Browsing by Author "Kangkagate, C"
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Item A 5-year prospective study of conventional risk factors of coronary artery disease in Shinawatra employees: a preliminary prevalence survey of 3,615 employees.(2000-11-24) Bhuripanyo, K; Mahanonda, N; Leowattana, W; Ruangratanaamporn, O; Sriratanasathavorn, C; Chotinaiwattarakul, C; Krittayapong, R; Kangkagate, C; Chaithiraphan, SWe conducted a prevalence survey of conventional risk factors of coronary artery disease in 3,615 Shinawatra employees and we planned to prospectively follow up this population to determine the impact of the risk factors in the development of coronary disease. The prevalence of hypertension, diabetes mellitus, hyperlipidemia, obesity, physical inactivity and smoking were 7.4 per cent, 1.4 per cent, 21.1 per cent, 13.9 per cent, 76.3 per cent and 16.3 per cent respectively. The awareness of hypertension, diabetes mellitus and hyperlipidemia were 42.2 per cent, 78 per cent and 32.9 per cent respectively. The prevalence of the risk factors was more common in males and increased with increasing age. Dependent variables which were associated with hypertension included: excessive weight; male sex; increasing age; hypercholesterolemia and diabetes mellitus. Variables which were associated with diabetes mellitus were hypertriglyceridemia, hypertension, male sex, increasing age and excessive weight.. Variables which were associated with hypercholesterolemia were hypertriglyceridemia, high HDL-cholesterol, increasing age, excessive weight and hematocrit level while overweight, hypercholesterolemia, low HDL-cholesterol, smoking, hematocrit level, low income and increasing age were associated with hypertriglyceridemia. Excessive weight was associated with hypertriglyceridemia, low HDL-Cholesterol, presence of hypertension, hypercholesterolemia, diabetes mellitus, increasing age and low education.Item Acute and follow-up results of laser angioplasty: single center experience.(2000-11-24) Mahanonda, N; Khuanprasert, S; Tresukosol, D; Panchavinnin, P; Phankingthongkum, R; Chotinaiwattarakul, C; Kangkagate, C; Sukrungreang, C; Suriyabantaeng, S; Chirachevin, W; Jaidee, T; Kaeokam-Aim, S; Chaithiraphan, SExcimer laser angioplasty was used to treat total occluded coronary arteries and instent restenosis lesions with high success rate. To assess immediate and long-term results of patients treated with excimer laser, we analyzed demographic information and the immediate results of 44 patients who underwent ELCA. The patients were followed up and assessed for clinical restenosis. The initial success rate of ELCA was 86.4 per cent which is comparable to plain balloon angioplasty performed during the same period. Clinical restenosis was 29 per cent. In conclusion, ELCA for patients with coronary artery disease can be performed with initial high success rate and reasonable long-term restenosis.Item Are routine checkups necessary?: The Shinawatra's employee study.(2000-11-24) Bhuripanyo, K; Leowattana, W; Ruangratanaamporn, O; Mahanonda, N; Sriratanasathavorn, C; Chotinaiwattarakul, C; Kangkagate, C; Akaniroj, S; Rochanasiri, W; Watthanaprakarnchai, W; Chaithiraphan, SThe authors performed a survey in 3,615 Shinawatra employees aged 18-60 years to determine the abnormalities found with routine checkup. The annual checkup included: history taking. anthropometric measurement, physical examination, complete blood count, urine analysis, chest roentgenography, blood chemistry (fasting blood glucose, BUN, creatinine, uric acid, AST/ALT, cholesterol, triglyceride and HDL-cholesterol). The prevalence of abnormalities with management change detected by complete blood count, urine analysis was low and we did not recommend the routine use of complete blood count and urine analysis. The prevalence of hypertension was more common in males and the prevalence increased sharply after the age of 25 years in males and 40 years in females. The prevalence of abnormalities of BUN, creatinine (both males and females) and uric acid (in females) was very low. There was high prevalence of high AST/ALT which suggested hepatitis in our population, and the prevalence was more common in males beginning at a young age. Diabetes mellitus was more common in males especially after the age of 45 years. Chest roentgenography abnormalities were found in 9.4 per cent and the prevalence of abnormalities