Evaluation of Left Ventricular Function using New Index in Echocardiography

BACKGROUND: Systolic and diastolic dysfunction frequently coexist in heart failure. The purpose of this study is to evaluate combined systolic and diastolic function in heart failure using new index presented by Dr. Tei. A new index: [(ICT+IRT)/ET] defined as the sum of isovolemic contraction time(ICT) and isovolemic relaxation time(IRT) divided by ejection time(ET). METHOD: Study patients consisted of 71 subjects. 20 normals, 23 patients in NYHA class II, 22 patients in NYHA class III and 6 patients in NYHA class IV. Left ventricular end-systolic and end-diastolic dimension, FS(fractional shortening) were measured by conventional echocardiography. ICT, IRT, ET, ICT/ET, deceleration time of mitral E wave and E/A of mitral flow were also measured.(ICT+IRT)/ET was easily obtained by subtracting ET from the interval between cessation and onset of the mitral inflow to give the sum of ICT and IRT. Cardiac output was calculated by left ventriculography in 10 normals and 19 patients. RESULTS: The mean value of (ICT+IRT)/ET was significantly different between group IV(0.88 +/-0.03) and group I(0.50+/-0.04) and II(0.50+/-0.03)(p<0.01). also, was significant between group IV and group III(0.63+/-0.04)(p<0.05). FS and deceleration time of mitral E wave were also significant between group III and group IV(p<0.05). Cardiac output calculated by left ventriculography was significantly correlated with(ICT+IRT)/ET(n=29, r=-0.463, p<0.05). CONCLUSION: (ICT+IRT)/ET is a new and simple Doppler index of combined systolic and diastolic left ventricular function in patient with heart failure.

A Case of Marfan Syndrome with Dissecting Aortic Aneurysm Involving Thoracic and Abdominal Aorta

Marfan syndrome is an inheritable connective tissue with protean clinical manifestations involving the ocular, skeletal and cardiovascular system. It is well estabalished that a clinical hall marker and the major cause of morbidity in Marfan syndrome is aortic root dilatation and associated aortic dissection which begins just above the coronary ostia in ascending aorta. We report a rare case of Marfan syndrome with aortic dissection which began just below left subclavian artery in descending aorta. A 20-years old woman was admitted to Soonchunhyang hospital because of sudden onset of back pain. On phsical examination, she had characteristic Marfanoid feature. Chest X-ray and Echocardiography showed cardiomegaly and severe dilatation of ascending aorta. Chest CT and aortography showed severe aneurysm of ascending aorta and aortic dissection of descending aorta with intimal flap. she was treated with medical treatment because of poor general condition.

A Case of Marfan Syndrome with Dissecting Aortic Aneurysm Involving Thoracic and Abdominal Aorta

Marfan syndrome is an inheritable connective tissue with protean clinical manifestations involving the ocular, skeletal and cardiovascular system. It is well estabalished that a clinical hall marker and the major cause of morbidity in Marfan syndrome is aortic root dilatation and associated aortic dissection which begins just above the coronary ostia in ascending aorta. We report a rare case of Marfan syndrome with aortic dissection which began just below left subclavian artery in descending aorta. A 20-years old woman was admitted to Soonchunhyang hospital because of sudden onset of back pain. On phsical examination, she had characteristic Marfanoid feature. Chest X-ray and Echocardiography showed cardiomegaly and severe dilatation of ascending aorta. Chest CT and aortography showed severe aneurysm of ascending aorta and aortic dissection of descending aorta with intimal flap. she was treated with medical treatment because of poor general condition.

A Case of Atrial Septal Aneurysm with Recurrent Atrial Fibrillation and Cerebellar Infarction

An atrial septal aneurysm is well recognized abnormality of uncertain clinical relevance. An intraatrial aneurysm was demonstrated in the fossa ovalis of a 41-year-old woman who suffered an episode of cerebellar infarction with recurrent atrial fibrillation. The disorder is rarely treated surgically. Most patients with this condition are given life-long anticoagulation, a treatment that may have serious complications. We report a rare case of atrial septal aneurysm with recurrent atrial fibrillation and cerebellar infarction which receiving an appropriate diagnosis and curative treatment.

