Kuei-Chuan Chan

Atorvastatin Administration after Percutaneous Coronary Intervention in Patients with Coronary Artery Disease and Normal Lipid Profiles: Impact on Plasma Adiponectin Level

There is controversy about the effects of statins on plasma adiponectin, and the impact of percutaneous coronary intervention (PCI) on plasma adiponectin level is still unknown. We investigated the impact of Atorvastatin on plasma adiponectin levels in coronary artery disease (CAD) patients with stable angina and normal lipid profiles after PCI.

Nifedipine gastrointestinal therapeutic system: an overview of its antiatherosclerotic effects

Atherosclerosis is the main underlying pathology of cardiovascular disease. Experimental studies in animal models provided early evidence of the antiatherosclerotic effects of nifedipine in reducing and reversing plaque formation and improving endothelial function. Over the past decade, clinical trials, including ‘Intervention as a Goal in Hypertension Treatment’, ‘Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement’, ‘Evaluation of Nifedipine and Cerivastatin on Recovery of Coronary Endothelial Function’ and ‘A Coronary Disease Trial Investigating Outcome with Nifedipine Gastrointestinal System’, have further demonstrated that nifedipine gastrointestinal therapeutic system can slow the progression of various markers of atherosclerosis, restore endothelial function, and reduce the incidence of coronary events and the need for coronary interventions. These results are reviewed here, along with the impact they have had on therapy guidelines for patients with hypertension and symptomatic stable angina.

Endovascular Repair of Iatrogenic Subclavian Artery Perforations Using Stent-Graft: Report of a Case

Purpose: To report a case of iatrogenic subclavian artery perforation treated with Vascular Stent-Graft.Case Report: A 54-year-old married male was admitted to Chung Shin Hospital with the chief complaint of severe sharp pain in his right clavicular region after a traffic accident on April 6, 2009. Fracture of the right clavicle was diagnosed after X-ray examination. The patient immediately underwent open reduction and internal fixation (ORIF) with a Kirschner wire with an uneventful postoperative course. The K-wire was removed 4 weeks later, on May 8, 2009. However, pain in the right clavicular area recurred and lasted for almost one month. A repeated X-ray was showed ”Non-union of the right clavicular fracture”. The patient underwent a ”redo” open reduction (ORIF) on June 2, 2009. During the operation, the patient sustained an accidental right subclavian artery injury resulting in active bleeding and pseudo-aneurysm formation there of; he was transferred to Chung Shan Medical University Hospital, and after CT angiography, he underwent endovascular repair of his right subclavian artery perforation.Results: The endovascular prosthesis (Fluency Plus Vascular Stent Graft 10 60 mm, Bard®) was successfully deployed at the site of the pseudoaneurysm via ipsilateral femoral artery access. No signs of endograft occlusion, migration, deformation, or fracrture have been observed during the follow-up period of eleven months.Conclusion: Endovascular repair of the subclavian artery injury may be an acceptable alternative to other more invasive modes of therapy. A sufficiently long follow-up, however, is needed to determine if the design of this endograft will resist compression in this vascular location.

Exercise Related Sudden Cardiac Death in Young Adults- A Patient Report

Exercise-related sudden cardiac death (SCD) is defined by symptoms that arise within 1 hour of participation in an athletic event. The major mechanisms involved in exercise-related SCD are related to hemodynamic and electrophysiological changes caused by exercise in the susceptible individual. Fatal ventricular arrhythmia is the most common mechanism of death. In young adults (＜35 years old), the majority of SCDs are caused by defined and hereditary cardiovascular disorders. Among other etiologies, hypertrophy cardiomyopathy and coronary artery anomalies are the most common. But different ventricular tachyarrhythmias may cause syncope or cardiac arrest in patients without known heart diseases. Few exercise-related sudden cardiac deaths due to ventricular tachycardia originated from irregular muscle arrangement in left ventricle myocardium had been reported. We described a 19 years old male without history of heart disease who developed sudden cardiac death during exercise. Ventricular tachycardia was noted at that time and ECG pattern at the beginning was the same as the pattern of ”idiopathic left ventricular tachycardia” in electrophysiological study. Post mortem diagonosis revealed irregular muscle arrangement in left ventricle myocardium was the only specific. Exercise related sudden cardiac death of young adult without history of heart disease, ventricular tachycardia was always the etiology and some of which were very likely related to irregular muscle arrangement in left ventricle myocardium.

Acute Myocardial Injury and Ventricular Arrhythmia in Organophosphate Intoxication - A Case Report

Organophosphate poisonings are common in Taiwan. Most of these poisonings are due to insecticide exposure. Cardiac complications are rare in organophosphate intoxications but are potentially fatal. Herein, we described a 48 year old man admitted to Chung-Shan Medical University hospital because of accidental intake of organophosphate. Diffuse ST-T change was noted on ECG during the next day following admission, followed by ventricular tachycardia. Acute myocardial injury with pulmonary edema ensued. Cardiac catherization revealed left ventricular global hypokinesia and normal coronary arteriography. He was treated with inotropic agents, anti-arrhythmic agents and IABP in addition to the antidote for organophosphate (Atropine and Pralidoxime). This patient discharged two weeks later with complete recovery.