Percutaneous transluminal coronary angioplasty in the young patients--Siriraj Hospital's experience.

The aim of this study was to follow-up immediate and long term results of patients aged less than 40 years with CAD treated by PTCA. Primary end points were to record major coronary events, incidence and timing of restenosis and requirement of repeated revascularization after initial PTCA. Data was collected retrospectively from records of patients aged less than 40 years who underwent PTCA from Jan 1996 to June 1998 in Her Majesty Cardiac Center, Siriraj Hospital. Patients were followed up and data was collected regarding recurrent angina, major coronary events and results of repeated coronary angiography and revascularization if available. Out of 830 procedures performed for 325 patients, 30 patients (9%) were less than 40 years of age and comprised of 26 males (87%) and 4 females (13%). Eighteen patients (60%) had more than one risk factor. The most important risk factor was smoking (60%) followed by dyslipidaemia (47%) and family history of coronary artery disease (20%). DM was strikingly uncommon. 14 patients had single vessel disease and 16 patients had multiple vessel disease. Initial stenosis was 87.5 +/- 9.8 and residual stenosis was 17.8 +/- 10.8. PTCA failed for 5 lesions, overall success rate was 89 per cent. Stent was used for 12 lesions in 10 patients. There was no major complication during the procedure. Minor complications included non occlusive dissection in four cases and groin haematoma in three cases. The follow up ranged from 7-36 months with the median of 23 months. During follow up, there was no major cardiac event such as death, acute MI, congestive heart failure or cerebero-vascular accident. Eleven patients (37%) had sustained improvement without recurrent angina. Recurrent angina occurred in 19 patients (63%) after initial PTCA and second/third recurrent angina occurred in 5 patients. On repeated coronary angiography angiographic restenosis was seen in 10 patients (33%) after initial PTCA. Overall repeated revascularization was done twenty times for sixteen patients which included 4 CABGs and 16 PTCA. Twenty one patients (70%) showed sustained improvement after repeated PTCA and medications. Follow up results of PTCA in young patients showed sustained improvement but achieved at high rate of repeated revascularization.

Comparison of supraventricular tachycardia from concealed bypass tract and Wolff-Parkinson-White syndrome.

Supraventricular tachycardia (SVT) is a common problem. There are 2 types of accessory atrioventricular pathway (AP) causing SVT: one can conduct antegradely (WPW syndrome) and another can conduct only in a retrograde direction (concealed bypass tract or CBT). There are little data of the significance and difference of the two types in Thailand. The objectives of this study were to compare characteristics of patients, accessory pathways and outcome of radiofrequency catheter ablation (RFCA) between the 2 types of accessory pathways. We reviewed the electrophysiology report of patients with supraventricular tachycardia from the accessory pathway who were referred for RFCA. There were 74 males and 74 females at a mean age of 37 years. CBT accounts for 44 per cent of SVT from AP. Compared to CBT, WPW syndrome was more in the right-sided location, more associated with heart disease, a higher number of accessory pathways, more inducible atrial fibrillation and more difficult to do ablation. However, the overall success rate of RFCA was similar. Although the recurrence rate was 8.4 per cent, all patients with recurrence were successfully reablated. We concluded from this study that RFCA is a highly effective method for the treatment for both forms of accessory pathway although there are some differences between WPW syndrome and CBT.

Radiofrequency catheter ablation in pediatrics: experience at Siriraj Hospital.

Tachyarrhythmia is one of the life threatening cardiac electrophysiology problems in children. It also affects quality of life of the patients. Radiofrequency catheter ablation (RFCA) has made a significant impact in the treatment of tachyarrhythmia since 1989. The present report is the first and largest report in Thai children. There have been 24 RFCA procedures in 21 children since it was initially performed at Siriraj Hospital from January 1996 to December 1999. The electrophysiology studies and medical records were analyzed retrospectively. Median age and weight at the time of the procedure were 11 (1.1-13) years old and 38.8 (6.8-78.2) kg respectively. The presenting symptoms were palpitation 66.7 per cent, presyncope 16.7 per cent, congestive heart failure and cardiogenic shock 8.3 per cent, syncope 4.2 per cent, and chest pain 4.2 per cent. Median duration of symptom was 3.5 (0.1-8.0) years. The underlying cardiac arrhythmias were Wolff Parkinson White (WPW) syndrome 50 per cent, concealed accessory pathway 16.7 per cent, atrioventricular node re-entry tachycardia (AVNRT) 16.7 per cent, atrial ectopic tachycardia (AET) 12.5 per cent, and WPW with AVNRT 4.2 per cent. The median fluoroscopy time and procedure time were 25 (4-145) minutes and 125 (60-320) minutes respectively. The median tachycardia cycle length was 332.5 (220-460) seconds. The immediate success rate was 21/24 (87.5%) procedures. The procedural complication was 1/24 (4.2%). Two patients (8.3%) had recurrences of tachycardia and were successfully controlled with antiarrhythmic drugs. Conclusion: RFCA is a safe, effective, and curative procedure with high success rate for pediatric tachyarrhythmias.

Experience of the first 60 cases of intracoronary stent placement.

In conclusion, elective stent placement, compared to angioplasty, has a higher clinical success rate. However, in our early experience major complications did occur.