Plasma Homocysteine, Folate and Vitamin B12 Concentrations in Coronary Artery Disease

BACKGROUND: Elevated plasma homocysteine concentrations are an independent risk factor for vascular disease. The metabolism of homocysteine is closely related to vitamin B12 and folic acid. The purpose of this study is to evaluate the correlation between homocysteine and vitamin B12 as well as folic acid in patients with coronary artery disease. METHODS: Sixteen patients, in whom coronary angiography revealed more than 50% of stenosis at least in one coronary vessel, were enrolled as the patient group, and sixteen hypertensive subjects were selected as the control group. Blood was collected in the peripheral vein to measure the concentrations of homocysteine, vitamin B12, and folate. We evaluated the correlation between homocysteine, vitamin B12 and/or folate in both groups. RESULTS: Total plasma homocysteine concentrations were higher in the coronary artery disease group than in the control group. There were no significant differences in the folate and vitamin B12 levels between the coronary artery disease group and the control group. In the control group, the concentrations of homocysteine showed negative correlation with both vitamin B12 and folate concentrations, but similar trends were not observed in the coronary artery disease group.

The Changes of Coronary Artery Stenosis by Sequential Coronary Angiographies

BACKGROUND: Progression of coronary atherosclerosis is a unpredictable process. It follows a nonlinear course, and information derived from sequential coronary angiograms is of little value in predicting future progression. This study was designed to evaluate the changing patterns of coronary artery disease(CAD) and to determine possible factors for progression. METHOD: We analyzed progression and regression of CAD in 22 patients(group I : patients with progression of the coronary lesion, group II : patients with regression or no significant change of the coronary lesion) who underwent coronary arteriography two times. Progression was defined either as an increase in percent stenosis of preexisting stenoses by > or =20% including occlusions or as formation of new stenoses > or =20%. The results were compared with clinical findings to determine the nature of the progression of coronary atherosclerosis. RESULTS: Progression of the coronary artery lesion was found in 14 of 22 patients, regression in 4 and no significant changes in 4. New lesions occured in 22 of 156 segments in previously normal segments of arteries. The highest progression percentage was shown by the proximal right coronary artery. Progression occured most frequently in segments with stenosis of 50% to 74% at initial arteriogram. There were no significant differences in mean values for age, blood pressure, total serum cholesterol and blood sugar between two groups. CONCLUSION: The coronary arterial lesions are more frequently progressive rather than regressive of stationary. The progression follows nonlinear course. Many new lesions occurred in segments with previously normal segments of arteries.

Estimating the Volume of Pericardial Effusion by M-Mode and 2-D Echocardiographic Method

BACKGROUND: This study was undertaken to test the validity of M-mode and a new cross sectional cehocardiographic quantification of pericardial effusion. METHODS: This study was performed in 12 patients with large pericardial effusion of whom hed M-mode and 2-D echocardiography just before therpeutic drainage of the effusion. The volume of Pericardial fluid removed by pericardiocentesis was compared with te echo-free space estimated by M-mode echocardiography and the volume estimated by new 2-D echocardiographic method. The pericardial sac volume and the cardiac volume were calculated by applying the formula for the volume of a prolate ellipse. RESULTS: 1) There was a good correlation between 2-D echocardiographic estimate and the actual volume removed by pericardiocentesis(r=0.72, p<0.05). 2) The correlation between the echo-free space estimated by M-mode echocardiography at the level of mitral valve and the actual volume was also good(r=0.81,p<0.001). CONCLUSION: The M-mode and 2-D echocardiographic method is successful in helping to estimate large pericardial effusion.

Plasma Atrial Natriuertic Peptide (ANP) Levels and Hemodynamic Data in Patient with Heart Disease

To difine the relation between plasma atrial natriuertic peptide (ANP) levels and hemodynamic changes, we measured plasma concentration of atrial natriuertic peptide in 19 patients with heart disease undergoing cardiac catherization and in 15 normal subjects. The following results were obtained; 1) There were significantly increased plasma levels of atrial natriuertic peptide in patients with elevated mean pulmonary arterial wedge pressure. 2) A significant step-up in atrial natriuertic peptide concentration was seen between the femoral venous and right atrial plasma (P<0.01) and between the right atrial and pulmonary arterial plasma (P<0.05). 3) Peripheral venous atrial natriuretic peptide levels were significantly correlated with mean pulmonary arterial pressure and pulmonary wedge pressure (r=0.05, r=0.65, P<0.05). 4) Plasma atrial natriuretic peptide levels in pulmonary artery were significantly correlated with mean pulmonary arterial pressure (P<0.05).