increased with age and was common after the age of 44 years. Most of the abnormalities found by chest roentgenography were pulmonary infiltration and cardiomegaly. The authors' findings did not recommend the routine use of complete blood count, urine analysis, fasting BUN and creatinine. We recommend routine blood pressure measurement in males aged 25 years or more and in females aged 40 years or more. We suggest routine blood cholesterol measurement in both sexes, blood triglyceride measurement in males aged 25 years or more and fasting blood sugar tests in males aged more than 44 years, chest roentgenography in males and females after the age of 45 years.Item Comparison of supraventricular tachycardia from concealed bypass tract and Wolff-Parkinson-White syndrome.(2000-11-24) Krittayaphong, R; Bhuripanyo, K; Raungratanaamporn, O; Sriratanasathavorn, C; Kangkagate, C; Pooranawattanakul, S; Chirapastan, A; Kovitcharoentrakul, T; Chaithiraphan, SSupraventricular tachycardia (SVT) is a common problem. There are 2 types of accessory atrioventricular pathway (AP) causing SVT: one can conduct antegradely (WPW syndrome) and another can conduct only in a retrograde direction (concealed bypass tract or CBT). There are little data of the significance and difference of the two types in Thailand. The objectives of this study were to compare characteristics of patients, accessory pathways and outcome of radiofrequency catheter ablation (RFCA) between the 2 types of accessory pathways. We reviewed the electrophysiology report of patients with supraventricular tachycardia from the accessory pathway who were referred for RFCA. There were 74 males and 74 females at a mean age of 37 years. CBT accounts for 44 per cent of SVT from AP. Compared to CBT, WPW syndrome was more in the right-sided location, more associated with heart disease, a higher number of accessory pathways, more inducible atrial fibrillation and more difficult to do ablation. However, the overall success rate of RFCA was similar. Although the recurrence rate was 8.4 per cent, all patients with recurrence were successfully reablated. We concluded from this study that RFCA is a highly effective method for the treatment for both forms of accessory pathway although there are some differences between WPW syndrome and CBT.Item Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease.(2000-11-24) Krittayaphong, R; Bhuripanyo, K; Raungratanaamporn, O; Sriratanasathavorn, C; Punlee, K; Kangkagate, C; Cheumsuk, W; Chaithiraphan, SVentricular arrhythmia (VA) from right ventricular outflow tract (RVOT) is a common problem. Symptomatic patients are usually treated with beta-blockers. There is little data on the systematic evaluation of the drug efficacy. The objectives of this study were 1) To determine proportion of exercise induced ventricular arrhythmia among patients with symptomatic ventricular arrhythmia and 2) to determine the response to beta blockers and the correlation between the response to betablockers and exercise induced VA. We prospectively studied 46 consecutive patients with symptomatic ventricular arrhythmia. Patients recorded their symptom scores underwent exercise testing and 24-hour ambulatory monitoring before treatment and 1 month after atenolol. Exercise induced ventricular arrhythmia was demonstrated in 28 per cent of patients with symptomatic ventricular arrhythmia. Atenolol improves symptoms, decreases PVC count from ambulatory monitoring, increases exercise duration and suppresses malignant form of VA during exercise. These effects are at a similar extent in both groups of patients: those with and without exercise induced VA. However, the effect on ventricular arrhythmia suppression during exercise of atenolol was seen only in patients with increased PVC during exercise. In conclusion, atenolol is a good option in treating patients with symptomatic VA from RVOT regardless of the pattern of PVC response to exercise. Atenolol can suppress PVC during exercise testing better in patients with exercise induced VA compared to those without.Item Effectiveness of percutaneous transluminal coronary angioplasty for patients with unstable angina.(1996-07-01) Mahanonda, N; Kangkagate, C; Chotinaiwattarakul, C; Chaithiraphan, SWe have reported a series of patients with unstable angina successfully treated with PTCA. It can be performed safely with a high success rate in a selected population.Item Experience of the first 60 cases of intracoronary stent placement.