Dae-Gyun Park

Background and Objectives: : ::The transradial coronary angiography and intervention is on the increase with its satisfactory results. It gives advantages of reduced vascular complication and increased comfort of patients. We evaluated the feasibility and problems of transradial coronary angiography and intervention as a routine procedure. Materials and Method: : ::Between February 1998 and December 1999 transradial approach was attempted

Background:Losartan potassium, an orally active, highly selective AT1 angiotensin Ⅱ receptor inhibitor, effectively reduces blood pressure by directly blocking receptors. The purpose of this study is to compare the antihypertensive efficacy, safety and tolerability of losartan potassium and fosinopril in patients with stage 1 to 3 hypertension. Methods:In this comparative, open labelled, randomized, parallel study, the efficacy, safety and tolerability of once-daily losartan(50mg versus once-daily fosinopril(10mg were evaluated over twelve weeks in 96 patients with stage 1-3 hypertension. If trough sitting diastolic blood pressure was equal to or greater than 90mmHg after a 6 week treatment period, the dosage for both study drugs was doubled until the end of the study(week 12. Results:After 6 weeks of treatment, mean reductions in trough sitting diastolic blood pressure were 7.4mmHg(95% confidence interval 5.0-9.9 with 50mg losartan and 6.7mmHg(95% confidence interval 4.4-9.2 with 10mg fosinopril. After 12 weeks of treatment(after dose titration, mean reductions in trough sitting diastolic blood pressure were 9.4mmHg(95% confidence interval 6.7- 12.1 with losartan and 10.3mmHg(95% confidence interval 7.6-12.9 with fosinopril. At weeks 6 and 12, there were no significant differences in the mean reduction of trough sitting diastolic blood pressure between the losartan group and the fosinopril group. Losartan and fosinopril were well tolerated without significant clinical and laboratory adverse reactions. The incidence of dry cough

ABSTRACT Amniotic fluid embolism (AFE) is a rare peripartum complication with a mortality rate of 61 to 86%. The main clinical manifestations include shock, acute pulmonary edema, neurologic signs, and coagulopathies. Most diagnosis of AFE is made on the postmortem examination of the maternal pulmonary vasculature, but antemortem confirmation of amniotic fluid material by aspiration of pulmonary blood is rare. We report the first case in Korea who survived from amniotic fluid embolism confirmed by the identification of amniotic fluid debris in pulmonary artery blood. Serial echocardiographic changes of left ventricle systolic dysfunction are also described with a brief review of literatures.

Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute pulmonary embolism (APE). Echocardiography and computed tomography (CT)-angiography may be difficult to perform in a serial follow up, unlike electrocardiography (ECG). Many ECG findings specific for APE have been reported, and many studies have found that negative T-waves (NTW) in precordial leads are most frequently observed in patients with APE. We analyzed serial changes in precordial NTW to detect RVD and predict the recovery of RVD in patients with APE. We examined 81 consecutive patients diagnosed with APE using CT-angiography or echocardiography. ECG, transthoracic echocardiography, and laboratory tests were performed within 24 hours of admission, and daily ECG follow-up was performed. Precordial NTWs were defined by the new development of pointed and symmetrical inverted T-waves in at least three leads. Recovery of NTW was defined as flattening or upright inverted T-waves in more th...

... Hyung Choi, MD, Chong Yun Rhim, MD, Kyung Sun Hong, MD, Dae Gyun Park, MD, Young Cheoul Doo, MD, Kyoo Rok Han, MD, Dong Jin Oh, MD, Kyu Hyung Ryu, MD, Young Bahk Koh, MD, Kwang Hack Lee, MD ... REFERENCES 1) Cowley MJ, Dorros G, Kelsey SF, Detre KM ...

Patients without previous history of cardiac disease can be regarded as low-risk when undergoing major non-cardiac surgery. The aim of this study was to examine whether preoperative B-type natriuretic peptide (BNP) level predicted postoperative cardiac events in these patients. Preoperative BNP level was measured in 163 patients whose risk was considered low according to the Revised Cardiac Risk Index. Postoperative cardiac events, including death during hospitalization, myocardial injury, arrhythmia, cerebrovascular accidents and congestive heart failure were assessed. Postoperative cardiac events occurred in 8 patients (4.9%). Preoperative BNP levels were significantly higher among patients who experienced postoperative cardiac events, compared to those who did not (130.6±148.8 vs. 57.9±70.8 pg/mL, p=0.009). Preoperative BNP level may provide prognostic information in low-risk patients undergoing major non-cardiac surgery.

