The role of transesophageal three-dimensional echocardiography in the measurement of dynamic changes of atrial septal defect

No abstract available.

A Clinical Study on Anti-Hypertensive Effect and Safety of Candesartan Cilexetil (Atacand) in Mild to Moderate Hypertensive Patients

BACKGROUND AND OBJECTIVES: Candesartan cilexetil (Atacand ), a selective type I angiotensin II receptor blocker, has recently been introduced as a new antihypertensive agent. We evaluated its anti-hypertensive effect and safety in mild to moderate hypertensive patients. MATERIALS AND METHODS: Candesartan cilexetil, 8 mg or 16 mg, was administered once a day over 8 weeks period in the patients with mild to moderate hypertension (25 male, 26 female, mean age: 53.5+/-1.2 years). For safety evaluation, laboratory tests were performed before and after treatment with candesartan cilexetil. Changes in blood pressure, heart rate and electrocardiogram were also observed. RESULTS: 1) The mean blood pressures in the sitting position were systolic 164.1+/-2.1 mmHg and diastolic 106.3+/-0.8 mmHg before treatment, which were lowered to 135.4+/-2.0 mmHg and 89.1+/-1.1 mmHg, repectively after 8 weeks of treatment (p0.05). 4) Laboratory tests revealed no significant abnormality by the treatment with candesartan cilexetil. 5) Left ventricular hypertrophy by ECG criteria detected in 3 cases disappeared after treatment with candesartan cilexetil. 6) No significant side effects were observed during the treatment period. CONCLUSION: Candesartan cilexetil, 8 mg or 16 mg, once a day is an effective and well tolerated antihypertensive treatment. It has a significant dose-dependent antihypertensive effect.

The Inhibitory Effect of Triflusal (Disgren)on the Platelet Aggregation in Healthy Volunteers: Impedance Method with the Whole Blood

BACKGROUND: Antiplatelet drugs play an important role in the prevention and treatment of coronary artery diseases. Triflusal, an antiplatelet drug structually related to acetylsalicylic acid, selectively inhibits the cyclooxygenase of platelet and thromboxane A2 formation. However there is a controversy about the clinical dosage and the quantitative evaluation of the platelet antiaggregatory effect of triflusal. In this study we have evaluated the platelet antiaggregatory effect and cost-effective dosage of triflusal in the whole blood of healthy volunteers. METHODS: Using the whole blood of 50 healthy people, we performed a baseline platelet aggregation function test induced by adenosine diphosphate (ADP) and collagen. The subjects were subdivided into 3 treated groups (300 mg, 600 mg, 900 mg). We compared the platelet aggregation effect between the baseline results and 2 weeks after triflusal administration. RESULTS: Triflusal inhibited the platelet aggregation induced by ADP and collagen in the 600 mg administration group most effectively. The platelet aggregation induced by collagen was inhibited dose-dependently. The definite inhibitory responders (% inhibition > or = 25) for platelet aggregation induced by collagen were more common than those induced by ADP (33% vs 27% in 300 mg, 71% vs 53% in 600 mg, 78% vs 39% in 900 mg). There were no serious clinical side-effects except gastrointestinal trouble. One volunteer in the 900 mg treated group discontinued the treatment due to epigastric pain. CONCLUSION: We conclude that triflusal has a dose-dependent inhibitory effect on platelet aggregation induced by collagen and that the most effective dosage for platelet antiaggregation effect is 600 mg per day.

The Inhibitory Effect of Triflusal (Disgren)on the Platelet Aggregation in Healthy Volunteers: Impedance Method with the Whole Blood

BACKGROUND: Antiplatelet drugs play an important role in the prevention and treatment of coronary artery diseases. Triflusal, an antiplatelet drug structually related to acetylsalicylic acid, selectively inhibits the cyclooxygenase of platelet and thromboxane A2 formation. However there is a controversy about the clinical dosage and the quantitative evaluation of the platelet antiaggregatory effect of triflusal. In this study we have evaluated the platelet antiaggregatory effect and cost-effective dosage of triflusal in the whole blood of healthy volunteers. METHODS: Using the whole blood of 50 healthy people, we performed a baseline platelet aggregation function test induced by adenosine diphosphate (ADP) and collagen. The subjects were subdivided into 3 treated groups (300 mg, 600 mg, 900 mg). We compared the platelet aggregation effect between the baseline results and 2 weeks after triflusal administration. RESULTS: Triflusal inhibited the platelet aggregation induced by ADP and collagen in the 600 mg administration group most effectively. The platelet aggregation induced by collagen was inhibited dose-dependently. The definite inhibitory responders (% inhibition > or = 25) for platelet aggregation induced by collagen were more common than those induced by ADP (33% vs 27% in 300 mg, 71% vs 53% in 600 mg, 78% vs 39% in 900 mg). There were no serious clinical side-effects except gastrointestinal trouble. One volunteer in the 900 mg treated group discontinued the treatment due to epigastric pain. CONCLUSION: We conclude that triflusal has a dose-dependent inhibitory effect on platelet aggregation induced by collagen and that the most effective dosage for platelet antiaggregation effect is 600 mg per day.