(1996-11-01) Mahanonda, N; Kangkagate, C; Panchavinnin, P; Tresukosol, D; Sriyaphai, W; Hongvisitagul, C; Chirapastan, A; Pinkaeo, S; Chotinaiwattarakul, C; Chaithiraphan, SIn conclusion, elective stent placement, compared to angioplasty, has a higher clinical success rate. However, in our early experience major complications did occur.Item The Fontan operation: experience at Siriraj Hospital.(2000-10-06) Soongswang, J; Pornvilawan, S; Nana, A; Laohaprasitiporn, D; Durongpisitkul, K; Sriyoscharti, S; Prakanrattana, U; Kangkagate, C; Suriyabantheong, S; Wansanit, K; Kaosa-Ard, B; Limpimwong, NSeventy five patients underwent modified Fontan operation at Siriraj Hospital from October 1987 to December 1998. Cardiology data was analyzed retrospectively. Four patients' data was unavailable. Median age at operation was 9.7 (1.8-34) years old. Tricuspid atresia accounted for 38 per cent of the patients. Ten patients (14.1%) died in the acute post operative period due to consequence of low cardiac output. Another 3 patients (4.2%) expired in the intermediate and late post operative period. Age at operation, pulmonary artery size, pre-operative oxygen saturation, and mean pre-operative pulmonary artery pressure were not different between those who survived and those who died. Abnormal pulmonary vein, atrioventricular valve regurgitation, and underlying ventricular morphology statistically affected the acute survival of modified Fontan operation. Intraoperative aortic cross clamp time, and post operative mean pulmonary artery pressure on day 0, 1 and 2 post operation were found statistically shorter and lower in the survival group. Survival rate at 5 years was 83 per cent. Modified Fontan operation is the final palliative operation of choice for low risk single ventricle physiology in our institution with acceptable outcome. Thorough pre-operative hemodynamic and anatomic studies and staging modified Fontan procedure may include a higher number of candidates and improve the outcome of the operation.Item Homocysteine and restenosis after percutaneous coronary intervention.(2001-12-11) Mahanonda, N; Leowattana, W; Kangkagate, C; Lolekha, P; Pokum, SNumerous clinical studies in Western and Asian countries suggest that individuals with elevated blood levels of homocysteine have an increased risk of atherosclerosis, myocardial infarction, cerebral infarction, and deep vein thrombosis. Homocysteine is also known to induce both atherogenic and thrombogenic mediators in cultured vascular cells so that homocysteine may influence the damage of endothelial cells, promote smooth muscle cell growth, induce atherogenic mediators and thrombus formation after coronary angioplasty. The association between homocysteine and restenosis after percutaneous coronary intervention (PCI) has been discussed. In this study, the relationship between plasma homocysteine levels and restenosis after PCI to investigate whether plasma homocysteine levels may be a predictor of restenosis after PCI was examined. One hundred consecutive patients who underwent successful PCI were enrolled and plasma homocysteine level was measured in all patients prior to PCI. Plasma for homocysteine level was obtained in 99 of 100 patients who had angioplasty. The mean plasma homocysteine concentration in the enrolled patients was 13.61 +/- 6.04 micromol/L. The minimum and maximum of plasma homocysteine were 4.40 micromol/L and 50.00 micromol/L, respectively. In healthy subjects, the normal reference range of homocysteine level is 5-15 micromol/L However, recent data suggest that some patients may be at increased cardiovascular and cerebrovascular risk at levels as low as 12 micromol/L. For this reason, both cut off points of homocysteine level > or = 15 micromol/L or > or = 12 micromol/L to identify the high homocysteine level group were used. Of 99 patients, high homocysteine level (> or = 15 micromol/L) was established in 9 patients with restenosis versus 20 patients without restenosis. If the cut off point of homocysteine level > or = 12 micromol/L was used, high homocysteine level was established in 14 patients with restenosis versus 39 patients without restenosis. From both cut off points of homocysteine level, there was no correlation between plasma homocysteine level and the restenosis group. (p>0.05).Item Hyperhomocysteinemia in patients with coronary artery disease.