Relations between left ventricular mass,diastolic function and endocrine factors in essential hypertension / 中华超声影像学杂志

Objective To study the changes of diastolic function of left ventricle by tissue Doppler imaging (TDI) and the serum level of endocrine factors,and analyse the relations between these factors and mass or diastolic function of left ventricle in patients with essential hypertension.Methods Sixty one patients with essential hypertension were divided into left ventricular hypertrophy(LVH) group and no left ventricular hypertrophy(NLVH) group.Twenty healthy subjects were considered as control group.The early(e) and late(a) diastolic maximal myocardial velocity and e/a of lateral wall motion of mitral valve annulus were recorded by TDI.The levels of atrial natritic peptide(ANP),brain natriuretic peptide(BNP),endothelium(ET),calcitonic gene related peptide(CGRP) and insulin like growth factor 1(IGF 1) were measured by radio immunology analysis.Results The e wave maximal velocity in LVH group was lower than that of NLVH group and control group [( 14.56 ? 7.83 ) cm/s,( 16.40 ? 0.66 ) cm/s,( 18.68 ? 3.78 ) cm/s,respectively],and a wave maximal velocity in LVH group was higher than that of NLVH group and control group [( 18.28 ? 9.60 ) cm/s,( 16.03 ? 5.88 ) cm/s ,( 14.53 ? 1.28 ) cm/s,respectively]; The e and a maximal velocity velocities in both LVH and NLVH groups had statistic differences with those of control group(P

Cardiac Function Changes According to the Type of Operation for Mitral Regurgitation / 대한흉부외과학회지

BACKGROUND: Before the development of an ideal artificial valve, repairing of native valves was considered the best choice and clinicians have been reported that valvuloplasty was much better than valve replacement, when possible with the respect to clinical outcomes. This study was conducted under the hypothesis that in some cases, the surgical and clinical outcomes could be better in patients with valve replacement and it may be influenced by left ventricular function. MATERIAL AND METHOD: This study included 40 patients who received pure mitral valve regurgitation. We divided the patients into three groups(Group I: classical valve replacement in 12 patients, Group II: preserving posterior leaflet in 18 patients, Group III: valvuloplasty in 10 patients) and compared the patient`s clinical findings, echocardiographical indexes obtained at admission and 4 weeks after operation. RESULT: After operation, Group II and III showed the better clinical condition changes than Group I but there was no statistical significance. According to NYHA classification, favorable results were achieved but there are no statistical significances in these three patient groups. The left ventricular function was worsened in Group I and in the Groups II and III, the left ventricular function showed no changes postoperatively. In Groups II and III, there were improvements in the postoperative clinical findings but the left ventricular ejection fraction revealed no statistical differences in these two groups. CONCLUSION: Due to different left ventricular functions, repair is considered a better method for the mitral regurgitation. If there the deformity is impossible to repair, preserving a portion of the leaflet is the preferred surgical method.

Early Results of Coronary Bypass Surgery in Patients with Severe Left Ventricular Dysfunction / 대한흉부외과학회지

From March, 1992 to March, 1996, a total of 279 patients underwent coronary bypass surgery at the Sejong General Hospital, Puchon. We selected 22 patients with severe left ventricular(LV) dysfunction from them. The criteria were the presence of global or segmental abnormalities of left ventricular contraction and LV ejection fraction(EF) less than 35% based on biplane LV angiography by planimetry method. The mean age of 17 male and 5 female patients was 60+/-5.6years(range:47~73 years). All had the anginas, which were Canadian class II in 6, class III in 12 and class IV in 4. All patients except one had the history of previous myocardial infarction more than once. Seven of them had the symptoms and signs of congestive heart failure, such as dyspnea on excertion and increased pulmonary vascular markings. Their mean LVEF was 29.4+/-4 5%(range : 18~35%) and mean LV end-diastolic pressure was 18.7 +/-8. 2mmHg(range:10~42mmHg). 21 patients had 3 vessel-disease and 1 had 2 vessel-disease. Complete revascularization was tried with the use of 16 internal mammary arteries and 60 sapheuous veins and 3 radial arteries grafts. The mean number of distal anastomosis was 3.5+/-1.1. Concomitantly, one mitral valvuloplasty and annuloplasty was performed in the patient with moderate mitral regurtigation. The hospital mortality was 4.5%. During the follow-up, there were 3 late deaths. Of 18 survivors, 2 patients were lost in follow-up 24 and 27 month respectively after operation and the remaining 16 patients have bcen followed up with an average of 30.4 +/-13.4 months.15 patients had improvement with respect to angina but 8 patients still have the continuing or progressing heart failure. The 1-year, 2-year and 3-year actuarial survival rate was 85.2, 69.1, 46.1%, respectively. This study indicates that coronary artery bypass sur ery can be performed in the patients with severe LV dysfunction at acceptable risk but does not greatly contribute to the improvement of congestive heart failure.