A Case of Stent Migration into Right Ventricle after Percutaneous Transluminal Angioplasty for Budd-Chiari Syndrome

No abstract available.

Clinical Comparison of Coronary Flow Reserve and Fractional Flow Reserve after PTCA in Patients with Coronary Artery Disease / 대한내과학회지

OBJECTIVES: Severity of coronary artery stenosis has been defined in terms of geometric dimensions, pressure gradient-flow relations, resistance to flow and coronary flow reserve(CFR) after maximum arteriolar vasodilation. Myocardial fractional flow reserve(FFR) is a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography. We compared the relationship between FFR and CFR after PTCA and the residual stenosis with FFR and CFR in the patients with acute myocardial infarction (AMI) and angina. METHODS: The study population consisted of 25 patients with AMI and 18 patients with angina. All AMI patients had successful restoration of infarc-related artery by thrombolysis or direct PTCA. Doppler index was measured using 0.014 inch Doppler wire 15 minutes after successful restoration of infarc- related artery. Hyperemic index was measured after intracoronary injection of adenosine(16-18ug). Baseline and hyperemic distal coronary artery pressure was measured using 0.014 inch pressure wire with advancing the wire distal to the lesion and simultaneous proximal aortic pressure was measured using guiding catheter. RESULTS: 1) Post-interventional FFR and CFR were 0.91+/-0.09 and 1.87+/-0.45 in AMI and 0.93+/-0.06 and 2.73+/-0.67 in angina. There was no significant correlation between FFR and CFR in AMI and angina(p=NS). CFR showed the weak correlation with hyperemic distal pressure(hPd) in AMI(p=0.04) and FFR with hDSVR in angina(p=0.04). FFR and CFR were not correlated with mean blood pressure and heart rate(p=NS). 2) FFR and hyperemic pressure gradient had the close correlation with residual stenosis after successful PTCA in AMI and angina(p<0.001). Baseline pressure gradient also showed weak correlation with FFR(p<0.05). 3) CFR was 1.87+/-0.45 in AMI and 2.73+/-0.67 in angina with significant difference between two groups (p<0.001) and FFR was 0.91+/-0.09 in AMI and 0.93+/-0.06 in angina without difference(p=NS). hPa and hPd showed the significant difference between the two groups(p<0.05). CONCLUSION: FFR seems to be a new index of the functional severity of coronary stenosis that is calculated from pressure measurements during coronary angiography.

Predictive Values of Early Rest / 24 Hour Delay Perfusion SPECT for Wall Motion Improvement in Patients with Acute Myocardial Infarction After Reperfusion / 대한핵의학회잡지

PURPOSE: We studied early rest/24 hour delay Tl-201 perfusion SPECT for prediction of wall motion improvement after reperfusion in patients with acute myocardial infarction. MATERIALS AND METHODS: Among 17 patients (male/female ll/6, age: 59+13) with acute myocardial infarction, 15 patients were treated with percutaneous transcoronary angioplasty (direct:2, delay:11) and intravenous urokinase (2). Spontaneous resolution occurred in infarct-related arteries of 2 patients. We confirmed TIMI 3 flow of infarct-related artery after reperfusion in all patients with coronary angiography. We performed rest Tl-201 perfusion SPECT less then 6 hours after reperfusion and delay Tl-201 perfusion SPECT next day. Tl-201 uptake was visually graded as 4 point score from norrnal (0) to severe defect (3). Rest Tl-201 uptake 1 grade in follow up echo compared with the baseline values. RESULTS: Among 98 segments with wall rnotion abnormality, the severity of myocardial wall motion decrease was as follow: mild hypokinesia: 18/98 (18%), severe hypokinesia: 28/98 (29%), akinesia: 5l/98 (52%), dyskinesia: 1/98 (1%), The wall rnotion improved in 85%. Redistribution (13%), and reverse redistribution (4%) were observed in 24 hour delay SPECT. Positive predictive value (PPV) and negative predictive value (NPV) of combination of late reversibility and rest Tl-201 uptake were 99%, and 54%. PPV and NPV of rest T1-201 uptake were 100% and 52% respectively. Predictive values of combination of rest Tl-201 uptake and late reversibility were not significantly different compared with predictive values of rest Tl-201 uptake only. CONCLUSION: We conclude that early Tl-201 perfusion SPECT predict myocardial wall motion improvement with excellent positive but relatively low negative predictive values in patients with acute myocardial infarction after reperfusion.

