Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 66 , Issue 11
Showing 1-19 articles out of 19 articles from the selected issue
Special Article
  • The Examination Committee of Criteria for `Obesity Disease' in Japan, ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 987-992
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    The present study was designed to establish adequate criteria for categorizing `obesity disease' in Japan in relation to obesity-related complications. The subjects were 1,193 Japanese subjects (775 men, 418 women; age: 20-84 years old, body mass index (BMI): 14.9-56.4 kg/m2) including subjects undergoing a health examination and obese subjects visiting an obesity clinic. Visceral fat area (VFA) and subcutaneous fat area (SFA) were determined by computed tomography (CT) at the umbilical level. Anthropometric parameters, including BMI, waist circumference (W), waist/hip circumference (W/H), ratio and waist circumference/body height (W/BH) ratio, were measured. Hyperglycemia, dyslipidemia, and hypertension were evaluated as obesity-related complications. The relationship between each parameter and the prevalence of the complications was investigated. The number of complications increased in accordance with BMI and the average value was greater than 1.0 at a BMI of 25. The best combination of the sensitivity and specificity for detecting subjects with multiple risk factors was a BMI of 25. BMI showed a close positive correlation with SFA (r=0.82), even for BMI ≥25 (r=0.77), but had a weaker correlation with VFA (r=0.54). The obese subjects with a BMI ≥25 had no correlation between BMI and VFA because of the wide individual variation of VFA. The number of disorders was greater than 1.0 at 100 cm2 of VFA and the best combination of the sensitivity and specificity for determining subjects with multiple risk factors was 100 cm2 of VFA. Between the simple anthropometric values and measurement of VFA, it was proven that W had the closest relationship with VFA in both men (r=0.68) and women (r=0.65). The regression line obtained from simple correlation analyses indicated that the W corresponding to 100 cm2 of VFA was 84.4 cm in men and 92.5 cm in women. These data suggest that obesity is adequately specified as a BMI ≥25 in Japan where the prevalence and degree of obesity remains mild. It is reasonable to establish the cut-off point of VFA at 100 cm2 as indicative of the risk of obesity-related disorders and a waist circumference of 85 cm in men and 90 cm in women approximates to this visceral fat mass. (Circ J 2002; 66: 987 - 992)
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Clinical Investigation
  • Naoki Isobe, Koichi Taniguchi, Shigeru Oshima, Zenpei Ono, Hitoshi Ada ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 993-999
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Patients with hypertension often develop left ventricular (LV) hypertrophy and deterioration of the cardiac and endothelial functions. Recent clinical trials have shown the added benefits of angiotensin II receptor blockers in hypertensive patients. Twenty-nine patients with hypertensive heart disease (HHD) underwent echocardiography, radionuclide ventriculography and the measurement of endothelial function before and after administration of candesartan (8 mg/day). The subjects were divided into poorly controlled blood pressure (BP) (group P, n=6) and well controlled BP (group C, n=23). Endothelial function was evaluated from flow-dependent dilation, which was calculated as the percent change of the radial artery diameter during reactive hyperemia after upper arm occlusion, measured with a high-resolution ultrasound system. In group C, LV diastolic function and endothelial function were significantly (p<0.05) improved at 3 months after administration, LV systolic function and hypertrophy were significantly (p<0.05) improved after 6 months and these effects were maintained at 12 months. Even in group P, LV function, LV hypertrophy, endothelial function and brain natriuretic peptide were significantly (p<0.05) improved at 6 months after administration. In patients with HHD, candesartan improves LV systolic and diastolic function, LV hypertrophy and endothelial function within 6 months of administration, regardless of the control of BP. (Circ J 2002; 66: 993 - 999)
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  • Yoshihisa Kinoshita, Takahiko Suzuki, Hiroaki Hosokawa, Koichi Yokoya
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1000-1002
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    The Symphony Peripheral StentTM is a self-expanding stent made of thermal memory Nitinol wire. Stents were implanted in 39 lesions of 32 patients (26 men, 6 women) with atherosclerosis obliterans (ASO). The ankle - arm index (AAI), and vessel diameters evaluated by quantitative angiography were compared before and 6 months after treatment. Symphony Peripheral StentTM implantation significantly improved the AAI from 0.50±0.4 to 0.9±0.2 (p<0.01), the minimum lumen diameter (MLD) from 2±1.5 to 5±1.4 mm (p<0.01) and percent diameter stenosis (% DS) from 69±20% to 16.5±8% (p<0.01). Re-evaluation of 33 of the 39 lesions 6 months after treatment revealed a low restenosis rate of 15%, an AAI of 0.8±0.3, MLD of 4.5±2 mm and %DS of 30±22%, so the Symphony Peripheral StentTM is thus a promising choice for patients with ASO. (Circ J 2002; 66: 1000 - 1002)
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  • Takeshi Soeki, Yoshiyuki Tamura, Hisanori Shinohara, Koichi Sakabe, Yu ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1003-1007
