TA) or triamcinolone acetonide suspension (TAS). @*Methods@#We retrospectively analyzed the medical records of 61 eyes of 61 patients who underwent 25-gauge PPV and ILM peeling for various macular diseases. We assigned the patients to PF-TA and TAS groups, i.e., according to the type of triamcinolone acetonide used. The degree of visualization of the vitreous and ILM was classified into four different categories. The number of dye injections during PPV, need for indocyanine green (ICG), time elapsed before ILM peeling, and intraocular pressure (IOP) before surgery, 1 day and 1 month after surgery were determined. @*Results@#The degree of visualization of the vitreous and ILM was significantly better in the PF-TA group compared with the TAS group. Although the number of dye injections during PPV was not different between the PF-TA and TAS groups (2.56 ± 0.07 and 2.37 ± 1.08, respectively, p = 0.06), the need for ICG was significantly different (6 and 22 eyes, respectively, p < 0.01). The time elapsed before ILM peeling was 185.68 ± 130.02 s in the PF-TA group and 411.15 ± 267.38 s in the TAS group (p < 0.01). The IOP was not different before or 1 day after surgery between the PF-TA and TAS groups, but was significantly different 1 month after surgery (12.88 ± 3.10 and 14.41 ± 2.91 mmHg, respectively, p = 0.03). @*Conclusions@#Visualization of the vitreous and ILM was better when using PF-TA compared to TAS. PF-TA-assisted PPV could reduce the usage of ICG and was associated with a reduced latency to ILM peeling. Because this was in turn associated with a lower IOP at postoperative 1 month, PF-TA was safer and more effective than TAS.

Factors Related to Repeatability of Intravitreal Bevacizumab Injections in Branch Retinal Vein Occlusion Macular Edema

PURPOSE: To identify the factors related to repeatability of intravitreal bevacizumab injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: The present study included 26 patients with macular edema secondary to BRVO occurring within 1 month of diagnosis. Initial best corrected visual acuity, type of BRVO according to the involved vein branch, distance between fovea and occlusion vein, central macular thickness, type of macular edema, presence of macula hemorrhage, and presence of capillary nonperfusion were evaluated at the time of diagnosis. The patients received an intravitreal bevacizumab injection at the time of diagnosis and reinjections when macular edema and visual acuity were aggravated. According to the factors considered, the reinjection-free rate which was considered a survival rate was evaluated for 1 year after the first injection. RESULTS: The patients with initial visual acuity lower than log MAR 0.5 showed 52.6% survival rate within 1 year compared with 14.3% of the patients with visual acuity higher than log MAR 0.5 (p < 0.01). The patients with occluded vein closer than a distance of 2.5 disc diameters (DD) from the foveal center had a 57.1% survival rate and the patients with occluded vein farther than a distance of 2.5 DD from the foveal center had a 25.0% survival rate (p = 0.04). Macular BRVO and major BRVO patients had 64.3% and 16.7% survival rates, respectively (p = 0.01). CONCLUSIONS: The patients with BRVO may have less chance of repetitive intravitreal bevacizumab injections due to macular edema when initial visual acuity is lower than log MAR 0.5, occluded vein is closer than 2.5 DD from the foveal center, and macular branch is involved at the initial diagnosis. These factors can be utilized to predict the prognosis of BRVO patients and the probability of repetitive intravitreal bevacizumab injections.

Relationship between Control Grade, Stereoacuity and Surgical Success in Basic Intermittent Exotropia

