The Characteristic Doppler Pattern of the Left Ventricular Outflow Tract in a Patient with Orthostatic Hypotension

No abstract available.

Detection of a Left Main Coronary Aneurysm with a Thrombus Presenting as an Acute Myocardial Infarction by Coronary Computed Tomographic Angiography / 대한내과학회지

Aneurysms of the left main coronary artery are very rare in patients with acute coronary syndrome. The increased accuracy of computed tomography permits the detection of coronary artery anatomic structures after one peripheral injection of contrast agent. We report a 42-year-old man with a left main coronary aneurysm, with a thrombus presenting as non-ST elevation myocardial infarction, detected by coronary computed tomographic angiography.

Detection of a Left Main Coronary Aneurysm with a Thrombus Presenting as an Acute Myocardial Infarction by Coronary Computed Tomographic Angiography / 대한내과학회지

Aneurysms of the left main coronary artery are very rare in patients with acute coronary syndrome. The increased accuracy of computed tomography permits the detection of coronary artery anatomic structures after one peripheral injection of contrast agent. We report a 42-year-old man with a left main coronary aneurysm, with a thrombus presenting as non-ST elevation myocardial infarction, detected by coronary computed tomographic angiography.

The Correlation Between Achilles Tendon Thickness and Cardiovascular Risk Factors

BACKGROUND: Achilles tendon thickness (ATT) has been associated with increased cardiovascular risk in patients with familial hypercholesterolemia (FH). The aim of this study is to establish the correlation among ATT, obesity and established cardiovascular risk factors such as diabetes mellitus, hypertension, coronary artery disease, peripheral artery disease, smoking, and dyslipidemia. METHODS: In total, 19 patients (male 31.5%, mean age 60.0+/-12.5) with dyslipidemia and 96 control (male 64.6%, mean age 62.3+/-8.5) were enrolled. ATT was measured by ultrasonography. Anterioposterior diameter which represents the ATT was measured bilaterally, 4 cm above the insertion of Achilles tendon to the tuber calcite. Dyslipidemia was defined as elevated total cholesterol, triglyceride, or LDL cholesterol, or low levels of HDL cholesterol. RESULTS: There was no significant differences including ATT between the two groups (for ATT, dyslipidemia group, 0.44+/-0.04 vs control, 0.45+/-0.02 cm, p=0.783). There was no significant correlation between ATT and other cardiovascular risk factors except weight (r=0.34, p=0.007) and body mass index (r=0.63, p<0.001). Dyslipidemia was not significantly correlated with ATT (r=0.02, p=0.783). Use of statin was not significantly correlated with ATT (r=0.04, p=0.605). CONCLUSION: ATT was not significantly increased in patients with dyslipidemia. Lipid accumulation of Achilles tendon was not found in patients with dyslipidemia in this study.

Various Expressions of Coronary Doppler Patterns of Myocardial Bridging

No abstract available.

A Randomized Study Assessing the Effects of Pretreatment with Cilostazol on Periprocedural Myonecrosis after Percutaneous Coronary Intervention

PURPOSE: It is unknown whether cilostazol pretreatment reduces postprocedural myonecrosis (PPMN). Cilostazol pretreatment reduces PPMN after percutaneous coronary intervention (PCI). MATERIALS AND METHODS: A total of 120 patients with stable angina scheduled for elective PCI were randomly assigned to a 7-day pretreatment with Cilostazol (200 mg/day) or to a control group. Creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) levels were measured at baseline and at 6 and 24 hours after PCI. The primary end-point was the occurrence of PPMN, defined as any CK-MB elevation above the upper normal limit (UNL). Aspirin and clopidogrel were co-administered for 7 days before PCI, and resistance to these agents was then assayed using the VerifyNow System. RESULTS: There was no difference in baseline characteristics between the final analyzable cilostazol (n=54) and the control group (n=56). Despite a significantly greater % inhibition of clopidogrel in the cilostazol group (39+/-23% versus 25+/-22%, p=0.003), the incidence of PPMN was similar between the cilostazol group (24%) and the control group (25%, p=1.000). The rate of CK-MB elevation at > or =3 times UNL was also similar between the two groups (6% versus 5%, p=0.583). The incidence of cTnI increase over the UNL or to 3 times the UNL was not different between the two groups. There was no significant difference in terms of the rate of adverse events during follow-up, although the cilostazol group showed a tendency to have a slightly higher incidence of entry site hematoma. CONCLUSION: This trial demonstrated that adjunctive cilostazol pretreatment might not significantly reduce PPMN after elective PCI in patients with stable angina.

A Rare Case of Radial Arteriovenous Fistula After Coronary Angiography

The percutaneous transfemoral approach has been routinely used for cardiac catheterization and coronary angioplasty. Local vascular complications following angioplasty are seen in 5% to 10% of patients, especially in those who need prolonged anticoagulation. Transradial access for coronary procedures dramatically reduces access site complications. We report a rare case of radial arteriovenous fistula, which developed after coronary angiography perfomed using the transradial approach.

