, Honkeun Cho, Si-Hoon Park, Gil Ja Shin, Dong Su Lee, Yang Hee Lim The Measurement of blood pressure by a doctor may trigger a pressor response, so there are marked differences between office and ambulatory or self-measured blood pressure and the subjects may misdiagnosed as hypertensives and receive unneccesary medication. The study is designed to evaluate the charicteristic of white coat hypertension, the degree of white coat effect and the relationship between the white coat hypertension and persistent hypertension.
Thirteen patients with office hypertension receiving no medication, were recruited from 434 patients experienced in ambulatory blood pressure. Past history, physical examination, office blood pressure, 12-channel standard electrocardiography, chest X-ray, plasma lipid battery, echocardiography and 24-hr ambulatory blood pressure monitoring with BP3 MEDIANA were performed.
1) White coat hypertensive patients were 13 of 434 patients(2.99%) who were performed 24-hr ambulatory blood pressure monitoring. The mean age was 45±12 years with 6 men and 7 women and rage of age was 26-65 years.
2) The lipid battery, chest X-ray and 12-channel standard electrocardiographty showed no significant finding.
3) The LV mass index was 90.7±11.0g/m3 but one of 8 who performed echocardiography showed concentric hypertrophty.
4) The LV ejection traction was 60.8±8.7% which normal range.
5) The mitral flow velocity parameters were E velocity 0.71±0.14m/sec, A velocity 0.54±0.24m/sec, E/A ratio 1.6±0.8, mitral valve deceleration time 214±27.6msec and isovolumic relaxation time 104±11.4msec but one of 8 showed LV relaxation abnormality.
6) The mean office systolic blood pressure was 159±13.8mmHg, mean office diastolic blood pressure 101±9.0mmHg, 24-hr mean ambulatory systolic blood pressure 128±4.9mmHg and 24-hr diastolic bliid pressure 82±8.6mmHg.
7) The night day ratio of systolic blood pressure was 0.93±0.06 and the night day ratio of diastolic blood pressure was 0.92±0.06 suggestive of blunted diurnal variation. The Dipper were 5 of 13 patients(38.5%) and the non-Dipper were 8 of 13 patients(61.5%).
8) Two of 13 white coat hypertensives were diagnosed as persistent hypertensives in follow-up periods and antihypertensive drug had been initiated.
White coat hypertension can be diagnosed by 24-hr ambulatory blood pressure monitoring. The influence of white coat effect to cardiovascular system was not established. Sixty-two percent of white coat hypertensives showed blunted diurnal variation in 24-hr ambulatory blood pressure monitoring and two of 13 were diagnosed as persistent hypertensives in our F/U study, so white coat effect cannot be merely innocent and need strict evaluation and regular follow-up.
, Jeong Yoon Yim, Sung Kee Ryu, Hong Keun Cho, Si-Hoon Park, Gil Ja Shin The pacemaker syndrome is a complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequence of ventricular pacing in the absence of other cause.
The following illustrates a case of pacemaker syndrome proven by cardiac catheterization. A 64-year-old female patient who had been previously managed with single chamber pacemaker(VVI mode) due to sick sinus syndrome, suffered from chest discomfort, headache, dizziness, lightheadedness.
We thought that she suffered from pacemaker syndrome and changed single chamber pacing to dual chamber pacing. At that time we performed cardiac catheterization perioperatively.
Pulmonary capillary wedge pressure, amin pulmonary arterial pressure, right atrial pressure and right ventricular pressure were normalized after the change and she didn't feel any symptoms.
, Gil Ja Shin The placement of stents in coronary arteries has been shown to be effective bail out procedure and reduce restenosis in comparison to balloon angioplasty. We experienced coronary stenting in 8 patients with coronary artery disease and report our results.
From October 1995 to April 1996, 8 cases of coronary artery stenting were per-formed at the Ewha Womans University Hospital. We evaluated results of the procedure, in-hospital complications, follow-up coronary angiography and follow-up clinical events.