PURPOSE: This study was conducted to identify the relationship between control grade, stereoacuity and surgical success in basic intermittent exotropia. METHODS: This retrospective study involved 44 basic intermittent exotropia patients who underwent strabismus surgery and completed at least 6 months of follow-up. The 44 patients were divided into three subgroups according to their control grade: group 1 (good control group, n = 12), group 2 (fair control group, n = 18), and group 3 (poor control group, n = 14). Evaluation was done to identify the relationships between near and distance stereoacuity and control grade, and between surgical success and control grade. Surgical success was defined as ocular alignment between 5 prism diopters esodeviation and 10 prism diopters exodeviation in the primary position at the final visit. RESULTS: Mean near stereoacuity measured by the graded circle test was 57.50 seconds of arc (seconds) in group 1, 77.77 seconds in group 2, and 131.43 seconds in group 3 (p < 0.01). Mean distance steroacuity measured by Mentor B-VAT II BVS contour circle was 108.33 seconds in group 1, 148.33 seconds in group 2, and 262.82 seconds in group 3 (p < 0.01). Ten patients (83.33%) in group 1, 12 (66.67%) in group 2, and 9 (64.29%) in group 3 obtained surgical success (p = 0.28). CONCLUSIONS: In basic intermittent exotropia, better control grade was significantly accompanied by better stereoacuity. Better control grade was accompanied by higher surgical success rate but with no statistical significance.

Relationship between Control Grade, Stereoacuity and Surgical Success in Basic Intermittent Exotropia

PURPOSE: This study was conducted to identify the relationship between control grade, stereoacuity and surgical success in basic intermittent exotropia. METHODS: This retrospective study involved 44 basic intermittent exotropia patients who underwent strabismus surgery and completed at least 6 months of follow-up. The 44 patients were divided into three subgroups according to their control grade: group 1 (good control group, n = 12), group 2 (fair control group, n = 18), and group 3 (poor control group, n = 14). Evaluation was done to identify the relationships between near and distance stereoacuity and control grade, and between surgical success and control grade. Surgical success was defined as ocular alignment between 5 prism diopters esodeviation and 10 prism diopters exodeviation in the primary position at the final visit. RESULTS: Mean near stereoacuity measured by the graded circle test was 57.50 seconds of arc (seconds) in group 1, 77.77 seconds in group 2, and 131.43 seconds in group 3 (p < 0.01). Mean distance steroacuity measured by Mentor B-VAT II BVS contour circle was 108.33 seconds in group 1, 148.33 seconds in group 2, and 262.82 seconds in group 3 (p < 0.01). Ten patients (83.33%) in group 1, 12 (66.67%) in group 2, and 9 (64.29%) in group 3 obtained surgical success (p = 0.28). CONCLUSIONS: In basic intermittent exotropia, better control grade was significantly accompanied by better stereoacuity. Better control grade was accompanied by higher surgical success rate but with no statistical significance.

Factors Affecting Final Visual Acuity in Infectious Endophthalmitis Following Cataract Surgery

PURPOSE: To evaluate the factors affecting the clinical outcome and final visual acuity in patients with infectious endophthalmitis following cataract surgery. METHODS: In this study, 35 patients who were diagnosed with endophthalmitis following cataract surgery from 2003 to 2012 were retrospectively analyzed. To evaluate factors affecting final visual acuity, the following were investigated: initial visual acuity, presence of diabetes mellitus, onset of endophthalmitis after the cataract surgery, performance of vitrectomy, duration between diagnosis and vitrectomy, presence of culture and results of bacterial cultures, type of corneal incision, presence of suture on corneal incision, presence of posterior capsule rupture, and surgeon's experience in referred cases. RESULTS: Intravitreal antibiotic injection was given in all 35 cases, and vitrectomy was additionally performed in 30 of the cases. Statistically, none of the initially investigated factors affected final visual acuity. Coagulase-negative staphylococci including staphylococcus epidermidis were the most common organisms isolated during the study period. CONCLUSIONS: No single factor investigated significantly affected the final visual acuity in postoperative endophthalmitis following cataract surgery.