(2000-11-24) Mahanonda, N; Leowatana, W; Bhuripanyo, K; Samranthin, M; Kangkagate, CHyperhomocysteinemia has been recognized as a risk factor of atherosclerosis. This study was aimed to measure the risk of coronary artery disease in patients with hyperhomocysteinemia. Age, HDL level, tHcy level and history of DM were independent risk factors for coronary artery disease. The level of tHcy of 11.0 mmol/L provides the best sensitivity and specificity of predicting coronary artery disease.Item Immediate angioplasty results of total coronary artery occlusion in Thai population.(1996-11-01) Mahanonda, N; Kangkagate, C; Sriyaphai, W; Kwosa-Ard, B; Pooranawatanakul, S; Suriyabanthoeng, S; Tresukosol, D; Panchavinnin, P; Chotinaiwattarakul, C; Chaithiraphan, SAttempted angioplasty of totally occluded vessels may be done. However, a lower success rate is expected compared to those with subtotal occlusion. The complication rate is comparable to that of partial occlusion in experienced hands.Item Impaired fasting glucose, diabetes mellitus and coronary risk factors.(2000-11-24) Bhuripanyo, K; Ruangratanaamporn, O; Mahanonda, N; Leowattana, W; Sriratanasathaavorn, C; Chotinaiwattarakul, C; Kangkagate, C; Chaithiraphan, SThe authors conducted a prevalence survey of impaired fasting glucose and diabetes mellitus in 3,615 Shinawatra employees, and we also determined various risk factors of coronary artery disease such as blood pressure level, body mass index and serum lipids. The prevalence of impaired fasting glucose and diabetes mellitus were 1.7 per cent and 0.8 per cent respectively. The prevalences were more common in males and increased with increasing age. Coronary risk factors were higher in impaired fasting glucose (IFG) and diabetes mellitus (DM) when compared with normal glucose levels. There were also significant differences between impaired fasting glucose and diabetes mellitus, except for pulse pressure, serum cholesterol level, LDL-cholesterol level and HDL-cholesterol level.Item Incidence and significance of pericardial effusion in acute myocardial infarction as determined by two-dimensional echocardiography.(1988-12-01) Sahasakul, Y; Chaithiraphan, S; Panchavinnin, P; Jootar, P; Charoenchob, N; Srivanasont, N; Tongtang, V; Kangkagate, CItem Left ventricular hypertrophy: relationship of echocardiographic and electrocardiographic findings in idiopathic dilated cardiomyopathy.(1996-02-01) Kiatchoosakun, S; Mahanonda, N; Phankingthongkum, R; Wansanit, K; Kangkagate, C; Sahasakul, Y; Jootar, P; Chaithiraphan, SDiagnosis of left ventricular hypertrophy is important in patients with cardiac disease. To test the correlation of echocardiographic and electrocardiographic findings for diagnosis of left ventricular hypertrophy in Idiopathic Dilated Cardiomyopathy (IDC), 18 patients with proven IDC were examined. There were 15 males and 3 females, ages ranged from 22-60 years (mean 43 +/- 10.7). LV mass index ranged from 134.4-421.2 g/m2 (mean 187.8 +/- 68.6). All 18 patients had LVH by echocardiography but only 10 patients (55.6%) had LVH by using ECG Romhilt-Estes scoring system. The correlation between echocardiographic and electrocardiographic findings for diagnosis LVH was not significant (r = 0.026; p = 0.935) and echocardiography was better than electrocardiography for diagnosis of LVH in IDC.Item Limitation of transthoracic echocardiography in the diagnosis of congenital heart diseases.(2000-11-24) Soongswang, J; Nana, A; Laohaprasitiporn, D; Durongpisitkul, K; Kangkagate, C; Rochanasiri, W; Kovitcharoentrakul, TNowadays, it has been widely accepted that echocardiography is the most efficient, non invasive diagnostic tool to diagnose congenital heart diseases. However, cardiac catheterization remains the gold standard to diagnose and obtain hemodynamic data prior to cardiovascular surgery. In order to find out the accuracy of transthoracic echocardiography in relation to the anatomical diagnosis of congenital heart diseases, 175 consecutive patients who underwent diagnostic cardiac catheterization during January 1999 to December 1999 were reviewed. All of them had complete echocardiographic studies prior to the procedure. The male to female ratio was 1.06:1. The median age at the time of echocardiography was 3.36 (0.01-28.8) years old. The indications of the cardiac catheterization were to demonstrate cardiovascular anatomy 64 per cent, to obtain pulmonary artery