All lesions were successfully stented without in-hospital complications including death, myocardial infarction, repeat coronary angioplasty, or CABG. During 2 months of fol-low-up, there was no clinical events. Follow-up coronary angiography was performed in one case, showing no restenosis.
Acute procedural results and angiographic and follow-up clinical outcomes were favorable, so coronary stenting seemed to be good therapeutic tool in treatment of coronary artery disease.
, Gil Ja Shin Percutaneous mitral balloon valvuloplasty was introduced by Dr. Inoue in 1984 and it is now widely used in the treatment of mitral stenosis due to its simple design to use.
From September 1993 to January 1996, 11 cases of percutaneous mitral balloon valvuloplasty were performed at the Ewha Womans University Hospital.
Following the percutaneous mitral balloon valvuloplasty, the mitral valve opening area was increased from 1.18±0.34cm2 to 1.91±0.62cm2(p<0.001). The mean mitral valve diastolic pressure gradient was decreased from 14.35±6.00mmHg to 5.41±4.03mmHg.(p<0.001) The NYHA functional class was improved significantly. Among 11 cases, 1 case(9%) was failed to expand mitral valve opening area and another 1 case developed grade 2 of mitral regurgitation. But there was no life threatening complication such as cardiac tamponade.
It is concluded that percutaneous mitral balloon valvuloplasty with Inoue alloon is an effective and simple method for most patient with mitral stenosis who do not have thrombi.
, Si-Hoon Park, Gil Ja Shin, Woo Hyung Lee Aortic dissection is caused by a circumferential or transverse tear of the intima by a discrepancy between the strength of the aortic wall and the intraluminal pressure.
Arterial hypertension seems clearly to be a factor in the genesis of aortic dissection.
An elevated blood pressure or evidence of its existence can be found in 70-80 percent of patients. Other factors predisposing to aortic dissection are congenital disorder of connective tissue, vasculitis, etc. But trauma or physical strain is unusual cause of classic dissection.
Diagnosis is confirmed by computed tomography, aortography or echocardiography.
A 62-year-old man without a history of hypertension, emphysema or congestive heart failure visited our hospital because of hoarseness which developed suddenly during the physical strain. A contrast material-enhanced computed tomographic (CT) scan was performed at an other hospital due to hoarseness, mild fever and general weakness. Then he visited to our ENT department and performed laryngeal CT due to hoarseness. The CT shows somewhat mass-like soft tissue, so he was transferred to our internal medical department.
The chest CT scan and simple chest PA was done and we found a dissecting aneurysm.
This case developed by Physical strain and diagnosed by hoarseness is unusual and rare.
, Si-Hoon Park, Gil Ja Shin, Woo Hyung Lee Femoral pseudoaneurysm is important complication after diagnostic femoral catheterizationor more complex procedure.
With the increasing use of larger-size percutaneous instruments and periprocedual anticoagulant or antiplatelet agent the incidence of postcatheterization femorl artery injuries ncluding pseudoaneuiysm has increased in the past few years.
Duplex ultrasonography and addition of color- flow Doppler provides an accurate, noninvasive. risk-free diagnosis and faster detection of intraaneurysrnal blood flow and the track betweenthe injured artery and the pseudoaneurysm.
Though early surgical repair of the arterial defect is usually recommended because of severeand life-threatening complication such as rupture, fhrornboembolism, compression neuropathyetc, Ultrasono-Guided Compression Repair(UGCR) is to be first-line treatment for its advantagesuch as high success rate, low morbidity and cost-effectiveness.
The authors report 2 cases of femoral psoudoaneurysrns treated using UGCR with nlanualcompression with C-clamp at the same time as a nonsurgical treatment.
, Si-Hoon Park, Woo Hyung Lee Left ventricular hypertrophy(LVH) is an important prognostic factor in essential hypertersion. But the method of diagnosis of LVH by electrocardiography has limitations.
In this study, we compared the sensitivity of the total 12-lead QRS amplitude with the sensitivity of certain standard electrocardiographic criteria for left ventriculart hyterthophy in patients with essential hypertension.