Distance Stereoacuity by Frisby Davis Distance Stereotest after Surgery in Intermittent Exotropic Patients

PURPOSE: To compare distance stereoacuity in patients with intermittent exotropia before and after surgery using the Frisby Davis distance stereotest (FD2), and to determine the preoperative factors that affect the postoperative distance stereoacuity. METHODS: A total of 56 patients with intermittent exotropia were examined for the present study. To determine preoperative factors that affect postoperative distance stereoacuity, age, gender, distance control, and presence of fusion were measured. The deviation angle was measured at near and at distance by using a prism cover test. Distance stereoacuity was measured with the FD2 test. RESULTS: According to the results of the FD2 test, the mean preoperative distance stereoacuity of patients was 64.7 +/- 76.1 sec of arc, and improved to 53.6 +/- 85.9 sec of arc postoperatively. The distance stereoacuity improved notably from 63.0 to 40.0 sec of arc after the successful surgery. No significant correlation was present between type of surgery, distance control, presence of fusion, and postoperative improvement of distance steroacuity. CONCLUSIONS: Decreased stereoacuity in intermittent exotropic patients improved postoperatively, and the FD2 test was valuable in evaluating the stereoacuity in intermittent exotropic patients pre- and postoperatively.

Effects of Partial Hepatectomy for Hepatocellular Carcinoma Meeting Milan Criteria Combined with Compensated Liver Cirrhosis

PURPOSE: This study examined the effects a partial hepatectomy through an analysis of survival rates and examine the recurrence pattern after a partial hepatic resection for HCC according to the Milan criteria combined with Child-Pugh A cirrhosis. METHODS: On hundred and twenty seven HCC patients with Child-Pugh A liver cirrhosis undergoing a hepatic resection for HCC from September 1987 through July 2004 in the hospital were retrospectively reviewed. Among them, 85 cases met the Milan criteria (M group). However, the remaining 42 cases did not (N group). The median age was 52 years and males outnumbered females by almost five times. The median follow up period was 39.8 months. RESULTS: No in-hospital mortality occurred in the M group, but there was a single mortality case in the N group. The size of the tumor, multiplicity and major resection rate were different between the two groups. The 5 years overall survival rate of each group was 62.3% and 37.3%, respectively (P=0.002) and the 5 year disease free survival rates were 44.0% and 24.5%, respectively (P=0.023). Forty one patients in the M group developed recurrences, of which 35 had only intrahepatic recurrences. Among them, 28 recurrences still met the Milan criteria. CONCLUSION: A partial hepatic resection should be considered a standard treatment method for a HCC meeting the Milan criteria with compensated liver cirrhosis in terms of safety and long-term survival. A salvage transplantation may play a role after a recurrence because most recurrences are intrahepatic recurrences that meet the Milan criteria.

The Effects of Serum Homocysteine on the Restenosis after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Hyperhomocyt(e)inemia is known to be one of independent risk factors for the ischemic heart diseases recently, but the role of hyperhomocysteinemia in restenosis after coronary intervention is unclear. The relationship between plasma homocysteine level and restenosis after coronary intervention was evaluated in Korean patients. MATERIALS AND METHOD: Eighty three patients underwent successful percutaneous coronary intervention (PCI) and follow-up coronary angiography were divided into two groups according to restenosis, and the level of plasma homocysteine was compared between groups with restenosis (n=5, M:F=7:8, 60.6+/-13.5 years) and without restenosis (n=8, M:F=0:8, 60.3+/-12.8 years). RESULTS: The clinical manifestation, atherosclerosis risk factors except for hypertension, and coronary angiographic findings were not significantly different in patients with or without restenosis(P=S). The value of homocysteine was 9.3+/-3.1 micromol/L in 35 patients with restenosis and 8.4+/-2.5 micromol/L in 48 patients without restenosis(P=S). All of 8 patients whose values of plasma homocysteine were more than 13 micromol/L, had angiographic restenosis. Plasma homocysteine was not an independent risk factor of restenosis by means of logistic regression analysis. CONCLUSION: Plasma homocysteine is not a potential risk factor of restenosis after percutaneous coronary intervention.