Acute aortic dissection is the most common catastrophic illness of the aorta. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode, but survival may be significantly improved by the timely institution of diagnostic modalities and appropriate medical and surgical therapy. But, approximately 10-20% of patients with acute aortic dissection

Dilated cardiomyopathy (DCM) is usually an idiopathic disease with a poor prognosis. Hypocalcemia is a rare and reversible cause of DCM. Here, we report a 50-year-old female with DCM, induced by idiopathic hypoparathyroidism, that improved after treatment with calcium.

We describe a 64-year-old male patient with panhypopituitarism who experienced polymorphic ventricular tachycardia (VT) associated with long QT intervals. The panhypopituitarism developed as a sequelae of radiation therapy administered 20 years prior to his current presentation and was recently aggravated by urinary tract infection with sepsis. In this case, polymorphic VT was resistant to conventional therapy (including magnesium infusion), and QT prolongation and T wave inversion were normalized after the administration of steroid and thyroid hormones. Thyroid hormone is generally known to be associated with torsades de pointes (TdP), but steroid or other hormones may also provoke TdP. Hormonal disorders should be considered as a cause of polymorphic VT with long QT intervals. Some arrhythmias can be life-threatening, and they can be prevented with supplementation of the insufficient hormone.

ABSTRACT The presence of pre-existing intracoronary thrombus has consistently been shown to be among the strongest predictors of unsuccessful angioplasty and abrupt vessel closure. Abciximab, platelet glycoprotein IIb/IIIa receptor antagonist, through prevention platelet aggregation and coronary thrombosis, has shown promise in helping to decrease the incidence of complications of PTCA when prophylatically administered in patients presenting with unstable angina or complex lesion morphology for PTCA and in lower risk patients as well. However, the cost of abciximab and its associated increased risk of bleeding may limit its use as a prophylactic treatment. This study was performed to evaluate the effect of the rescue administration of abciximab in seven patients with thrombus containing lesion during angioplasty. Thrombus was disappeared in 4 patients and decreased in 2 patients, and the follow-up angiogram showed normal brisk flow in all 6 patients. There were no death or myocardial infarction on clinical follow-up at a mean of 7 months except one which was developed restenosis at the angioplasty lesion. Dissolution of thrombus and restoration or maintenance of TIMI grade 3 flow were achieved without complications after administration of abciximab when delivered in a rescue manner on thrombus containing lesion during angioplasty. These results showed that failure to give preprocedural proph-ylactic abciximab did not appear to exclude the possibility of a beneficial effect of abciximab, given therapeutically during the early stage of thrombus formation in patients with complicated lesion during angioplasty.

... The changing clinical spectrum of thromboangiitis obliterans (Buerger's disease). Circulation 1990;82(suppl Ⅳ):3-8. 6) McKusick VA, Harris WS, Ottesn OE, Goodman RM, Shelley WM, Bloodwell RD. Buerger's disease: a distinct clinical and pathologic entity. ...

ABSTRACT The Eisenmenger syndrome is characterized by severe irreversible pulmonary hypertension and right-to-left shunting of blood through the pulmonary-systemic communication. The resultant right-to-left shunt leads to clinical cyanosis and secondary manifestations of chronic hypoxemia. Clinical features include dyspnea on exertion, fatigue, palpitation, hemoptysis, syncope, chest pain and predisposition to brain abscess and cerebrovascular accident. Brain abscess is a serious complication of cyanotic congenital heart disease and major cause of death. We report a patient with Eisenmenger syndrome in whom the presence of right-to-left shunt and paradoxical embolism appears to be critical for the development of brain abscess.

... Infective Endocarditis with Systemic Septic Emboli Kim JS, Park DG, Park KC, Hong KS, Doo YC, Han KR, Oh DJ, Ryu KH, Rim CY, Koh YB, Lee KH, Lee Y. ... His chest X-ray showed rapid decrease of cardiomegaly and pulmonary congestion in two days. ...

ABSTRACT There were numerous reports for clinical characteristics and prognosis of patients with variant angina (VA) but little information is available for patients with VA who presented as acute myocardial infarction (AMI). The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI.

Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.

ABSTRACT An earlier index of reperfusion after thrombolytic therapy in patients with acute myocardial infarction is desirable to determine whether additional therapy is necessary to salvage the myocardium. Cardiac troponin-T has been developed as a new myocardial specific marker for myocardial injury and has been used for early assessment of reperfusion therapy. This study was performed to investigate the utility of cardiac troponim-T for assessment of reperfusion therapy using serial serum troponin-T and the rapid assay kit.