Comparisons of the Effects of Stent Eccentricity on the Neointimal Hyperplasia between Sirolimus-Eluting Stent versus Paclitaxel-Eluting Stent

PURPOSE: Previous studies suggested that asymmetric stent expansion did not affect suppression of neointimal hyperplasia (NIH) after sirolimus-eluting stents (SES) implantation. The aim of this study was to evaluate the effects of stent eccentricity (SE) on NIH between SES versus paclitaxel-eluting stents (PES) using an intravascular ultrasound (IVUS) analysis from the randomized trial. MATERIALS AND METHODS: Serial IVUS data were obtained from Post-stent Optimal Expansion (POET) trial, allocated randomly to SES or PES. Three different SE (minimum stent diameter divided by maximum stent diameter) were evaluated; SE at the lesion site with maximal %NIH area (SE-NIH), SE at the minimal stent CSA [SE-minimal stent area (SE-MSA)], and averaged SE through the entire stent (SE-mean). We classified each drug-eluting stents (DES) into the concentric (> or = mean SE) and eccentric groups (< mean SE) based on the mean value of SE. RESULTS: Among 301 enrolled patients, 233 patients [SES (n = 108), PES (n = 125)] underwent a follow-up IVUS. There was no significant correlation between %NIH area and SE-NIH (r = - 0.083, p = 0.391) or SE-MSA (r = - 0.109, p = 0.259) of SES. However, SE-NIH of PES showed a weak but significant correlation with %NIH area (r = 0.269, p < 0.01). As to the associations between SE-mean and NIH volume index, SES revealed no significant correlation (r = - 0.001, p = 0.990), but PES showed a weak but significant correlation (r = 0.320, p < 0.01). However, there was no difference in the restenosis rate between the eccentric versus concentric groups of both DES. CONCLUSION: This study suggests that lower SE of both SES and PES, which means asymmetric stent expansion, may not be associated with increased NIH.

A case of carotid sinus syncope due to maxillary neoplasm combined with vasovagal syncope / 대한내과학회지

Causes of syncope are manifold. Hypersensitive carotid sinus reflex is a cause of syncope and other bradycardia symptoms. Rarely, maxillary neoplasms can cause carotid sinus syncope. The authors identified a case of carotid sinus syncope by maxillary neoplasm accompanied by vasovagal syncope.

Is Stent Underexpansion the Main Cause of In-Stent Restenosis after Sirolimus-Eluting Stent Implantation?: An Intravascular Ultrasound Study

BACKGROUND AND OBJECTIVES: Intravascular ultrasound (IVUS) can be useful for assessing the causes of in-stent restenosis (ISR) after sirolimus-eluting stent (SES) implantation. We used IVUS to evaluate the causes of ISR after SES implantation. SUBJECTS AND METHODS: SES implantation was performed in 502 patients with 670 coronary lesions. Of these patients, 27 patients had angiographic ISR in 28 lesions. We evaluated the patterns of ISR and we wanted to elucidate the possible mechanism of ISR after SES implantation with using IVUS analysis. RESULTS: The ISR pattern was focal in 26 lesions, and diffuse in 2 lesions, including 1 total occlusion. When analyzing the 21 IVUS-applicable lesions, stent underexpansion [the minimal stent cross-sectional area (CSA) was < 5 mm2 and it was < 4.5 mm2 in the cases of small coronary arteries (reference vessel diameter < 2.8 mm)] was observed in 10 lesions (48%). Stent fracture (defined as non-visualization of the struts on IVUS at the restenotic segments) and edge restenosis was identified in the 3 (14%) and 3 lesions (14%), respectively. Except for edge stenosis, stent underexpansion was observed in 55% of the intra-stent restenotic lesions and it was more prominent in the small coronary arteries (7/8 small coronary artery lesions). Stent underexpansion, stent fracture or edge restenosis were not related to the 7 ISR lesions (33%) in which profound intimal hyperplasia within the stent occurred. CONCLUSION: Our observation of ISR after SES implantation with using IVUS showed that most ISR lesions have mechanical problems, especially stent underexpansion. However, one third of the ISR lesions were associated with profound intimal hyperplasia within the stent.

Clinical Outcomes of Cobalt-Chromium Alloy ArthosPico Stent for Native Coronary Lesions

BACKGROUND AND OBJECTIVES: It has been reported that strut thickness is associated with the occurrence of in-stent restenosis. This prospective, multicenter, single-arm study was designed to evaluate the safety and efficacy of the ArthosPico stent manufactured with thin-strut cobalt-chromium alloy steel for simple de novo coronary lesions. SUBJECTS AND METHODS: A total of 150 coronary lesions that were > or =3.0 mm in diameter and < or =20 mm in length, which could be covered by a single stent, were enrolled. Clopidogrel was used for 1 month. RESULTS: Acute coronary syndrome was involved in 60.7% of patients. The right coronary artery (50.0%) was the most common target vessel. All stents were successfully deployed at the target lesions. Reference vessel diameter was 3.1+/-0.5 mm and lesion length was 13.6+/-4.6 mm. Minimal lumen diameter was increased from 1.03+/-0.48 to 3.04+/-0.49 mm after the procedure. Follow-up angiography was obtained in 117 lesions (78%). Binary restenosis was documented in 12.0% of stented segments and in 13.7% of analytic segments. Late luminal loss was found to be 0.78+/-0.75 mm in stented segments and 0.59+/-0.74 mm in analytic segments. During 7.0+/-2.8 months follow-up, cardiac death or non-fatal myocardial infarction occurred in 2 (1.3%) and 2 (1.3%) patients, respectively. Target lesion revascularization was performed in 11 (7.3%) patients. CONCLUSION: The cobalt-chromium alloy ArthosPico stent for relatively simple coronary lesions showed favorable acute and long-term outcomes in terms of very low incidence of death or myocardial infarction and a single digit rate of target lesion revascularization.