Long-Term Clinical Follow-up in A Case of Takayasu's Arteritis Involving the Ostium of Left Coronary Artery after Ostioplasty

A 25-year-old woman presented with effort-induced chest pain. Physical examination revealed different blood pressures, 180/100 mmHg in right arm and 100/60 mmHg in left arm. Resting electrocardiogram was normal, but down-slope depression of ST segment more than 3 mm in V3-6, II, III, aVF developed at the stage 1 of treadmill exercise test. Stress Thallium-201 scan showed severe ischemia in the anteroseptal and lateral wall of left ventricle. Diagnostic coronary angiogram showed critical stenosis in the ostium of left main coronary artery. The left subclavian artery was occluded totally with well-developed collateral circulation. The patient underwent ostioplasty of left coronary ostium using pericardial patch, and her symptom improved after surgery. Follow-up coronary angiogram one year after surgery showed patent coronary artery ostium with good flow and myocardial perfusion improved on follow-up Thallium-201 SPECT. She has no major cardiac events during 7-year clinical follow-up.

Clinical and echocardiographic changes in patients with mitral stenosis according to different therapeutic modalities / 대한내과학회지

BACKGROUND: Although rheumatic mitral stenosis is still a prevalent and clinically significant valvular heart disease in Korea, the natural history of rheumatic mitral stenosis has not been clearly determined yet. The present study aimed to evaluate the clinical and echocardiographic changes in patients with rheumatic mitral stenosis according to different therapeutic modalities. METHODS: A total of 91 patients (66 women; mean age, 50.9+/-12 years) with dominant rheumatic mitral stenosis and mitral valve area of less than 1.5 cm2 who were followed for more than 3 years (mean: 5.1 years) were included in this study. The subjects were divided into 3 groups according to the therapeutic modalities for mitral stenosis (A: medical therapy (n=31), B: percutaneous mitral valvuloplasty (n=30), C: mitral valve replacement (n=30)). Clinical and echocardiographic follow-up was performed before and immediately after therapeutic intervention such as percutaneous mitral valvuloplasty (PMV) and mitral valve replacement (MVR) and every year thereafter. Clinical symptoms and echocardiographic findings were compared between 3 groups. RESULTS: The patients of group B consisted of less females and more younger (p=NS). Clinical symptom of dyspnea was more severe in group B and C initially (A: 1.8+/-0.8, B: 2.5+/-0.8, C: 2.9+/-0.7; A vs. B, A vs. C, p<0.05) but more improved in group B and C (A: 1.6+/-0.5, B: 1.3+/-1.0, C: 1.6+/-0.5; A vs B, A vs. C, p<0.05) during the follow-up. The prevalence of atrial fibrillation did not change significantly during follow-up. Mitral valve area decreased significantly in A group from 1.1+/-0.4 to 0.9+/-0.3 cm2 (p<0.05), but, no significant change was observed in group B and C. No significant changes were observed in the left ventricular end-diastolic, end-systolic dimensions, and ejection fraction during the follow-up period. No clinically significant aggravations of associated valvular regurgitations and systolic pulmonary artery pressure were observed. CONCLUSION: In patients with mitral stenosis more than moderate severity, PMV or MVR is superior to medical therapy for controlling clinical symptoms and maintaining the mitral valve area. Therapeutic modality does not influence the change in the dimension and systolic function of the left ventricle. Accompanied other valvular regurgitation does not change significantly regardless of therapeutic modality, indicating that any additional therapy for associated valvular regurgitation is unnecessary.

Long-term Clinical and Angiographic Results of Coronary Stenting in Diabetic Patients

BACKGROUND: Diabetes is a major risk factor for restenosis and high mortality after percutaneous coronary intervention. The impact of coronary stenting on the clinical outcome of diabetic patients remains controversial. METHOD: The in-hospital and long-term clinical outcomes of 104 consecutive diabetic (60+/-8 year-old, 74 male) and age-matched 193 control (57+/-10 year-old, 162 male) patents underwent coronary stenting between January 1998 and March 1999 at Chonnam National University Hospital were compared. RESULTS: 1) Coronary stenting was successful in 98% of diabetic patients and 97% of non-diabetic patients. Post-procedural minimal luminal diameter (MLD) was not different between two groups(2.89+/-0.42 vs. 2.95+/-0.62 mm), but follow-up MLD was lower in diabetics than that in non-diabetics (1.70+/-0.96 vs. 2.05+/-0.72 mm, P < 0.05). 2) Restenosis rate on follow-up coronary angiograpy was not different between two groups (40.7% in diabetics and 32.0% in non-diabetics. 3) In-hospital outcome was not different between two groups. Long-term clinical follow-up (16+/-11 months) revealed higher overall major adverse cardiac events in diabetics than in non-diabetics (38.7 vs. 30.7 %, P < 0.05). CONCLUSION: Coronary stenting in diabetics can be performed with acceptable short-term results. However, long-term clinical outcome in diabetic patients was worse than in non-diabetics.

