Yung Woo Shin

Survival and Prognostic Factors in Patients with Primary Pulmonary Hypertension

Objectives: Primary pulmonary hypertension (PPH) that affects predominantly young and productive people is a progressive fatal disease of unknown cause. The objectives of this study were to characterize mortality in patients with PPH and to investigate the factors associated with their survival. Methods: Thirteen patients with PPH were enrolled between 1988 and 1996 and followed-up through July 1999. Measurements at diagnosis included hemodynamic and pulmonary function variables in addition to information on demographic data and medical history. Results: 1) The mean age of the patients with PPH enrolled into the study was 36.1 ± 9.3 years with female predominance. 2) The estimated median survival was 3.4 ± 0.6 years. 3) Decreased cardiac index was the only significant predictor of mortality (Cox proportional hazards model). Conclusion: Patients with PPH have a poor survival expectancy. In this limited study with a small number of patients, mortality is largely associated with decreased cardiac index.

Left-Sided Accessory Pathway with Ostial Atresia of the Coronary Sinus: A Case Report

We report a case of atrioventricular (AV) reentrant tachycardia with ostial atresia of the coronary sinus (CS). On levophase coronary venogram, dual anomalous venous drainage into both atria was seen; no ostium of the CS and no persistent left superior vena cava were noted. Based on mapping, radiofrequency (RF) energy was applied at the mitral ring and the bypass tract was eliminated. Eight months after the procedure, the patient has remained completely symptom‐free.

Catheter ablation of a left free-wall accessory pathway via the radial artery approach.

Catheter ablation of the left free-wall accessory pathways (APs) is normally performed by the retrograde transaortic approach via a femoral artery or the transseptal approach. Here we report a case of an overt left free-wall AP, which was successfully ablated with a retrograde transaortic approach via the radial artery without any vascular complications. The patient has remained free of any symptoms or pre-excitation observed on the ECG during a 10-month post-ablation follow-up.

The changes in cardiac dimensions and function in patients with end stage renal disease undergoing hemodialysis

Background It is absolutely necessary to evaluate cardiac function on starting and during hemodialysis in patients with end stage renal disease. In this study, we tried to determinate the changes of cardiac function associated with hemodialysis. Methods Twenty patients with end stage renal disease, who had been in a hemodialysis program from February, 1997 to August, 1999 in Pusan National University Hospital, were enrolled. They were examined with echocardiography and gated blood pool scintigraphy on starting hemodialysis and after follow-up. The data were analyzed by paired t-test. Results The patients were 46.2±16.8 years old and male to female ratio was 8:12. The underlying diseases were diabetes mellitus (n=10), hypertension1), glomerulonephritis2) and others1). The duration of symptoms associated with end stage renal disease and underlying diseases was 3.4±2.6 years and the duration of hemodialysis was 13.8±7.0 months. The LVEDID, LVESID and RVC decreased significantly (−6. 10, −7.80 and −20.00%, respectively, p < 0.05) with no significant changes for LAD, IVS, PWT and EF (p > 0.05). In ten cases associated with diabetes, LVEDID decreased (−7.90%, p < 0.05). In twelve cases associated with cardiac diseases, LVEDID and LVESID decreased (−8.60 and −10.50%, respectively, p < 0.05). In four cases associated with diabetes without cardiac diseases, LAD decreased (−5.10%, p < 0.05) and in four cases associated with cardiac diseases without diabetes there were no significant changes in cardiac dimensions and EF. In seven cases associated with diabetes and cardiac diseases, LVEDID decreased (−10.50%, p < 0.05). The EF on gated blood pool scintigraphy decreased (−0.9%, p < 0.05) as a whole while it increased (5.90%, p <0.05) in the cases associated with diabetes and cardiac diseases. Conclusion During the early hemodialysis stage of end stage renal disease, we found a change of concentric left ventricular hypertrophy and relatively preserved left ventricular function. Furthermore, we can expect that adequate hemodialysis – with dry weight as low as possible – may prevent progression to eccentric left ventricular hypertrophy and dilated cardiomyopathy.