Visualization of Ostium Secundum Atrial Septal Defect by Transesophageal Echocardiography

Atrial Septal Defect(ASD) is usually suspected clinically but requires a confirmative diagnostic procedure before surgical repair. Conventional transthoracic echocardiography has relatively high sensitivity and specificity for ASD, but difficulty in visualizing the ASD occasionally. Transesophageal echocardiography has special advantages for investigating the posteriorly located cardiac structures, including the atrial septum, which is imaged perpendicularly at a relatively short distance. We describe a case in which ostium secundum ASD was not visualized by conventional transthoracic echocardiography, but was diagnosed confidently by transesophageal echocardiography. It is concluded that transesophageal echocardiography appears to be a promising diagnostic tools for the evaluation of ASD on the basis of its ability to provide excellent imaging of the entire atrial septum and related posterior cardiac structures.

Experimental Study on Ventricular Fusion in Wolff-Parkinson-White Syndrome

WPW syndrome is the most common variaty of preexcitaton syndrome in which whole or part of ventricular muscle is activated by the atrial impulse earlier than would be expected if the impulse reached the ventricle by way of normal conduction system alone. WPW syndrome result from existence of accessory muscle bridge(atrio ventricular connection) between atrium and ventricle. The ventricular complex observed in WPW syndrome during periods of sinus rhythm is the result of fusion, with intial phase of ventricular activation representing excitation via accessory pathway and later forces produced by excitation of residual portions of ventricle via normal His-purkinje system. The variations in QRS aberrancy in WPW syndrome depend on varying degree of preexcitation. This experimental study was undertaken to increase our knowledge on the ventricular fusion in WPW syndrome through epicardial mapping after experimental induction of ventricular preexcitaion of WPW type. In 5 normal dogs, the heart was widely exposed through transverse thoracotomy and positioned in a pericardial cradle, then electric wires were fixed on the epicardium of right atrium and ventricular bases(anterobasal and posterobasal) areas of right ventricle, anterobasal and poaterobasal areas of left ventricle for atrial and ventricular pacing. Epicardial mapping was then performed during atrial pacing alone and during atrioventricular sequential pacing at the same rate. Atrioventricular sequential pacing was done with various short AV intervals(60-110 msec) for the purpose of premature stimulation on ventricular base. In mapping we used the grid system which consisted of 29 areas to cover the right ventricle and 23 areas to cover the left ventricle. We drew 9 epicardial ishochrone maps in 5 dogs. The epicardial data during atrio-ventriclar sequential pacing were then compared with those during atrial pacing at an identical rate to study the ventricular fusion in WPW syndrome. The results were as follows; 1) The preexciting wave spread radially from the stimulated basal area to the right and left(or anterior and posterior wall) and the apex. 2) Preexciting wavefronts collided with the normal wavefronts in a wide range of ventricular activation time. 3) Preexcitation widened according to the degree of the shortening of the AV interval. 4) The duration of ventricular activation was greater in preexcited ventricles than in normally activated ventricles. The more prematurely the ventricle was stimulated, the greater the duration of ventricular activation was.

Aneurysm or Diverticulum of Left Ventricle

Two cases of abnormalities of the left ventricular wall(left ventricular aneurysm or diverticulum) are presented. A saccular deformity of the left ventricle may be and aneurysm or a diverticulum. In one case, the defect seems to be subcalvular aneurysm(or fibrous diverticulum) or aneurysm of the membranous ventricular septum; this lesion seems to be a natural consequence of spontaneous closure of a defect of the membranous septum. The other case, it seems that the defect is ventricular aneurysm with syndrome of myocardial infarction and normal coronary arteries, or double or accessory chambered left ventricle. The thromboembolic phenomenon was noted on a left frontoparietal lobe of brain. Both cases have the diagnosis supported by cardiac catheterization and angiography. The clinical, angiographic and pathologic characteristic of diverticulum and aneurysm of the heart are reviewed, and an attempt is made to clarify the concept of aneurysm and diverticulum of the heart.

Effect of Reperfusion Experimental Myocardial Infarction in Rats

The purpose of this study was to determine the effect of reperfusion about infarct size and infarct expansion by different duration of ischemic time. Temporary coronary ligation was performed in rats for 30min, 60min, 90min and 120min, followed by reflow. Rats with permanent ligation were used for comparison. After 7 days, transverse histologic heart sections were prepared for structual analysis. The results were as follows ; 1) Reperfusion after 30 min ischemic time 1.Infarct size of reperfusion (method 1 ; 16.5+/-8.3%, method 2 ; 20.9+/-8.0%) was smaller than that of permanent ligation (method 1 ; 29.8+/-8.9%, method 2 ; 33.5+/-12.1%)(p<0.01, p<0.05). 2. Expansion index of reperfusion (46.9+/-19.6) was smaller than that of permanent ligation (88.0+/-34.9)(p<0.01). 3. The infarct thickness of reperfusion (1.59+/-0.40mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 4.The viable left ventricular tissue area of reperfusion (28.8+/-2.90mm2) was larger than that of permanent ligation (24.2+/-3.10mm2)(p<0.01). 2) Reperfusion after 60 min ischemic time 1. There was no difference in infarct size between reperfusion and permanent ligation. 2. Expansion ratio (27.2+/-5.9%) and expansion index (51.8+/-24.6) of reperfusion were smaller than those of peremanent ligation (35.7+/-7.4%, 88.0+/-34.9)(p<0.05, P<0.05). 3. The infarct thickness of reperfusion (1.48+/-0.32mm) was larger than that of permanent ligation (1.10+/-0.21mm)(p<0.01). 3) Reperfusion after 90~120 min ischemic time reduced neither infarct size nor infarct expansion. The results of this study in the rat preparation suggest a beneficial effect of reperfusion even in late on infarct expansion independent of myocardial salvage.