Atotal of 50 hypertrophy patients and 50 normal adults were studied. For diagnosis fo left ventricular hypertrophy by electrocardiography, we use Sokoliw and Lyon index, the ratio of RV6 : RV5 and a method using the total QRS complex voltage of standard 12-lwads. By echocardiography, we calculated left ventricular mass index.
The total QRS voltage ranged from 127mm to 332mm(mean : 205±51mm) in hypertensives, 86mm to 308mm(mean : 149±42mm) in nonmal group. Using 175mm as the upper limit of normal, this method gave a sensitivity of 80% show reasonable sensitivity of any criteria tested. The Sokolow-Lyon index gave a sensitivity of 45%, the RV6/RV5 ratio gave only 10% of sensitivity.
Total 12-lead QRS voltage more than 175mm is a useful indicator of left ventriculat hypertrophy in patients with essential hypertension.
, Si-Hoon Park Permanent pacemaker implantation is a worldwide procedure in patients who have hemodynamic instability due to bradyarrythmia or atrioventricular block. We summerized the results of 29 patients who have undertaken permanent pacemaker implantation in Ewha Womans University Mokdong hospital.
Medical records of 29 patients who have undertaken pacemaker implantation were reviewed regarding indications, clinical findings, type of pacemakers, and the results of pacemaker implantations.
The patients had a mean age of 65±15.9 years(M : F=9 : 20).The indications of pacemaker implantation are as follows : sick sinus syndrome(SSS) in 9 patients ; complete atrioventricular block(AV block) in 10, high degree AV block in 8 ; severe AV Wenckebach block in 2. Types of permanent pacemakers included single chamber in 17 patients, and dual chamber in 12 patients. The modes were VVI in 14 patients, DDD in 9 patients, and VDD in 6 patients. Pacemaker syndrome was reported in one case and there were no serious complications such as wound infection, lead fracture, lead displacement, or migration of generators.
Patients with SSS and high degree and complete AV blocks were successfully treated with permanent pacemaker implantation in Ewha Womans University Mokdong hospital.
, Hong-Keun Cho, Seong-Hoon Park, Si-Hoon Park Percutaneous mitral valvuloplasty(PMV) became a treatment modality or mitral stenosis because of its low morbidity, short hospital stay, and low cost. We reviewed clinical and hemodynamic results after PMV for the patients with mitral stenosis in Ewha Womans University Mokdong hospital.
We compared the results of echocardiographic, hemodynamic, and clinical parameters before and after PMV. PMV was performed under fluoroscopic guidance in 21 patients(M:4, F:17, mean age 43±12 years) with mitral stenosis from October 1993 to April 1999. Transesophageal echocardiography(TEE) and Transthoracic echocardiography(TTE) were performed for the evaluation of mitral valve, chamber size, and the presence of left atrial thrombus before procedures. TIE was also used for follow-up evaluation. On presentation, all patients showed at least NYHA class II. Five patients had atrial fibrillation. Two patients with thrombus in the left atrium were included to study group after thrombolytic treatment with coumadin. Echo-score of our patients was not greater than 8.
Mean mitral valve area(MVA) by 2 dimensional or Doppler echocardiography was increased from 1.16±0.36cm2 before PMV to 2.06±0.33cm2 after PMV. There were marked improvements in transmitral gradients(11.60±5.54mmHg before PMV vs 4.93±2.53mmHg after PMV, p<0.001), left atrial dimension(46.41±14.66mm vs 42.03±15.01mm, p=0.042), and cardiac output(4.21±1.25L/min vs 6.88±9.57L/min, p<0.0001) following PMV, Severe(≥GIII) mitral insufficiency or severe postprocedural complications were not noted. This suggested that all procedure was successful.
The Procedural success rate of PMV in Ewha Womans University Mokdong hospital was 100%. Low echo score of our patients might explain this high procedural success rate. Long-term-follow-up is warranted in the near future.
, Si-Hoon Park, Hong-Keun Cho, Gil Ja Shin 
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