Early outcome and Restenosis rate after Coronary Artery Stenting in the Elderly

BACKGROUND AND OBJECTIVES: With the prolonged life expectancy and changes in dietary habits in Korea, the number and percentage of elderly patients with ischemic heart disease(IHD) has been increased. Primary success rate and long-term clinical outcomes of elderly patients were compared with younger patients, who underwent coronary artery stent(CAS). MATERIALS AND METHOD: A retrospective analysis of 379 patients, who underwent CAS at Chonnam National University Hospital from January 1993 to June 1998, was performed. Clinical characteristics, lipid profiles, coronary angiographic findings, success rates and in-hospital mortality rates and follow-up coronary angiographic findings of elderly patients older than 70 years (Group I; n=1, 73+/-4 years) were compared with the patients under the age of 70 years (Group II; n=88, 56+/-11 years). RESULTS: Female was more prevalent in Group I than Group II (41/91, 45.1% vs. 57/288, 19.9%, P < 0.001). Ejection fraction was lower in Group I than in Group II (56.9+/-6.4 vs. 63.8+/-15.3 %, P < 0.05) and left ventricular end-diastolic pressure was higher in Group I (17.9+/-7.9 vs. 14.0+/-7.7 mmHg, respectively P < 0.05) than in Group II. There were no significant differences in the distribution of the risk factor except for smoking (Group I; 26/91, 28.6% vs Group II; 130/288, 45.3%, P < 0.05). Lesion and procedural characteristics were not different between two groups. Primary success rate of Group I was 94.5%(86/91) and 96.5%(278/288), which were not different between two groups. On follow-up coronary angiogram, restenosis rate was not different between two groups (Group I: 9/37, 24.37% vs. Group II 50/154, 32.5%, P=S). CONCLUSION: The initial success rate and restenosis rate of coronary stenting in the elderly patients are not different from those of younger group. Thus coronary stent can be performed effectively in elderly patients.

Predictive Factors for the Restenosis after Long Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: In-stent coronary restenosis remains one of major clinical problems in percutaneous coronary intervention. Long stent has been known to be associated with high restenosis rate. Predictive clinical and angiographic factors were analyzed after long coronary stenting. METHODS: One hundred four patients (57.2+/-9.6 year-old, 105 male) who underwent long coronary stent implantation and follow-up coronary angiogram, out of 237 patients implanted long coronary stents between June 1996 and January 1999 at Chonnam National University Hospital. RESULTS: Primary success rate was 100%. Lesion length was 18.5 +/- 9.2 mm and the length of stent was 27.3 +/- 6.1 mm. Mean duration of clinical follow-up and follow-up coronary angiogram was 20.1+/-6.8 months and 6.3+/-2.7 months respectively. Restenosis rate according to follow-up coronary angiogram was 42.5% (57/134). Clinical variables of age, sex, clinical diagnosis, risk factors, and angiographic variables of target artery and lesion types, indications for stenting, stent types, reference diameter, lesion length, minimal luminal diameter, and acute gain were not related with late stent restenosis. Diameter stenosis before stenting was higher in the group with restenosis (81.9+/-16.9 %) than in group without restenosis (71.1+/-18.5%; p<0.05), and lower lower in the group with restenosis (-7.6+/-15.7%) and in the group without restenosis (5.6+/-22.4%; p<0.05) after stenting. CONCLUSIONS: Primary success rate was comparable. Severe luminal stenosis before stenting and overdilation after stenting are associated with restenosis after long coronary stenting.