Comparison of Myocardial Fractional and Coronary Flow Reserve after Revascularization in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the residual diameter stenosis after PTCA with fractional flow reserve (FFR) and coronary flow reserve (CFR), and investigate the correlation between FFR and CFR in patients with acute myocardial infarction (AMI). MATERIALS AND METHOD: The study population consisted of twenty seven patients with myocardial infarction. Baseline and hyperemic average peak velocity (APV) were measured using Doppler wire 15 minutes after restoration of infarct-related artery (IRA). CFR was obtained by the ratio of distal hyperemic APV to baseline APV. Distal coronary arterial pressure (Pd) was measured with advancing the wire distal to the lesion of IRA. Simultaneous proximal aortic pressure (Pa) was measured using guiding catheter. Myocardial FFR was obtained by the ratio of hyperemic Pd to hyperemic Pa. RESULTS: Post-interventional CFR and FFR were 0.85+/-0.44, 0.91+/-0.09. CFR did not show significant correlation with luminal diameter stenosis (%ST). There was no significant correlation between FFR and CFR with a correlation coefficient of 0.29 (p=.25). But, significant correlation was found between %ST and FFR, %ST and hyperemic PG (hPG) with correlation coefficient of -0.70 (p=.0012) and 0.68 (p=.0018). CONCLUSION: In AMI patients, %ST has a significant correlation with FFR and hPG after PTCA. But, there was no significant correlation between FFR and CFR.

Prognostic value of dobutamine echocardiography in prediction of late recovery of regional myocardial dysfuction in patients with acute myocardial infarction

BACKGROUND AND OBJECTIVES: Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of acute myocardial infarction (AMI). The aim of this study was to assess the ability of dobutamine echocardiography (DE) to detect viable myocardium and predict the late improvement of regional left ventricular dysfunction after AMI. METHODS: Twenty-five patients (male 24, mean age 57+/-9.6) with AMI underwent DE (dobutamine: 0, 5, 10 and 20 microgramm/kg/min) in 4.8+/-2.2 days after infarction. Revascularization of infarct related artery was performed in 20 patients (percutaneous coronary angioplasty 18, coronary artery bypass graft surgery 2). A follow-up 2D-echocardiography was performed at 7.1+/-2.3 months after AMI. RESULTS: 1. Improvement of regional wall motion abnormality (RWMA) was observed in 12 patients during DE[DE (+) group]. Thirteen patients showed no improvement of RWMA[DE (-) group]. 2. In follow-up 2D-echocardiography 10 patients showed improvement of RWMA among DE (+) group (positive predictive value= 83.3%). Two patients showed improvement of RWMA among DE (-) group (negative predictive value=84.6%). Sensitivity and specificity of DE in predictiong late recovery of RWMA were 83.3% and 84.6% each. DE performed in the early stage of AMI seems to be useful in prediction of late recovery of regional left ventricular dysfunction.

Primary intracranial hemorrhage presenting as acute myocardial ischemic syndrome / 대한내과학회지

A 44 years old woman was admitted to Inha University hospital in semicomatose state. An electrocardiogram (ECG), taken in the emergency room, showed ST segment elevation in the precordial leads. She underwent a urgent echocardiography. It showed that there was akinesia of anteroseptal segment from the mid left ventricle to the apex and inferior segment from the mid left ventrile to the lower mid left ventricle. With the impression of acute myocardial infarction (AMI), she underwent a urgent coronary angiography. There was no significant luminal narrowing of the right or the left coronary arteries but the left ventriculography revealed akinesia of anterolateral and diaphragmatic segments of the left ventricle. Computerized tomography (CT) of the brain, taken shortly after coronary angiography, showed subarachnoid hemorrhage. The abnormal ECG and echocardiography findings, simulating acute myocardial infarction, were assumed to be caused by coronary vasospasm derived from subarachnoid hemorrhage accompanied by massive adrenergic discharge.