pressure and pulmonary vascular resistance 13.7 per cent, and to get both information 22.3 per cent. Tetralogy of Fallot (23.4%) was the most frequent cardiac malformation, followed by complex congenital heart diseases (22.3%), simple left to right shunt (12%), pulmonary atresia with ventricular septal defect (8.6%), tricuspid atresia (5.7%), simple d-transposition of great arteries (4%), etc. From cardiac catheterization; 49 cases (28%) revealed additional data which were surgically important, 3 cases (1.7%) resulted in different diagnoses, and 3 cases (1.7%) revealed additional information which was not surgically important. Inadequate imaging technique (36 cases, 65.5%) and limitation of technique (19 cases, 34.5%) were the reasons for missing anatomical findings of transthoracic echocardiography. Age at the time of echocardiography was not a significant factor affecting the accuracy. Persistent left superior vena cava, multiple aorto-pulmonary collateral arteries, pulmonary artery anatomy, and coronary artery anatomy were the most frequent cardiac lesions misdiagnosed by transthoracic echocardiography that were somewhat surgically important. The incorrect echocardiographic diagnoses were aorto-pulmonary window, patent ductus arteriosus, and vascular ring. Thorough and extensive echocardiographic scanning coupled with cooperative or adequately sedated patients by an experienced operator using an efficient echocardiographic machine might improve the accuracy of transthoracic echocardiography in the diagnosis of congenital heart diseases.Item Myocardial injury after radiofrequency catheter ablation.(2000-11-24) Sriratanasathavorn, C; Leowattana, W; Raungratanaamporn, O; Krittayaphong, R; Bhuripanyo, K; Kangkagate, C; Charernthai, S; Pokum, S; Chaithiraphan, SRadiofrequency catheter ablation has been a good treatment option for various types of cardiac arrhythmia. However there is concern about myocardial injury associated with radiofrequency catheter ablation. We studied myocardial injury with biochemical markers and echocardiogram in 41 consecutive patients who underwent electrophysiology study (EP study) and radiofrequency catheter ablation (RFCA) at our institute from April to July 2000. The concentration of biochemical markers (CK-MB mass, troponin T and myoglobin) and result of the echocardiograms were analyzed with other characteristics. In 41 patients subjected to EP study with possible RFCA, abnormal levels of troponin T, CK-MB mass and myoglobin were found in 46 per cent, 15 per cent and 44 per cent immediately after procedure, which went up to 64 per cent, 22 per cent and 2 per cent at twenty four hours. Compare to the group with normal troponin T level, the patients with abnormal level at 24 hours after RFCA had a longer procedure time (119+/-44 min. vs 90+/-22 min.), more frequent use of impedance ablation catheters (65% vs 27%), more RF applications (9+/-8 vs 18+/-16) and more ventricular ablation sites (69% vs 9%). The echocardiogram results showed no remarkable abnormality in any patients. Troponin T was the most sensitive marker to detect thermal myocardial injury associated with radiofrequency catheter ablation. Prolonged procedure time, RF applications, the use of impedance ablation catheter and ventricular ablation site were associated with elevated troponin T concentration after RFCA.Item Obesity and risk factors of coronary heart disease in healthy Thais: a cross-sectional study.(2000-11-24) Mahanonda, N; Bhuripanyo, K; Leowattana, W; Kangkagate, C; Chotinaiwattarakul, C; Pornratanarangsi, S; Samranthin, MAssociation between obesity and conventional risk factors for coronary artery disease is well established. Obesity is currently considered an independent risk for coronary artery disease. The relationship between body mass index (BMI) and fasting plasma lipids and glucose and blood pressures in non-obese subjects is not established. The authors studied relationships between BMI and lipids, and glucose, and blood pressure levels in healthy a population. The authors measured the weights and heights of 3,615 employees of a company during a routine yearly health examination. There were 1,250 males aged 31.3 +/- 6.6 and 2,365 females aged 29.3 +/- 4.9 years old. The average BMI for males and females were 23.5 +/- 3.6 and 20.1 +/- 3.0 respectively. The levels of total cholesterol (Chol), LDL-cholesterol, and triglyceride (TG), fasting plasma glucose (FPG) had a positive relationship with BMI (r = 0.22, 0.26, 0.41, 0.20; p < 0.001). HLD-cholesterol had a negative correlation with BMI (r = -0.36, p < 0.001). Both systolic (SBP) and diastolic (DBP) blood pressures had a positive correlation with BMI. The association persisted after all values were adjusted by age and sex. BMI has a significant positive relationship with the conventional risk factors for coronary artery disease and a negative relationship with HDL-cholesterol.Item Percutaneous balloon pulmonary valvuloplasty in children: experience at Siriraj Hospital.