Spontaneous closure of iatrogenic coronary artery fistula to left ventricle after septal myectomy for hypertrophic obstructive cardiomyopathy.

Cases of iatrogenic coronary artery fistulas draining into the left ventricle after surgical myectomy for hypertrophic obstructive cardiomyopathy have been published as sporadic reports. However, its management scheme and prognosis are not clear because of the low incidence. A 46-yr-old woman was hospitalized for evaluation of chest pain and shortness of breath for 3 months. Transthoracic echocardiographic examination showed typical hypertrophic obstructive cardiomyopathy with a peak pressure gradient of 71 mmHg across the left ventricular outflow tract. The patient underwent surgical septal myectomy. Postoperative color Doppler imaging revealed a diastolic blood flow from the interventricular septal myocardium to the left ventricular cavity, i.e. iatrogenic coronary artery fistula to the left ventricle. Ten days later, the fistula closed spontaneously which was diagnosed by transthoracic echocardiography and confirmed by coronary angiography.

Amount of left ventricular hypertrophy determines the plasma N-terminal pro-brain natriuretic peptide level in patients with hypertrophic cardiomyopathy and normal left ventricular ejection fraction.

BACKGROUND: N-terminal pro-brain natriuretic peptide (NT-proBNP) is increased in patients with hypertrophic cardiomyopathy (HCM); however, the determinants of NT-proBNP level have not been clarified in HCM. HYPOTHESIS: This study was performed to determine the relationship between NT-proBNP levels and various echocardiographic variables of patients with HCM and normal left ventricular ejection fraction (LVEF). METHODS: We assessed plasma NT-proBNP levels and echocardiographic variables of 36 patients (19 men, 58 +/- 14 years) with HCM and an LVEF of > or = 55%. Echocardiographic variables measured were LV wall thickness, end-diastolic LV internal dimension (LVIDd) and volume (LVEDV), LV mass, and LV mass index (LV mass/body surface area, LVMI). Left ventricular outflow tract pressure gradient, transmitral E and A velocities, deceleration time (DT) of the transmitral E wave, and septal annular E' velocity were measured by Doppler technique. The relationship between echocardiographic variables and plasma NT-proBNP level was analyzed. RESULTS: The plasma NT-proBNP level was 775.2 +/- 994.2 pg/ml (range 33.1-4729.0 pg/ml). It showed positive correlations with LV end-diastolic septal thickness (r = 0.39, p = 0.010) and LVMI (r = 0.27, p = 0.050), while it revealed negative correlations with LVIDd (r = -0.44, p = 0.004), LVEDV (r = -0.44, p = 0.004) and DT(r = -0.31,p = 0.034). The NT-proBNP level was higher in the patients with than in those without LV diastolic dysfunction (p = 0.033) and was independently related to LVIDd (p = 0.001), LVMI (p = 0.006) and DT (p = 0.031) by multivariate analysis. CONCLUSION: In patients with HCM and normal LVEF, the amount of LV hypertrophy and LV diastolic dysfunction may exert a significant role in determining plasma NT-proBNP level.

Congenital mitral insufficiency caused by anomalous mitral arcade in an elderly patient: use of echocardiography and multidetector computed tomography for diagnosis.

Anomalous mitral arcade is a rare congenital malformation and few survive to adulthood. A 65-year-old man presented with mild dyspnea and cardiac murmur. Transthoracic and transesophageal echocardiography showed an arc-like configuration of the papillary muscles, constrained by an interconnecting fibrous band in direct continuity with the anterior mitral leaflet, and mitral insufficiency caused by the restricted mobility of the mitral valve. Multidetector computed tomography confirmed these findings.

Clinical outcome of cardiac surgery in octogenarians.

The purpose of this study was to investigate the operative results and the clinical outcomes for octogenarians who underwent cardiac surgery. Twenty consecutive octogenarians who had cardiac operations at Samsung Medical Center from October 1994 through December 2004 were included in the study. The medical records were retrospectively reviewed and the follow-up results were obtained by the interview. The patients were 15 men and 5 women, and their mean age was 83.1 yr (range: 80-89 yr). The surgical priority was urgent for 5 patients and it was elective for 15 patients. Coronary artery bypass grafting (CABG) was performed in 14 patients, valve surgery was performed in 4 patients and CABG plus valve surgery was performed in 2 patients. There was one hospital death on day one after urgent CABG in an 80-yr-old man who had left main coronary artery occlusion. There were three deaths during the follow-up. Sudden death occurred in one patient at 2 months after valve surgery, and there were two non-cardiac deaths at 12 and 14 months, respectively, after CABG. Non-fatal postoperative complications occurred in 2 of 5 urgent patients and in 3 of 15 electives. The survival rate for the 19 hospital survivors at 24 months after surgery was 80% and the mean follow-up period was 22.5 months (range: 1-58 months). In conclusion, cardiac surgery could be performed within acceptable limits of the risk and its long-term results could be expected to be favorable for the octogenarians.