Clinical Outcomes Following Sirolimus-Eluting Stent Implantation in Patients with End-Stage Renal Disease: Korean Multicenter Angioplasty Team (KOMATE) Registry

BACKGROUND AND OBJECTIVES: Sirolimus-eluting stents (SES), as opposed to bare metal stents (BMS), have been shown to markedly reduce restenosis. However, many clinical trials have excluded the subset of patients (pts) with end-stage renal disease (ESRD). The aim of this study was to evaluate the clinical outcomes following SES implantation in ESRD pts. SUBJECTS AND METHODS: We analyzed the clinical outcomes in 50 pts from our registry following SES implantation, and compared the outcomes between those with ESRD receiving SES (SES-ESRD) and BMS (BMS-ESRD), and with non-ESRD pts following SES implantation (SES-non ESRD). RESULTS: A comparison of the SES-ESRD (50 pts, 72 lesions) with BMS-ESRD groups (42 pts, 45 lesions); those in the SES-ESRD group included; diabetes 78%, hypertension 94% and age 62+/-10 years. Those in the SES-ESRD group were more likely to have diabetes (diabetes of BMS-ESRD, 57%; p=0.04). The reference vessel diameters (RVD) of the SES-ESRD group were smaller (2.76+/-0.50 mm vs. 3.05+/-0.46 mm, p<0.001), but the lesion length was longer (25.6+/-7.0 mm vs. 19.1+/-8.8 mm, p<0.001) than those of the BMS-ESRD group. The SES-ESRD group had a lower 1-year major adverse cardiac events (MACE) rate than the BMS-ESRD group (6.0% vs. 33.3%; p<0.001). There were no differences in mortality and incidence of myocardial infarction between the two groups. The incidence of target vessel revascularization decreased significantly in the SES-ESRD group (2.0% vs. 19.0%, p=0.01). From a multivariate regression analysis, the use of SES was the only significant independent predictor of MACE (OR=0.054, 95% confidence interval 0.01 to 0.26, p<0.001). A comparison with SES-non ESRD group in our total registry (644 pts, 758 lesions); MACE in the SES-ESRD group (6.0%) was higher than in the SES-non ESRD group (3.1%), but there was no statistical significance (p=0.23). CONCLUSION: Compared with BMS, SES caused an improvement in the clinical outcomes in pts with ESRD.

One case of with the right ventricular free wall vegetive infective endocarditis complicated by pulmonary embolism in a patient with ventricular septal defect / 대한내과학회지

Infective endocarditis is still one of the important fatal diseases especially when it is accompanied with systemic embolic manifestations. So, this is often misdiagnosised because of a variability of systemic embolic manifestations. We experienced a case of infective endocarditis with pulmonic embolic manifestations whose illness was initially diagnosed as recurrent pneumonia. She was a 20-yrs-old girl with ventricular septal defect and treated as community acquired pneumonia. But transesophageal echocardiography revealed a vegetation on right ventricular free wall. So, she was diagnosed as having infective endocarditis and treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. This a first case of infective endocarditis with ventricular septal defect who have a vegetation on right ventricular free wall in korea. Therefore, we report this case with brief review of related literatures.

Follow-up of Patients Undergoing Percutaneous Mitral Balloon Valvuloplasty(PMV): Analysis of Factors Predicting Restenosis at 1 Year Follow-up

To determine the long-term results after PMV, the incidence of restenosis and analysis the factors predicting restenosis, 108 patients were studied at pre-, post-PMV, after 3 months and 1 year (13+/-4 months) with echocardiography. 1) Restenosis was demonstrated in 25 of 108 patients(23%) at 1 year follow-up. 2) Descriminant analysis showed echocardiographic score and mitral valve area before PMV as predictors of restenosis. 3) There were significant decreament of mitral valve area from 1.8+/-0.4cm2 (after PMV) to 1.5+/-0.3 cm2 at 3 months follow-up and further stenosis (1.2+/-0.3 cm2) at long-term follow-up in group with restenosis. In contrast, in group without restenosis, mitral valve area after PMV was 1.8+/-0.3cm2, aat 3 months follow-up was 1.8+/-0.3cm2 and at long term follow-up was 1.8+/-0.4cm2. 4) There was higher restenosis rate in group with Inoue balloon (47%) than group with double balloon (18%) despite of large EBDA/BSA.