(1997-09-05) Laohaprasitiporn, D; Nana, A; Soongsawang, J; Kangkagate, C; Wansanit, K; Kovitcharoentrakul, T; Kaosaard, B; Pooranawatanakul, S; Suriyabantheong, STwenty-seven children with pulmonary valvar stenosis with pressure gradient (PG) > or = 40 mmHg underwent percutaneous balloon pulmonary valvuloplasty (PBPV) at Siriraj Hospital between February 1993 and August 1996. There were 13 males and 14 females, with an age range from 2 months to 14 years, and body weight from 4.7 to 42.1 kg. The majority (92.6%) were asymptomatic. Before the PBPV, the pulmonary valve annulus (PVA) measured by echocardiography was significantly greater than that measured by cardiac catheterization (15.2 +/- 3.7 vs 14.5 +/- 3.9 mm, P = 0.006). However, there was linear association (r = 0.972) between the two methods. The PG obtained by the two methods showed no significant difference (90.8 +/- 35.3 by echocardiography vs 97.3 +/- 47.2 mmHg by catheterization, P = 0.266). Immediately after PBPV, the right ventricular systolic pressure (113.7 +/- 41.1 pre vs 62.3 +/- 28.1 mmHg post) and the PG 103.4 +/- 43.4 pre vs 49.0 +/- 31.1 mmHg post) were significantly reduced (p < or = 0.0005). At 6-mo follow-up echocardiography, the PG was 28.6 +/- 17.6 mmHg and was significantly reduced (P = 0.0005). The PVA significantly increased at the 12 mo follow-up (15.2 +/- 3.6 pre vs 17.6 +/- 3.8 mm post, P = 0.001). Only minor complications were reported in the present study; bleeding (3.7%), transient bradycardia (7.4%) and pulmonary regurgitation not more than moderate severity (79%). The immediate and intermediate results of PBPV are excellent with a success rate of 85 per cent.Item The prevalence of left ventricular hypertrophy and associated factors in a Thai population.(2000-11-24) Sriratanasathavorn, C; Bhuripanyo, K; Mahanonda, N; Leowattana, W; Ruangratanaamporn, O; Chotinaiwattarakul, C; Krittayapong, R; Kangkagate, C; Chaitiraphan, SElectrocardiographic left ventricular hypertrophy (LVH) has been a bad prognostic factor for cardiovascular morbidity and mortality. However the prevalence and prognostic value of LVH are varied among nationalities and populations. Several factors have been shown to associate with LVH. Some factors are treatable such as hypertension. We prospectively studied the prevalence of LVH and associated factors in selected group of Thai population. The study population was 1,606 Shinawatra employees who were 30 year old or more. The prevalence of LVH was 13 per cent (210) among study population. Hypertension, lower body weight and male sex were significantly associated factors. In the subjects with LVH, the prevalence of hypertension was 25.6 per cent, male ratio was 5:1 and mean body weight was 57.7 kg, compare to 9.8 per cent prevalence of hypertension, 2:1 female ratio and mean body weight was 62.3 kg in the group without LVH.Item Prevalence of new coronary risk factors in Thai population.(2000-11-24) Chotinaiwattarakul, C; Mahanonda, N; Bhuripanyo, K; Leowattana, W; Kangkagate, C; Krittayaphong, R; Wansanit, K; Hongvisitkul, C; Pokum, SMany new cardiovascular biomarkers of atherosclerosis have recently been emerging. However, there is a paucity of these data in the Thai population. This study aims to determine the prevalence of these biomarkers of atherosclerosis and the relationship between these new risk factors and other conventional risk factors for atherosclerosis in the healthy Thai population. As a yearly check-up program, we surveyed 3,615 normal healthy populations for their conventional risk factors and some new cardiovascular biomarkers for atherosclerosis. The authors found hyperhomocysteinemia and high level of Lp(a) in 27 per cent and 32 per cent of the cases respectively. Prevalence of recent and past chlamydial infection was found in 30 per cent and 51 per cent respectively.