Hypertrophic Obstructive Cardiomyopathy with Infundibular Stenosis Treated by Alcohol Ablation Therapy

This report describes an uncommon case of hypertrophic obstructive cardiomyopathy (HOCM) accompanying infundibular stenosis of the right ventricle treated by alcohol ablation therapy, in a 28-yr-old male patient presenting with dyspnea on exertion. HOCM with infundibular stenosis was detected by echocardiogram and cardiac catheterization and patient has dynamic obstructions of both ventricular outflow tracts. We performed alcohol ablation therapy to improve clinical symptoms and to relieve dynamic obstructions of both ventriclular outflow tracts. This is the first case in which HOCM with infundibular stenosis of the right ventricle was treated by alcohol ablation therapy.

ST Segment Depression and T-wave Inversion during Superaventricular Tachycardia

BACKGROUND: Paroxysmal supraventricular tachycardia(PSVT) is frequently associated with ST segment depression or T-wave inversion. However, the mechanism of ST-T changes in the context of various mechanisms of PSVT is not clear. The purpose of this study was to evaluate the prevalence of ST depression or T-wave inversion during PSVT and determine whether these changes are related to the mechanism of PSVT or the rate of the tachycardia. METHODS: Twelve-lead electrocardiograms were recorded during sinus rhythm and during PSVT in 163 patients who underwent an electrophysiologic study for ablation. Tachycardia cycle length, presence of ST depression or T-wave inversion during PSVT and the mechanism of tachycardia were evaluated. Significant ST depression was defined as at least 1mm horizontal or downsloping depression, measured 80ms after the J point and T-wave inversion as inversion of T-wave which was positive in the same lead during sinus rhythm. RESULTS: 1) The mechanism of PSVT analysed for ST segment depression was atrioventricular nodal reentry tachycardia in 60 cases and atrioventricular reentry tachycardia in 111 cases. The mean tachycardia cycle length was 373.8+/-68.0 msec. 2) ST depression and T-wave inversion was observed during PSVT in 56%(96/171) and 45%(77/171) of cases, respectively. 3) Tachycardia cycle length, degree of ST depression and number of leads with ST depression are not different according to the mechanism of PSVT. 4) ST depression and tachycardia cycle length had significant correlation, especially in atrioventricular reentry tachycardia. 5) Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia than atrioventricular nodal reentry tachycardia(p<0.05), but no difference between manifest and concealed bypass tract. CONCLUSIONS: ST segment depression is rate-related phenomenon and not different according to the mechanism of PSVT. Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia.

Plasma Antigen and Activity of Tissue Plasminogen Activator and Plasminogen Activator Inhibitor-1 in Patients with Myocardial Infarction

BACKGROUND: It is well known that coronary arterial thrombosis plays an important role in the pathogenesis of acute coronary syndrome and this has focused interest on the role of the fibrinolytic system, especially tissue plasminogen activator(t-PA) and plasminogen activator inhibitor-1(PAI-1), which are major determinants of fibrinolytic system. But there are considerable variations in the reported association between these two components and acute coronary syndrome. METHODS: To evaluate association between t-PA, PAI-1 and myocardial infarction, plasma level of t-PA and PAI-1 in resting state and after venous occlusion were measured and analysed in patients with previous myocardial infarction at least 6 months after the acute phase, who showed less than 70% luminal narrowing angiographically and control group. The relationship between t-PA, PAI-1 antigen and activity and relation to age, serum triglyceride, cholesterol, and peak creatine kinase(CK) enzyme were also analyzed. RESULTS: 1) In resting state, there was a significant difference of plasma level of both t-PA and PAI-1 antigen, activity between patient and control group(10.72+/-3.28 vs 8.16+/-4.03ng/ml, 0.53+/-0.34 vs 0.02+/-0.07U/ml, 26.24+/-8.30 vs 20.82+/-8.82ng/ml, 14.62+/-5.97 vs 6.99+/-6.44U/ml)(p<0.05), and resting plasma level of PAI-1 activity showed a good correlation with peak creatine kinase(CK) enzyme(r=0.76, p<0.01). 2) After venous occlusion, plasma level of t-PA antigen was significantly increased(8.16+/-4.03 vs 9.87+/-3.86ng/ml)(p<0.05) whereas t-PA activity and PAI-1 antigen were not significantly changed in control group. In patient group, t-PA antigen, t-PA activity and PAI-1 antigen were significantly inceased after venous occlusion(10.72+/-3.28 vs 14.66+/-5.41ng/ml, 0.53+/-0.34 vs 1.41+/-1.69U/ml, 26.24+/-8.30 vs 29.87+/-8.78ng/ml)(p<0.05). PAI-1 activity was significantly decreased after venous occlusion in both groups(6.99+/-6.44 vs 6.06+/-5.99U/ml, 14.62+/-5.97 vs 12.67+/-6.46U/ml)(p<0.05). CONCLUSION: Both fibrinolytic and anti-fibrinolytic systems are augmented in resting and after fibrinolysis stimulation test in patient group. These findings suggested a impairment of fibrinolytic system in patient group and a possibility that both elevated plasma levels of t-PA and PAI-1 may be markers of coronary artery disease.