A Case of Ticlopidine-induced Neutropeina Treated with rhG-CSF

There are many conditions which are associated with neutropenia, such as infections, chemical and physical agents, and hematopoietic diseases. But ticlopidine-induced neutropenis is rarely reported in Korea. We experienced a case of neutropenia which developed after approximately 1 month of ticlopidine administrarion to a stable angina pectories patient. A 59 year-old woman with stable angina pectoris was placed on ticlopidine. Forty days later, she was admitted for high fevers and shaking chills. On admission, leukocyte count was 900/mm (3) (neutrophil 0/mm (3)), hemoglobin was 11.8g/dl, and platelet count was 440.000/mm (3). After confirming ticlopidine-induced neutropenia by bone marrow aspiration and biopsy, we administated rhG-CSF (neutrogen (r), Choongwae. Co. Korea) at a dose of 3-5ug/kg daily. On the 25th day of treatment, leukocyte count reached 2,890/mm (3). She experienced no adverse effects of rhG-CSF treatment and recorved completely. We assume that the rapid recovery of granulocytes was attributable to rhG-CSF, and we suggest that rhG-CSF should be tried in a patients with ticlopidine-induced neutropenia with depletion of myeloid precursors in the hypocelluar bone marrow.

Coronary Less Shortening Wallstent in the Long Lesion of Coronary Artery Disease: 6 Months Follow-up Results

BACKGROUND: Despite of the first coronary wallstent implantation ushered in the new era in interventional cardiology with the purpose of circumventing the two major limitation of coronary balloon angioplasty, early acute occlusion and late restenosis, however, previous investigators suggested the high rate of subacute occlusion after original wallstent implantation. Recently the low incidence of the subacute closure and restenosis rate with the newely modified less shortening coronary wallstent in native coronary artery and in aortocoronary vein grafts were reported. In this study we report the acute and 6 months follow up results with less shortening coronary wall stent in 32 patients. METHODS: Thirty two patients were enrolled from March 1996 through February 1997 at the Yonsei cardiovascular center of Yonsei University. The specific angiographic criteria for enrollment included at least 70% stenosis and a lesion that was 20mm or more in length and a vessel diameter of at least 2.5mm. Enteric coated aspirin(100mg daily) and ticlopidine(500mg daily) at least 3 days before the procedure and received continuous infusion of 24,000U of heparin for 1day after the procedure. Angiography was performed in two orthogonal views at pre, post procedure and 6months later. Quantitative analysis was performed with the use of the electronic caliper comparing to the empty catheter. All continuous variables were expressed as mean SD and analyzed with the t-test. Differences between groups were analyzed with Chi-square analysis and Fishers Exact test where appropriate. RESULTS: The newly modified Coronary Less Shortening Wallstents were successfully implanted in all the 35 diffuse coronary lesions(more than 20mm in length) of the 32 patients, including 15 pts of acute myocardial infarction, 14 pts of unstable angina, and 3 pts of stable angina. Average 6 months follow up angiography was performed in 26 patients. Immediate angiographic results with Less Shortening Wallstent comparing with 6 months follow up were 3.0+/-0.4mm and 1.7+/-0.9mm in minimal luminal diameter(MLD), 5.1+/-9.1% and 46.8+/-25.8% in diameter stenosis(DS). During the in-hospital phase, no major cardiac event occurred except 2 cases of transmural myocardial infarction, including one of stent thrombosis(3.1%) and one of side branch occlusion, despite of inclusion of 7 cases of threatened occlusion in the long lesion. The restenosis rate at follow up angiography was 30.7%(8/26 pts). The restenosis rate was higher in patients with stent insertion into right coronary artery or adjuvant high pressure oversize ballooning after stent insertion but not statistically significant. CONCLUSIONS: The results of this study suggested that new Less Shortening Wallstent might reduce the requirement of multiple stent in the long lesion and a lower rate of subacute thrombotic occlusion in comparison to the reports with its prototype. Restenosis rate was not significantly different from other types of stents. Althouth the restenosis rate was high in patients with stent insertion, there was no statistical significance probably due to small sample size. But further large scale long term follow-up study is needed to evaluate the role of new Less Shortening Wallstent.