Assessment of cardiac sympathetic neuronal integrity using iodine-123 metaiodobenzylguanidine myocardial scintigraphy and its clinical efficacy as a new noninvasive screening test for the diagnosis of coronary artery spasm

BACKGROUND: It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. Recently, advances have made possible the imaging of the cardiac adrenergic nervous system with metaiodobenzylguanidine (MIBG) labeled with iodine-123. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation by iodine-123-metaiodobenzylguanidine single-photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of iodine-123-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm. METHOD: Coronary arteriography and provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (21 men, 5 women, mean age 49.1+/-9.3, range: 26-59) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups ; Group 1 comparised of 18 patients subjects to the positive provocative test, Group 2 comparised of 8 patients subjects to the negative provocative test. Four healthy subjects served as control. All patients also underwent iodine-123-MIBG SPECT for the evaluation of cardiac sympathetic integrity. The SPECT findings were qualitatively evaluated by two experienced physicians who were blind to the clinical data. RESULTS: Abnormal sympathetic nervous innervation using iodine-123-MIBG SPECT was observed either as a reduced uptake or defect pattern in the perfused areas in 13 of the 18 vessels of ergonovine induced vasospasm. Normal sympathetic innervation as evidenced by normal iodine-123-MIBG uptake was noted in all of the 60 segments of normal vessel territories. Reduced uptake of iodine-123-MIBG was not detected in the perfused areas of five vasospasm-induced vessels (perfusion territory of LAD in 2 and the RCA in 3 patients). The sensitivity and specificity of iodine-123-MIBG for detection coronary artery spasm were 72.2% (95% confidence interval [CI] 55% to 89%) and 100%, respectively. The positive predictive value and negative predictive value were 100% and 92.3% (95% CI 91% to 93%), respectively. CONCLUSION: Iodine-123-MIBG SPECT is a feasible method to noninvasively evaluate and localize the territories of coronary arteries with spasms. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for the diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan, but abnormal iodine-123-MIBG SPECT.

Interventional Treatment of Total Occlusion of Abdominal Aorta

BACKGROUND: Total occlusion of the infrarenal abdominal aorta is a very rare disease in clinical practice. The clinical outcome may be poor unless management is attempted promptly. Surgical bypass has been recommended as the treatment of choice for these lesions. However, there was relatively high surgical mortality and morbidity associad with aorto-bifemoral bypass graft in patients with other systemic disease, especially coronary artery disease. As a result, the use of, thrombolysis with percutaneous transluminal angioplasty (PTA) has recently been extended to this disease as an alternative method to surgery. PTA is technically simpler with less morbidity and mortality than surgery.We report our experience with thrombolysis and balloon angioplasty of total aortic occlusion in 14 patients between March 1991 and December 1996. METHODS: Fourteen patients, whose mean age was 59+/-13 years (11 male, 3 female), serve as the study's patients. Aortography was introduced via transbrachial artery. The end hole multipurpose catheter with guidewire was introduced into the thrombotic portion of the total occlusion. Urokinase was infused into the thrombus through the catheter if there were no contraindications. in sysremic thrombolysis. Thrombolytic therapy was continued until the thrombi was resolved and flow was restored. Balloon dilatation was followed in residual stenotic lesions. Stents were implanted in case of suboptimal results after ballooning. RESULTS: Clinical findings were resting leg pain in 6 patients, gangrene in 5 patients, and claudication in 3 patients. The causes of aortic occlusion were thromboembolism in 4 patients and thrombosis of an atherosclerotic aorta in 10 patients. Location of obstruction was below the renal artery in all cases. The clinical outcome of interventional therapy was successful in all cases except one patients. Operative treatment was undertaken in 2 cases because they could not received thrombolytic therapy due to contraindication and complication of thrombolytic therapy (gastrointestinal bleeding). Near normal revascularization was achieved in 3 patients by thrombolytic therapy only. PTA was performed at the stenotic after thrombolytic therapy in 4 patients. Stenting were performed at the stenotic sites after balloon dilatation in another 4 patients. There was bleeding complication in one case. CONCLUSIONS: Interventional therapy such as thrombolytic therapy with PTA is an effective and safe treatment modality for abdominal aortic total occlusion in selected cases. These techniques were very useful in some high risk patients who received surgical bypass procedures.

