Quantitative Evaluation of Right-Ventricular Function in Patients with Tricuspid Regurgitation

BACKGROUND: Tricuspid regurgitation (TR) is a common finding that can be detected with use of Doppler echocardiographic technique in patients with right ventricular dysfunction as well as in normal children, adolescents and adult. It is difficult to evaluate the right ventricular function by conventional method, including echocardiography, especially in case with TR. METHOD: To determine the degree and relationship of right ventricular function and duration of TR, we examined the 41 patients with TR associated with heart disease, group 2 (n=19) with no definitive evidence of right ventricular dysfunction nor significant pulmonary hypertension, and group 3 (n=22) with right ventricular dilatation or wall motion abnormality, or history of longstanding pulmonary hypertension or moderate or severe TR, and compared 59 normal subjects (group 1) with trivial or mild TR without definitive heart disease. Using Doppler echocardiography, duration of TR (TRD) and pulmonary ejection period (ET) is measured, and calculated the TR time interval (RTI) by the difference of TRD and ET divided by ET. RESULT: Pre-ejection period (PEP), ET and systolic time interval (STI, PEP/ET) of right ventricle are significantly prolonged in group 2 and 3 compare to those of group 1 (p<0.001 respectively), TRD is significantly prolonged in group 3 compare to those of group 1 and 2, and isovolumic contraction time (IRT), isovolumic relaxation time (IRT) and RTI are significantly different in each group and prolonged in group 2 and 3. RTI is significantly correlated to STI (r=0.56), ICT (r=0.75) and IRT (r=0.94), but independent to heart rate. CONCLUSION: We conclude that Doppler measurement of RTI (TRD-ET)/ET{=(ICT+IRT)/ET} is a simple and useful new index for the evaluation of RV function including systolic and diastolic function.

A Case of Nephrotic Syndrome Associated with Total Hydatidiform Mole / 대한신장학회잡지

A case study and review of nephrotic syndrome associated with a total Hydatidiform mole in 54- year-old female is presented. She has generalized edema, nephrotic range proteinuria(8.05gm/day), hypoalbuminemia(2.5g/dl) and high serum level of beta- hCG(200,000IU/L). Radiological investigations showed a 16-cm sized heterogenous enhanced mass in the uterus. A renal biopsy performed before evacuation of H-mole showed a focal segmental glomerulosclerosis. The complete remission of symptoms and signs of the nephrotic syndrom after evacuation of a molar tissue was achieved. A review of the literature revealed that this patient appears to be the first case of the FSGS with nephrotic syndrome associated with a total mole that remitted completely after the mole evacuation.

Clinical Observation on Congenital Heart Disease in Adult

BACKGROUND: With the advance of the techniques of echocardiography and cardiovascular surgery, early detection and successful cardiovascular surgery of congenital heart disease is possible in infant as well as in child. And with the advance of the social insurance, the new case of adult congenital heart disease with mild cardiovascular symptom or frank symptom of the pulmonary hypertension is decreasing. We statistically analyze the new case of adult congenital heart disease. METHOD: 92 patients who were diagnosed to congenital heart disease by echocardiography from January 1993 to June 1998 were studied. 2.25 MHz probe for two-dimensional and Doppler echocardiography and biplane 5 MHz phased-array probe for transesophageal echocardiography(Ultramark-9) were used. RESULT: Among 92 patients, 45 patients(48.9%) were male and 47 patients(51.1%) were female and 6 patients(male : 2, female : 4) had multiple congenital heart disease. 61 patients(66.3%) had no definitive cardiovascular symptom and right bundle branch block was most common electrocardiographic abnormality. 32 cases(32.8%) were atrial septal defect, 21 cases(21.5%) ventricular septal defect, 12 cases(12.3%) patent ductus arteriosus, 8 cases(8.2%) congenial bicuspid aortic valve and so on. Female predominance was noted in ventricular septal defect and endocardial septal defect, while male predominance in bicuspid aortic valve and discrete subaortic stenosis. Atrial septal defect and patent ductus arteriosus were no sex difference. 23 cases(25.0%) were between 20 29, 17 cases(18.5%) between 15-19, and 2 cases(2.2%) over 70 years old. CONCLUSION: Our analysis shows similarity to previous report. With advance of the technique of echocardiography and cardiovascular surgery, a few new case of adult congenital heart disease can be diagnosed hereafter.

A Case of Left Main Coronary Artery Disease Treated with Medication

We report a case of 34-year-old woman who had left main coronary artery disease and treated with medication only. She was presented with severe chest pain. Isolated left main coronary disease was demonstrated on selective left coronary angiography. There was no regional wall motion abnormality on echocardiogram with normal global LV systolic function. We considered the lesion as a varient of Takayasu's arteritis. So with anti-anginal medication, treatment started with steroid therapy. After then there was no chest pain. We performed follow-up coronary angiography after 1 month and 3 month in which revealed improved left main lesion. Since then there was no subjective symptom and Thallium-201 SPECT revealed no significant ischemic finding. We think that this case's underlying disease is may be Takayasu's arteritis which has isolated left main stenosis without systemic involvement and improved with medical treatement only.