A Giant Aneurysm of the Sinus of Valsalva with Calcification

Aneurysms of sinus of Valsalva often remain undiagnosed until they rupture. A huge, heavily calcified unruptured aneurysm originating from the right sinus of Valsalva was detected incidentally in a 61-year-old man. Chest X-ray showed cardiomegaly and 10 cm sized huge calcified mass lesion around the cardiac shadow. Two-dimensional echocardiogrm revealed pericardial effusion with huge calcified mass compressing right ventricular outflow and color-flow Doppler echocardiogram visualized blood flow from aortic root into aneurysm. Chest CT scan and MRI revealed a large thrombosed aneurysm arising from aortic root measuring 1010cm. After pericardiocentesis cardiac catheterization was performed, which showed elevated right ventricular systolic pressure up to 80 mmHg. Aortic root angiogram revealed huge unruptured calcified aneurysm in the sinus of Valsalva arising from the right coronary sinus. The patient underwent surgical correction for the prevention of aneurysmal rupture and the relief of right ventricular outflow obstruction.

The Effects of Lipoprotein(a) on Coronary Stent Restenosis

BACKGROUND: Lipoprotein (a) [Lp(a)] contains apolipoprotein(a), which is a structural homologue of plasminogen and competes with it for binding sites. It also acts by increasing plasminogen activator inhibitor-1 expression. The objective of this study was to evaluate the relationship between Lp(a) levels and restenosis rate after successful coronary stent placement. METHODS: The study included 306 patients who underwent coronary stent placement and follow-up coronary angiogram at Chonnam National University Hospital from August 1996 to June 2000. Restenosis rate was analyzed according to the level of Lp(a); Group I with high Lp(a) (n=7, Lp(a) 36 mg/dL, 58.98.8 years, female: 35.1%) and Group II with low Lp(a) (n=29, Lp(a) < 36 mg/dL, 57.79.8 years, female: 18.8%). RESULTS: 1) There was no significant differences in risk factors of atherosclerosis, clinical diagnosis, the number of involved coronary artery, left ventricular function, angiographic lesion characteristics by American College of Cardiology/American Heart Association clasification and Thrombolysis In Myocardial Infarction flow in two groups. 2) Angiographic restenosis rates were not different between two groups (group I : 33.8%, group II : 35.4%). CONCLUSION: Plasma Lp(a) levels are not related with the angiographic restenosis rate after coronary stent placement.

The Rescue Use of A Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab; Reo-Pro ) in High-Risk Patients with Acute Myocardial Infarction Underwent Percutaneous Coronary Intervention

BACKGRUOND: Platelets are known to play a major role in the ischemic complications of percutaneous coronary intervention (PCI). Accordingly, we evaluated the effect of rescue use of a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab; Reo-Pro ) in Korean patients with acute myocardial infarction (AMI) at high risk for the ischemic complications who underwent PCI. METHOD: Sixty eight patients (54 male, 59.1+/-9.96 years) treated by the rescue use of Reo-Pro out of 1,117 patients underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2000. All of target lesions were thrombus-containing lesions in patients with AMI. The primary end points consisted of any of the followings : cardiac death, nonfatal MI, repeated revascularization. The number of end-point events were tabulated at 6 months after PCI. RESULTS: The primary success rate was 92.6% (63/68). At primary end points, there were 5 cases (7.3%), composed of 2 deaths (2.9%), 1 MI, 2 repeated revascularization (2.9%). There was no major bleeding complication after PCI. At secondary end point, there were 23 cases (34.9%) including primary end point, composed of 3 deaths (4.4%), 1 MI and 19 revascularization (28.0%). CONCLUSION: The rescue Reo-Pro can be used safely and effectively in high-risk Korean patients with AMI.