Real-time determination of left ventricular ejection fraction by automatic boundary detection in patients with dilated cardiomyopathy: a comparison with radionuclide ventriculography

Echocardiographic automatic boundary detection (ABD) is a new on-line technique which automatically outlines the left ventricular endocardial border and instantly calculates the left ventricular area and volume from two dimensional echocardiographic images. To determine if left ventricular ejection fraction (LVEF) can be derived using the ABD method, 25 consecutive patients with dilated cardiomyopathy, aged 52.1 +/- 15.2 (range 14 approximately 75), underwent complete echocardiographic examination with both the ABD method and radionuclide ventriculography (RVG). End-diastolic and end-systolic left ventricular areas were obtained on-line from the apical four chamber view. Left ventricular length was also measured from an apical view. Left ventricular volumes and ejection fraction were calculated using the single plane area-length method. ABD measurements could be obtained in all patients. Linear regression analysis compared ejection fraction derived by ABD and RVG. The mean radionuclide LVEF was 20.9 +/- 6.8% and mean ABD-derived LVEF was 22.7 +/- 5.8%. Linear regression analysis revealed that the ABD-derived LVEF is closely correlated with the RVG-derived LVEF (r = 0.87, p<0.001). In conclusion, ABD echocardiography is a new on-line technique which may be used to accurately calculate LVEF in patients with dilated cardiomyopathy.

4 Cases of Midventricular Obstructive Hypertrophic Obstructive Cardiomyopathy

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.

4 Cases of Midventricular Obstructive Hypertrophic Obstructive Cardiomyopathy

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.

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.

Iodine-123-Metaiodobenzylguanidine Myocardial Scintigraphy in Patients with Dilated Cardiomyopathy : Correlation between Myocardial MIBG Uptake and Echocardiographic Parameters

BACKGROUND: The prognosis of patients with dilated cardiomyopathy remains poor. Doppler echocardiography and cardiac iodine-123-metaiodobenzylguanidine(MIBG) myocardial scintigraphy are useful non-invasive diagnostic modalities to assess the prognosis in these patients. However, the relationship between myocardial MIBG uptake and Doppler echocardiographic. variables was not well investigated. We analyzed the cardiac MIBG imaging in 40 patients with dilated cardiomyopathy and assessed the correlation between the echocardiographic parameters and myocardial MIBG uptake. MIBG uptake(DHM), assessed as the heart/mediastinum ratio measured on anterior view image obtained 4 hours after injection, was compared with M-mode(left ventricular end-diastolic dimension, left ventricular ejection fraction) and Doppler parameters. RESULTS: 1) Early and delayed MIBG uptake of heart were significantly lower in patient group compared with normal control subjects. There were no significant differences in lung and mediastinum uptake of MIBG between the two groups. 2) Early and delayed MIBG uptake ratios of the heart to lung and heart to mediastinum were significantly lower in patient group compared with those of normal control subjects. 3) DHM was significantly lower in patients with NYHA functional class 3, 4 than those with NYHA functional class 1, 2 in patient group. There was, however, no significant difference of DHM in patient group divided by the degree of mitral regurgitation and left ventricular diastolic filling pattern. 4) There were no significant correlations between DHM and other prognostic factors(left ventricular end-diastolic dimension, left ventricular ejection fraction, peak velocity of early diastolic filling(E velocity), deceleration time of E wave, cardiac output, pulmonary capillary wedge pressure, left ventricular end-diastolic pressure and 24hr urine norepinephrine). CONCLUSION: Iodine-123-MIBG scan is a useful noninvasive imaging modality in the assessment of cardiac sympathetic neuronal integrity in patients with dilated cardiomyopathy. There were no significant correlations between cardiac MIBG uptake and other prognostic factors. The cardiac MIBG uptake probably can be utilized as an independent prognostic factor, hence it would be suggested that a large prospective clinical study is needed to consolidate these findings.

Angiographic Follow-up after Intracoronary Stenting with Flexible Coil(Gianturco-Roubin) Stent

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.

Angiographic Follow-up after Intracoronary Stenting with Flexible Coil(Gianturco-Roubin) Stent