AVE Micro-II Stent: 6-months Follow up Result

BACKGROUND: Several stents are now available for the treatment of failed or suboptimal angioplasty. However, one of the limitations of stents is difficult to deploy especially in tortuous vessels, lesions at a bend, and distal to previously deployed stents. The AVE Micro-II stent has a very low profile(1.65mm), optimum radio-opacity, and highly flexible properties. It is mounted on a semi-compliant balloon with a monorail delivery system. Therefore, it is easy to operate and feasible in tortuous, distal lesions and variety of lesion lengths. We report clinical outcomes and angiographic follow up results of AVE Micro-II stent. METHODS: Between January 1996 and September 1996, 77 patients were stented with the AVE Micro-II stent. Six-months follow-up angiogram was performed in 57 patients(64 lesions, follow-up rate : 74%). RESULTS: The overall angiographic restenosis rate was 26.6%. By univariable analysis, the rate of restenosis was significantly higher for stents in angulated lesions, in smaller post-stent luminal diameter, in the left anterior descending artery lesion than the right coronary artery, in ostial lesion(p=0.02), in peristent dissecting lesions(p=0.02), in tortuous proximal vessels(p=0.03). Stenting of angulated lesions(p=0.0001, Odds ratio=54.64), small post-stent luminal diameter(p=0.01, Odds ratio=5.46), and the left anterior descending artery than the right coronary artery(p=0.03, Odds ratio=17.2) were the strong independent predictors of restenosis in a multiple logistic regression analysis. Event-free survival(freedom from death, myocardial infarction or revascularization) was 80.7% at 6 months. CONCLUSIONS: 1) The AVE Micro-II stent can be placed safely and efficiently. 2) The angiographic restenosis rate was 26.6%, and 80.7% of patients remained free of cardiovascular events at 6 months. 3) Stenting of angulated lesions, small post-stent luminal diameter, and the left anterior descending artery than the right coronary artery are associated with higher rates of restenosis.

Familial Cardiac Myxoma with Acromegaly(Complex Myxoma)

BACKGROUND: Cardiac myxomas are rare benign tumors of the heart. Although cardiac myxomas are histologically benign, they may be lethal because of their strategic position. Most cases are sporadic, but rare familial occurrence has been described. PATIENTS AND RESULTS: The left atrial myxoma with cerebral embolism was diagnosed in the 21 year old female and the left atrial myxoma with acromegaly due to pituirary adenoma was subsequently diagnosed in her 19 year old male sibling. The myxoma in the male patient was successfully excised. CONCLUSION: Echocardiography can be used effectively in the diagnosis of atrial myxoma, detection of its possible recurrence, and screening other members of the family.

Effect of Percutaneous Transluminal Coronary Angioplasty on Myocardial Perfusion : Measurement with Myocardial Contrast Echocardiography

BACKGROUND: Myocardial contrast echocardiography(MCE) has been known to be a safe and useful method to assess the adequacy of myocardial perfusion. This study was performed to assess the change of myocardial perfusion following successful percutaneous transluminal coronary angioplasty using MCE in the patients with significant coronary arterial obstructive diseases. METHODS: The study comprised of eight patients(mean age 55 years, male 7, female 1). Four patients were unstable angina and four patients post non-Q wave myocardial infarction angina. Six patients had one vessel disease and two paients two vessel disease. All patients underwent successful PTCA at the proximal(2 patients) and the mid(6 patients) left anterior descending coronary artery. Pre- and post-PTCA myocardial perfusion was assessed by comparing peak contrast intensity and slope of time-intensity curve after injection of hand-agitated Hexabrix(6cc) respectively. The variables were measured off-line at thirty two end-diastolic frames of the left ventricle in each patient. RESULTS: 1) Diameter stenosis of target lesion changed from 91±9 to 24±14% after successful coronary angioplasty(p < 0.005). 2) Peak contrast intensity was increased from 47.4±30.7 to 64.9±36.4 gray scale U/pixel in anteroseptal segment and from 46.6±14.3 to 67.9±35.8 gray scale U/pixel in anterior segment(p < 0.05). 3) The slope of time-intensity curve after PTCA became more steeper compared to that of pre-PTCA(anteroseptal : −0.32±0.48 vs −0.76±0.66 p=0.071, anterior : −0.33±0.39 vs −0.81±0.80 p=0.086). 4) During the study, there was no significant clinical or hemodynamic complications except three patients who developed transisient sinus bradycardia after intracoronary injection of handagitated Hexabrix. CONCLUSION: Myocardial contrast echocardiography appeared to be safe and useful in the evaluation of myocardial perfusion following coronary angioplasty assessed by the changes of peak contrast intensity and slope of contrast time-intensity curve.

Estimation of Size of Adult Atrial Septal Defect

Transcatheter closure of secundum atrial septal defect(ASD) with a "buttoned" double-disk device is feasible, effective and safe method as an alternative to surgical closure. Stretched diameter of ASD, determined by balloon sizing is generally used as a guide to prediction of success or selection of device size used for transcatheter closure of ASD. To test whether other non-invasive assessment of ASD size can provide an alternative method for a stretched diameter, we studied the relationship between various measures of ASD in 22 adult patients with ASD. Although transthoracic echocardiographic horizontal or vertical diameter of ASD, the maximal diameter of ASD measured at operation and pulmonary-to systemic flow ratio(Qp : Qs), the stretched diameter had no significant correlation with other measurements. It is conclused that other assessments of ASD size can not be used as adjuncts in the estimation of the stretched ASD diameter, which in turn can be used for prediction of success or selection of device size for occlusion of the ASD.