Clinical Characteristics of Ventricular Tachycardia

BACKGROUND AND OBJECTIVES: There has been few study on the epidemiology and clinical characteristics of ventricular tachycardia (VT) in Korea, although their determination is crucial to the management of VT. The purpose of this study is to determine the clinical characteristics of VT. MATERIALS AND METHODS: Hospital medical records were reviewed on clinical characteristics including demographic feature, underlying disease, and clinical presentation in 66 patients who visited emergency room or out-patient clinic with VT as a primary medical problem from April 1996 to March 1999. The diagnosis of VT was made based on physical signs and ECG recording during the VT and confirmed with electrophysiology study in some cases. RESULTS: There were 42 men and 24 women (mean age: 50.218.9 years). The most common presenting symptom was palpitation (n=30), which was followed by dyspnea (n=18), syncope (n=11), sudden death (n=5). Five patients had no specific symptom. Underlying disease was coronary artery disease in 18 (27.3%) patients, dilated or hypertrophic cardiomyopathy in 11 (16.7%), valvular heart disease in 7 (10.6%), myocarditis in 3 (4.5%), but absent in 20 (30.3%). Idiopathic VT (n=16) usually originated from either right ventricular outflow tract (RVOT, 56.3%) or left ventricular septum (LVS, 31.3%). One-year cardiac mortality rate was 43.8% in coronary artery disease (n=16), 20.0% in cardiomyopathy (n=10), 33.3% in valvular heart disease (n=6), but zero in idiopathic VT (n=19). CONCLUSIONS: These findings suggest that idiopathic VT may be the most common type of VT in Korea and usually originates from either RVOT or LVS. The response to medical therapy is poor in VT with underlying heart disease but excellent in idiopathic VT.

Acute Inferior Myocardial Infarction due to Septic Embolism into the Left Anterior Descending Artery from Infected Bicuspid Aortic Valve in A Young Man

A bicuspid aortic valve is one of common congenital cardiac anomaly. But the septic embolism from bicuspid aortic valve into the left anterior descending artery (LAD) resulting in acute inferior myocardial infarction is very rare. A twenty eight year-old man suffered from severe chest pain and fever of four-week's duration. Acute inferior myocardial infarction was diagnosed on electrocardiogram. Transesophageal echocardiogram demonstrated vegetation on the bicuspid aortic valve directed into left coronary artery ostium, and diagnostic coronary angiogram revealed round filling defect within the distal LAD. He underwent operation for aortic valve replacement, which indicated vegetated bicuspid aortic valve directed into the ostium of left coronary artery.

The inhibitory effect of platelet glycoprotein IIb/IIIa receptor blocker-coated stent on porcine coronary stent restenosis / 대한내과학회지

BACKGROUND: The problems of coronary stent thrombosis and restenosis still remain to be solved.The glycoprotein IIb/IIIa receptor blocker, Abciximab (ReoPro), plays important roles in the treatment of high-risk patient with acute platelet-rich thrombus and in the inhibition of smooth muscle cell proliferation. The aim of this study was to determine whether the use of ReoPro-coated stents could reduce the neointimal formation in a porcine coronary stent restenosis model. METHODS: ReoPro was coated on the surface of stent by means of plasma polymerization followed by chemical grafting. Stent overdilation injury was performed with control bare stent (Group I, n=13), and ReoPro-coated stents (Group II, n=14). Follow-up quantitative coronary angiogram was performed at 4 weeks after stenting and histopathologic assessment were compared in both groups. RESULTS: The diameter stenosis by QCA between two groups was significantly higher in Group I (23+/-5 % vs. 15+/-7 %, p=0.003). On histopathologic examination, no in-stent thrombus was observed. The percent area stenosis was significantly higher in Group I than in Group II (48+/-17 % vs. 30+/-16 %, p=0.01). The area of neoinima was larger in Group I than in Group II (3.2+/-1.2 mm2 vs. 2.0+/-1.0 mm2, p=0.01). By immunocytochemistry, proliferation cell nuclear antigen indices were higher in Group I (4.2+/-2.1 %, vs 2.4+/-1.8 % p=0.03). CONCLUSION: The ReoPro-coated stent is safe and effective in the prevention of in-stent thrombus and restenosis, which may be related with the inhibition of platelet thrombus and neointimal cell proliferation.