BACKGROUND: Intracoronary stent with various designs have been developed to treat dissections or acute closure after angioplasty. The efficacy of flexible coil stent as a bail-out device has been reported. However, the restenosis after stenting still remained as a main limitation like other devices. This study reports on the angiographic follow-up after successful intracoronary stenting with flexible coil stent. METHOD: From April 1993 through July 1994, coronary stenting was tried in 21 patients by a single operator for various indications(acute or threatened closure, suboptimal result after balloon angioplasty). The nineteen(95%) out of 20 patients in whom stent was successfully deployed underwent follow-up coronary angiography 7.6+/-3.0 months after coronary stenting. RESULT: Mean age was 54.7+/-11.3(33-73) years and 16 parients were men. Clinical diagnosis of patients were as follows : stable angina 7, unstable angina 6, old myocardial infarction with stable angina 6 and acute myocardial infarction in 1 patient, respectively. Stents were implanted at left anterior descending artery in 9, left circumflex artery in 5 and right coronary artery in 8. Ten out of 21 stents(47.6%) were found to be renarrowed more than 50% at follow-up coronary angiography. There was no significant difference in clinical and angiographic variables between restenosis group and no-restenosis group. Coronary artery bypass graft surgery was performed in 1 patient for the treatment of restenosis after stenting. Repeat PTCA was performed in 3 patients and remaining 5 patients were followed medically. CONCLUSION: Flexible coil(Gianturco-Roubin) coronary stent is a useful adjunct percutaneous intervention to prevent or minimize complicatioms associated with dissections. Despite favorable initial angiographic and clinical results, 47.6% of stents were found to be renarrowed significantly at follow-up coronary angiography. New techniques or more optimal characters of stents would be desired.

Peripheral Vascular Disease in Patients with Significant Coronary Artery Disease

BACKGROUND: Although it is known that patients wth peripheral vascular disease are at high risk for coronary arterial disease, however, it has not been determined that patients with coronary artery disease(CAD) correlates with peripheral vascular disease(PVD). This study was designed to determine the prevalence and clinical characteristics of peripheral vascular disease(PVD) in patients with coronary artery disease(CAD). METHODS: A total of one hundred seventy-eight patients with CAD confirmed by coronary angiogram(145 male, age 58.5+/-10.1) were included in this study from February 1992 to May 1994. Coronary and peripheral angiograms were performed in all patients and the patients were divided into two groups; patients with PVD dand patients without PVD. Clinical characteristics were compared between two groups. RESULTS: Peripheral vascular disease was present in 49 patients(27.5%) among 178 CAD patients. The mean age of patients with PVD was significantly older than that of patients without PVD. The hypertension was statistically significant difference between two groups(P<0.05). There were no major differences in the number of risk factors or number of stenotic coronary arteries in patients with and without PVD. CONCLUSION: The prevalence of PVD in patients with CAD was high and it is reasonable to state that most common risk factors for coronary and peripheral atherosclerosis were age, hypertension and obesity.

Doppler Echocardiographic Evaluation of Diastolic Function in Different Patterns of Ventricular Hypertrophy and Topography in Essential Hypertension

BACKGROUND: Left ventricular hypertrophy and diastolic dysfunction have been well established in patients with essential hypertension. The left ventricular adaptation to hypertension represents a variety of spectrums with complex changes in topography. Left ventricular topography and diastolic and systolic function were evaluated in 48 patients with essential hypertension(group 1) and 33 age-matched normal controls(group 2) by transmitral inflow and pulmonary venous flow patterns assessed by Doppler echocardiography. The following Doppler parameters were measured : early(E) and late(A) peak velocities and velocity integrals. E/A ratio, deceleration time of E wave ; systolic(S) and diastolic(D) peak velocities and velocity integrals of pulmonary venous flow, S/D ratio, and atrial reversal peak velocity. RESULTS: 1) There were no significant differences of age, sex, heart rate, and body surface area between the two groups. 2) Systolic and diastolic blood pressures and left atrial dimension and left ventricular mass index and relative wall thickness were significantly increased in group 1. Deceleration time and isovolumic relaxation time were significantly increased in group 1(231.9±47.6msecs vs 202.0±40.7msecs, 106.7±21.4msecs vs 83.2±14.3msecs, p < 0.05, respectively), whereas E/A ratio was decreased compared with group 2(1.08±0.35 vs 1.43±0.44, p < 0.05). Time-velocity integral of atrial reversal pulmonary venous flow was significantly increased in group 1(1.5v0.5 vs1.3±0.4, p < 0.05). 3) In group 1, 47.9% had concentric hypertrophy, 41.7% had eccentric hypertrophy and 10.4% had normal left ventricular mass index and left ventricular dimension. 4) In concentric hypertrophy, thickness of ventricular septum and posterior wall were significantly increased, whereas left ventricular end-diastolic dimension was significantly decreased compared with those of patients with eccentric hypertrophy. 5) There were no significant differnces of peak E velocity, deceleration time of E wave, E/A ratio, time-velocity integral of E and A wave, isovolumic relaxation time between patients with concentric hypertrophy and eccentric hypertrophy. 6) There were no significant differences of pulmonary venous flow pattern between concentric hypertrophy and eccentric hypertrophy. 7) Systolic blood pressure was identified as an independent factor which associated with left ventricular mass index. CONCLUSION: There were no significant differences in diastolic functional indices assessed by Doppler profiles of transmitral inflow and pulmonary venous flow between the patients with concentric hypertrophy and eccentric hypertrophy. The supine systolic blood pressure was identified as an independent factor associated with left ventricular mass index.

