Seung-Jung Park

Minimal withdrawal of dual antiplatelet agents under the guidance of a point-of-care platelet activity assay early after drug-eluting stent implantation for surgical removal of renal cell carcinoma

A 58-year-old man presented with unstable angina, for whom drug-eluting stent (DES) was successfully implanted in mid portion of left anterior descending artery and diagonal branch bifurcation. During hospitalization, renal cell carcinoma was incidentally found. Right radical nephrectomy was planned 5 weeks after the DES insertion to minimize thrombotic risk following discontinuation of antiplatelet agents. Seven days and 5 days prior to the operation, clopidogrel and aspirin were withdrawn respectively while platelet activity was serially monitored using VerifyNow Aspirin/P2Y12 assay. According to the results of the assay, the infusion of tirofiban was started from the third day after stopping dual antiplatelet therapy and maintained till 8 h prior to the nephrectomy. With the help of this bridge therapy, the surgery was successfully performed and histology confirmed a renal cell carcinoma. Clopidogrel and aspirin were resumed the next day after the operation. Eight days after his nephrectomy, the patient was discharged without stent thrombosis or bleeding complication.

Two Cases of Anomalous Origin of a Right Coronary Artery: Same Anatomy, but Different Physiology

Two Cases of Anomalous Origin of a Right Coronary Artery: Same Anatomy, but Different Physiology Kyungil Park, MD, Bon-Kwon Koo, MD, PhD, Il-Young Oh, MD, Seung-Jung Park, MD, PhD, Jung-Won Suh, MD, PhD, Hyun-Jae Kang, MD, PhD, Hyo-Soo Kim, MD, PhD, Ki-Bong Kim, MD, PhD, Byung-Hee Oh, MD, PhD, and Young-Bae Park, MD, PhD a Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea b Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea c Cardiovascular Center, Bundang Seoul National University Hospital, Gyeonggi-do, South Korea d Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea

Long-term prognosis of left ventricular lead.

Transvenous left ventricular (LV) lead implantation is on the increase due to cardiac resynchronization therapy (CRT). However, there has been paucity of data on the prognosis of LV lead. Consecutive 32 patients with LV lead for CRT (n=22) or pacemaker (n=10) were subjected. Serial changes in pacing threshold and impedance along with lead-related complications were evaluated. Over 2 yr follow-up, there was no significant change in relative threshold voltage to the initial value (100%, 110%, 89.6%, and 79.6% at baseline, 1, 6, and 24 months respectively, P=0.62) as well as lead impedance (816±272, 650±178, 647±191, and 590±185 ohm at baseline, 1, 6, and 24 months respectively, P=0.80). The threshold change was not affected by lead position, lead polarity, and indication of lead implantation. The cumulative rates of lead revision were 6.3% (n=2) and 9.4% (n=3) in 6 month and 2 yr follow-up, respectively. One case of phrenic nerve capture at left lateral decubitus position was detected 1 month after the implantation. However, there were no serious complications over 2 yr period. In conclusion, transvenous LV lead implantation showed favorable long-term prognosis. Pacing parameters remained stable without significant changes over 2 yr follow-up.

Atrial Fibrillation as a Potential Risk for ST-Segment Elevation Myocardial Infarction

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] An 83-year-old woman presented with dyspnea that had developed 5 days earlier. Electrocardiography suggested ST-segment elevation myocardial infarction with underlying rhythm of atrial fibrillation (A) .