Prediction of Pulmonary Arterial Pressure by Pulsed Doppler Echocardiography

Noninvasive prediction of pulmonary arterial pressure is of paramount importance in heart disease. To estimate pulmonary arterial pressure, several echocardiographic techniques, including abnormal pulmonary valve motion, prolongation of RV preejection period/RV ejection time ratio and contrast echocardiography have been proposed. Recently Doppler echocardiography has been known to detect intracardiac blood quantitatively. For assessment of the benefit of several indices by Pulsed Doppler echocardiography for mean pulmonary arterial pressure, 22 patients(mean pulmonary pressure> or =20mmHg; 11, <20mmHg; 11) were compared with the mean pulmonary arterial pressure by cardiac catheterization. In comparison of mean pulmonary arterial pressure(MPAP); 1) Right preejection period / RV ejection time RPEP/RVET;r=0.278 2) Right preejection period / Acceleration time RPEP/AT : r=0.654 3) Acceleration time(AT) AT=-1.55(MPAP)+154.37(r=-0.763) AT=-92.99(log MPAP)+239.41(r=-0.752) AT is less than 105 msec in 9 or 11 pulmonary hypertension and one of 11 normal individual. 4) Acceleration time/ RV ejection time AT/RVET=-136.36(MPAP)+83.31(r=-0.817) AT/RVET=-0.29(log MPAP)+0.81(r=-0.803) 5) (Right preejection period+Decceleration time) / AT (RPEP+DT)/AT=9.6(MPAP)-0.16(r=0.806) (RPEP+DT)/AT=3.86(log MPAP)-2.46(r=0.789) In conclusion AT/RVET, (RPEP+DT)/AT and Acceleration time of 105 msec are valuable indices to estimate mean pulmonary arterial pressure by Pulsed Doppler echocardiogram.

Clinical Application of Esophageal Electrocardiogram

The esophageal electrocardiogram is of increasing significance in the study and diagnosis of cardiac arrhythmia and of posterior myocardial disease. We used both bipolar and unipolar esophageal recording leads and standard electrocardiogram equipment, and compared the effectiveness of esophageal electrocardiogram with co nventional electrocardiogram. The effectiveness of esophageal electrocardiogram were as follows: 1) Differentiation of sinus, atrial, junctional, or ventricular rhythm. 2) Differentiation of origin of premature beats. 3) Differentiation of atrial flutter and fibrillation. 4) Detection of retrograde atrial conduction of extraventricular systole. 5) Detection of electrical alternance of QRS amplitude. 6) Diagnosis of posterior myocardial infarction. The results reported here indicate that the esophageal electrocardiogrm seems to be a valid method in the diagnosis of cardiac arrhythmias without invasiveness.

A Case of Complete A-V Block due to Intra-His Block

His bundle recordings enable us to diagnose conduction disturbances not discernable in the standard leads, and to localize conduction block in the subdivisions of the conduction system. Cases of intra-His bundle block were first reported in 1970 by Narula and Samet. Thereafter many additional reports and studies were made. We report a case of 3degrees A-V block due to conduction block at the His bundle level. A 71-year-old woman was admitted because of dizziness. Surface ECG showed 3degrees A-V block. His bundle electrogram revealed typical split His potential. A-H intervals were 80 msec and H'-V intervals 50~70 msec. And there found no relation between AH and H'A. Atrial pacing resulted only prolongation of A-H to 90 msec but dissociation between h and H' was consistent. We implanted a permanent endocardial pacemaker in her chest.

Echocardiographic Measurement of Systolic Time Intervals in Normal Adults and the Patients with Dilated Cardiomyopathy

The systolic time intervals were measured in 25 normal controls and 23 patients with dilated cardiomyopathy by simultaneous recording of the aortic valve echocardiogram and ECG. These values were compared to corresponding ones obtained from the method using simultaneously recorded phonocardiogram, ECG, and indirect carotid pulse tracings. And we assessed left ventricular function by systolic time intervals in dilated cardiomyopathy. The results were as followings. 1) High degree of correlation(r> or =0.94) was found between the two methods for each intervals, EMS, LVET, PEP, PEP/LVET. 2) In normal controls, PEP/LVET obtained from echocardiographic measurement was 0.31+/-0.02. 3) In the patients with dilated cardiomyopathy, PEP/LVET(0.59+/-0.13) was significantly higher(p<0.001), PEP index was longer(p<0.05), LVET index was shorter(p<0.05) than in normal controls.

Two Cases of Weber-Christian Disease / 대한피부과학회지

Two cases of Weber-Christian disease are reported. This very rare disease, we had two another reports of case sincc last ten years in The Korean Journal of Dermatology. In our cases both patients are seventeen years old girls and have the histories of remissions and exacerbations for two to three years. The skin lesions of subcutaneous nodules are scattered on the trunk, extremities and even to the hand dorsurns, with the atrophic depressions. Histologic features are typical with faormy histiocytes in the subcutaneous fat tissue. On tne treatments these patients are given oral corticosteroid, antihistaminics and salicylate with some improvments.