The Clinical Presentation and Course of Intramural Hematoma of Aorta

Aortic intramural hematma(IMH) has been known as a variant of acute aortic dissection without intimal rupture. The clinical presentation mimics that of acute aortic dissection. IMH may progress to frank aortic dissection or aortic rupture. Therefore IMH maybe regarded as early sign of developing classic aortic dissection or a precipitating facter. there are Important two questions, The first is whether IMH truly represent a different pathology or simphy the precursor of the conventtional aortic dissection. The second is what the optimal mode of management of IMH is. In this study, To answer these questions, We retrospectively performed this study. Fifteen patients of IMH were included. We could follow 12 patients. Among them extention of IMH to type III aortic dissection has been observed in 2 cases(1 type A and 1 type B). One patients of type A underwent aortic graft stent deployment successfully. In the other patient of type B, who had a history of myocardial infarction and longstanding heart failure by that time, dissection developed at abdominal aorta with renal arterial involvement. The patient died of multiorgan failure despite intensive conservative managements. The remaining ten patients are alive with only medical care and with good clinical outcome. In conclusion we feel that conservative treatment of patients with IMH result in favorable outcome relatively even in the cases involving the ascending aorta. But more longterm follow-up of larger number of patients will provide better guidelines regarding the proper management of IMH.

Pulmonary Embolism in Lupus Anticoagulant Positive Postmenopausal Woman after Estrogen Replacement Therapy

Pulmonary embolism is the impaction of material into branches of the pulmonary arterial bed. It usually occurs in patients with primary hypercoagulable states or secondary hypercoagulable states like cancer, preganancy, and estrogen replacement therapy. We report a case of a pulmonary embolism in a patient with positive lupus anticoagulant who received estrogen replacement therapy. The patient was referred due to suddenly developed shortness of breath and echogenic mass densities in the right atrium on 2 dimensional echocardiography. The patient was markedly improved with intravenous urokinase and subsequent oral anticoagulant therapy. Related articles are also reviewed.

Morphological Characteristics of Hypertrophic Cardiomyopathy in Korean : Echocardiographic Study

BACKGROUND: Patients with hypertrophic cardiomyopathy(HCMP) may present a wide spectrum of clinical and morphological manifestations. There was little literature regarding clinical and morphological features of HCMP in Korea. METHODS: 1) Study population : Among 18, 183 patients who unerwent echocardiography from June 1990 to Qctober 1993 at Yonsei cardiovascular center Echocardiography laboratory, 65 patients with HCMP were enrolled to study population. All patients with HCMP have at least onesegment of left ventricular wall measuring 17mm or more in thickness at end diastole. 2) Two dimensional echocardiography : All standard views were performed and recorded with Super VHS video tape. All records were reviewed and the maximal wall thickness was measured at video monitor by aid of electronic caliper of our echocardiographic machine. 3) Dopple echocardiography : Peak velocity of E and A wave and deceleration time were measured. The intracavitary peak systolic pressure gradient was also measured using continous wave Doppler at the site of abnomal mosaic pattern in color flow interrogation. RESULTS: 1) Mean age of the patients was 50+/-15 ranging from 11 to 84 and the sex ratio was 2.3:1(male:female). 2) The type 3(involving all segments except inferior wall) was the most frequently observed in Korean(47%). 3) The mid anterior septum was the most frequently involved segment(71%) and the non-obstructive type was perdominant(78%). 4) There was 17 cases of apical HCMP and 4 cases of mid ventricular obstructive type. 5) There was no significant correlation between symptoms and dynamic obstruction. 6) The EA ratio had statistically significant difference between obstructive and non-obstructive groups probably due to mitral regurgitation. CONCLUSION: The type 3 was the most frequent type of HCMP in Korean and the non-obstructive type was more frequently observed than obstructive type. Among the all left ventricular segments, the mid anterior septum was most frequently involved.