Antioxidative activity of furanocoumarins isolated from Angelicae dahuricae.

The methylene chloride extract of the root of Angelicae dahuricae showed high protective activity against 2,2'-azobis (2-aminodinopropane) dihydrochloride (AAPH)-induced cellular damage. From this extract, 11 furanocoumarins were isolated, namely oxypeucedanin hydrate, 9-hydroxy-4-methoxypsoralen, byakangelicin, pabulenol, alloisoimperatorin, neobyakangelicol, byakangelicol, oxypeucedanin, imperatorin, phellotorin and isoimperatorin, respectively. Among these 11 furanocoumarins, 9-hydroxy-4-methoxypsoralen and alloisoimperatorin displayed potent antioxidant effects against the DPPH radical and against renal epithelial cell injury by using AAPH to generate peroxyl radicals in vitro.

Tyrosinase-inhibitory furanocoumarin from Angelica dahurica.

An extract of the roots of Angelica dahurica BENTH. et HOOK. (Umbelliferae) showed potential tyrosinase inhibition against mushroom tyrosinase. Employing a bioassay-linked HPLC method, followed by semipreparative HPLC, the active principle was isolated and characterized as 9-hydroxy-4-methoxypsoralen.

Three new dammarane glycosides from heat processed ginseng.

Three new dammarane glycosides were isolated from the processed ginseng (SG; Sun Ginseng). Their structure were determined to be 3beta,12beta-dihydroxydammar-20(21),24-diene-3-O-beta-D-glucopyranosyl(1 --> 2)-beta-D-glucopyranoside; 3beta,12beta-dihydroxydammar-20(21),24-diene-3-O-beta-D- glucopyranoside and 3beta,6alpha,12beta-trihydroxydammar-20(21),24-diene-6-O-beta-D-glucopyranoside based on spectroscopic evidences. The compounds were named as ginsenoside Rk1, Rk2, and Rk3 respectively.

Cytotoxic dammarane glycosides from processed ginseng.

Steaming ginseng at high temperature increased its cytotoxicity to SK-Hep-1 hepatoma cancer cells. HPLC separation and fractionation followed by MTT assay revealed that ginsenosides Rg3, Rg5, Rk1, Rs5, and Rs4 are the active principles. Their 50% growth inhibition concentration (GI50) values were 41, 11, 13, 37, and 13 microM, respectively. Cisplatin had a GI50 of 84 microM in the same assay conditions.

Mushroom tyrosinase inhibition activity of some chromones.

Currently, aloesin is used in the cosmetic industry as a whitening agent because it inhibits tyrosinase activity. Aloesin is a C-glycosylated chromone compound isolated from aloe, and it is difficult to synthesize because of C-glycosyl moiety in the molecule. The purpose of this study is to search for a new chromone compound which is easy to synthesize and which posesses stronger tyrosinase inhibitory activity than aloesin. Fourteen chromone derivatives were synthesized and screened for their mushroom-tyrosinase inhibitory activity. 5-Methyl-7-methoxy-2-(2'-benzyl-3'-oxobutyl)chromone (15) showed the strongest activity among tested compounds. Its activity was not only stronger than aloesin, but also stronger than arbutin and kojic acid. The kinetic analysis revealed a competitive inhibition of 15 with tyrosinase for the L-tyrosine binding site.

Four new acetylated ginsenosides from processed ginseng (sun ginseng).

Four new acetylated ginsenosides were isolated from the processed ginseng (SG, sun ginseng). Their structures were determined to be 3beta,12beta-dihydroxydammar-20(22),24-diene-3-O-beta-D-glucopyranosyl(1-->2)-beta-D-6"-O-acetylglucopyranoside; 3beta,12beta-dihydroxydammar-20(21), 24-diene-3-O-beta-D-glucopyranosyl(1-->2)-beta-D-6"-O-acetylglucopyranoside; 3beta, 6alpha, 12beta-trihydroxydammar-20(22),24-diene-beta-O-beta-D-6'-O-acetylglucopyranoside and 3beta,6a,12beta-trihydroxydammar-20(21),24-diene-6-O-beta-D-6'-O-acetylglucopyranoside based on spectroscopic evidences. The compounds were named ginsenoside Rs4, Rs5, Rs6 and Rs7, respectively.