Cilostazol, a phosphodiesterase inhibitor, is an antiplatelet agent with positive chronotropic effect, the impact of which on left ventricular (LV) volume and function in acute myocardial infarction (AMI) was evaluated in the present study. In 56 patients with AMI treated with primary coronary stenting, serial echocardiographic studies within 24 h and at 6 months were performed. Patients received a conventional antiplatelet regimen either without cilostazol (group 1, n=29) or with cilostazol (group 2, n=27). At 6 months, the difference in the change in heart rate between group 1 and group 2 was statistically significant (9.9 beats/min; p=0.04). However, changes in LV end-systolic volume (LVESV) (7.1+/-8.2 vs 10.0+/-21.7 ml, p=0.60), LV ejection fraction (EF) (8.2+/-9.9 vs 9.0+/-12.6%, p=0.85) and the ratio of early mitral inflow velocity to the mitral annular velocity (E/E') (0.6+/-3.7 vs -1.7+/-3.2) were not different between the 2 groups. Cardiac event rate was similar between the 2 groups. On multivariate regression analyses, cilostazol therapy had no significant influence on the changes in LVESV, LVEF or E/E'. In this study, the addition of cilostazol on conventional drug therapy had no adverse influence on LV remodeling or LV function after AMI.

This study was designed to evaluate the safety and efficacy of algorithm-based atorvastatin therapy initiated at different starting doses of 10, 20, and 40 mg in Korean dyslipidemic patients. Five hundred seventy-four patients were screened, and 425 were enrolled (low risk, n = 29; intermediate risk, n = 45; high risk, n = 351). The starting dose depended on a patient's cardiovascular risk and LDL-cholesterol (LDL-C) levels. Of the patients, 253 (59.5%), 63 (14.8%) and 109 (25.6%) patients were assigned at baseline to 10 mg, 20 mg and 40 mg atorvastatin, respectively. 390 patients (91.8%) completed the study, and 35 discontinued prematurely. No patient in the low or intermediate risk groups was titrated to 80 mg at Week 4, whereas, 26 in the high risk group were. 81.9% of patients achieved their LDL-C target at Week 4, which was sustained through to Week 8 (86.0%). 89.1% of patients who were not titrated achieved their LDL-C target at Week 8, and 82.1% of patients who were titrated 1 step up achieved their LDL-C target at Week 8. Overall, about 40% reduction in LDL-C, non-HDL-C levels, and LDL-C/HDL-C ratio was observed during the follow-up. Triglyceride was reduced by approximately 10% by Week 8. HDL cholesterol was slightly increased over 8 weeks (2.6%). Atorvastatin was well tolerated at all dose levels. Patient-tailored statin therapy according to an individual's risk category and LDL-C levels was safe and effective with a quick achievement of LDL-C target in Korean dyslipidemic patients.

The maze operation is effective for the restoration of sinus rhythm; however, restoration of atrial mechanical function has not been demonstrated in all patients. Maze operations were performed in 32 patients (13 men, 19 women; mean age 47.1 +/- 9.0 years) combined with valvular surgery (n = 25), coronary artery bypass graft (CABG) (n = 3), and others (n = 4). At 1 week, 3 months, 6 months, and 1 year after the operation, prospective serial Doppler echocardiographic examination was carried out to determine the presence of atrial mechanical function. Sinus rhythm was restored and maintained during the follow-up period in 26 (81%) patients; in 22 patients this was due solely to the operation, whereas in four patients an antiarrhythmic agent was needed to maintain sinus rhythm. Another four patients showed paroxysmal atrial fibrillation (AF) despite treatment with an antiarrhythmic agent. Right atrial mechanical function was restored in all 30 patients with sinus rhythm or paroxysmal AF; in 19 (63%) of these, left atrial mechanical function was restored. In patients with restored left atrial mechanical function, peak A velocity (A) and A/E ratio (A/E) of mitral inflow were significantly lower than in the 16 postoperative control patients (A: 0.46 +/- 0.14 m/sec vs 0. 75 +/- 0.29 m/sec, p < 0.01; A/E: 0.40 vs 0.80, p < 0.01). In patients with left atrial mechanical function, the duration of AF was significantly shorter than in patients without left atrial mechanical function (1.9 +/- 2.9 years vs 7.1 +/- 3.0 years, p < 0. 01), but there were no significant differences in left atrial size and volume. The maze operation could be safely added to standard open heart surgery for the correction of underlying structural heart disease. The rate of conversion to sinus rhythm resulting solely from the operation might be lower than the rates previously reported with only the duration of AF adversely affecting the restoration of left atrial mechanical function. Considering the fact that not all patients converted to sinus rhythm show atrial mechanical function, the role of the maze operation in the prevention of systemic embolism, with subsequent improvement in survival, requires further study.