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) stimulate endothelial cell proliferation and induce angiogenesis, but the timing and significance of their release in patients with acute myocardial infarction (AMI) are unknown in relation to future left ventricular remodeling. Venous blood samples were obtained at admission and up to 3 weeks later in 40 patients with AMI and in 40 age- and sex-matched control subjects. Blood samples were also taken from the coronary sinus (CS) in 20 patients on day 7 following AMI. Left ventricular end-diastolic volume in the subacute (1 week) and chronic (3 months) phases was assessed by left ventriculography to identify the remodeling group (n=15), which was defined as an increase in left ventricular end-diastolic volume index ≥5 ml/m2 relative to the baseline value. Serum HGF and VEGF concentrations were higher in newly admitted patients with AMI than in the controls (HGF, 0.33 ±0.09 vs 0.24±0.08 ng/ml, p<0.01; VEGF, 92.2±43.1 vs 67.2±29.8 pg/ml, p<0.01), peaking on day 7 (HGF, 0.41±0.12; VEGF, 161.7±76.9), and gradually decreasing between days 14 and 21. The HGF concentration in the CS did not differ from the concentration in the periphery, but the VEGF concentration was significantly more abundant in the CS than in the peripheral sample on day 7 (p<0.05). The serum HGF concentration on day 7 was higher in the remodeling group than in the nonremodeling group (0.47 ±0.13 vs 0.36±0.09 ng/ml, p<0.01), but there was no difference between the groups on admission, day 14 and day 21. The serum VEGF concentration did not differ between the remodeling and nonremodeling groups at any time. Thus, the serum HGF concentration on day 7 after AMI is mostly from noncardiac sources and predicts left ventricular remodeling. (Circ J 2002; 66: 1003 - 1007)
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  • Satoshi Yuda, Satoshi Nakatani, Chikao Yutani, Masakazu Yamagishi, Soi ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1008-1013
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    The purpose of this study was to clarify whether or not a change in the clinical characteristics of cardiac myxoma has occurred during the past 2 decades. The clinical records of 57 patients (22 men, 35 women; age, 52±14 years) with myxoma that had been surgically treated between May 1978 and July 1997 at the National Cardiovascular Center in Japan were reviewed. All myxomas were discovered by transthoracic echocardiography. They were divided into an early group (n=30) treated in the first decade (1978-1987) and a late group (n=27) treated in the second decade (1988-1997). The incidence of myxoma, patient characteristics, preoperative symptoms and echocardiographic features did not differ between the 2 groups. In contrast, the maximal dimensions of myxoma in the early group were significantly larger than those in the late group (6.3 ±2.7 cm vs 4.3±1.3 cm, p=0.012). The weight of myxoma in the early group tended to be heavier than that in the late group (76±80 g vs 25±18 g, p=0.054). The incidence of patients with asymptomatic myxoma also tended to increase in the late group (7% vs 26%, p=0.07). Although there was no difference in the incidence of myxoma, smaller and asymptomatic myxomas were more frequent during the last decade, probably as a result of the development of cardiac imaging, particularly echocardiography. (Circ J 2002; 66: 1008 - 1013)
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  • Chin-Hsiao Tseng, Ching-Ping Tseng
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1014-1018
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    A total of 361 Chinese patients with type 2 diabetes were studied for the association between peripheral vascular disease (PVD) and the insertion/deletion polymorphism involving a 287-bp alu repeat sequence at intron 16 of the angiotensin-converting enzyme (ACE) gene. The patients were divided into PVD (+) (n=45) and PVD (-) (n=316) based on an ankle-brachial index <0.9 and ≥0.9, respectively. Polymerase chain reaction was used to identify gene polymorphism. Results showed that D allele frequency in the patients without and with PVD was 31.8% and 33.3%, respectively (p=NS). The prevalence rates of II, ID and DD genotypes in the PVD (-) group were 45.6%, 45.3% and 9.2%, respectively; and the respective values for the PVD (+) group were 44.4%, 44.4% and 11.1% (p=NS). Prevalence rates of PVD in genotypes II, ID, and DD were 12.2%, 12.3% and 14.7%, respectively (p=NS). In logistic regression analyses, the unadjusted and adjusted odds ratios for DD vs II and ID vs II genotypes for PVD were not statistically significant. The respective adjusted odds ratios were 1.88 (0.56-6.29) and 1.33 (0.63-2.80). In conclusion, there was not a significant association between the ACE genotype and PVD in Chinese type 2 diabetic patients. However, a type 2 error can not be ruled out. (Circ J 2002; 66: 1014 - 1018)
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  • Öcal Berkan, Mansur Sagban
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1019-1023
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Sialic acid (SA), a family of acetylated derivatives of neuraminic acid, is elevated in patients with coronary heart disease. Cardiac troponin T (cTnT), myoglobin (Mb), and creatine kinase-MB (CK-MB) are specific markers of myocardial injury and are, at present, widely used to detect perioperative myocardial damage during coronary artery bypass grafting (CABG) surgery. The present study investigated the net myocardial release of SA and the cardiac markers (cTnT, Mb, CK-MB) during reperfusion after hypothermic cardioplegic cardiac arrest in 25 patients undergoing elective CABG. Additional paired arterial, central venous, and coronary sinus blood samples were obtained after atrial cannulation before aortic cross-clamping (preischemic sample) and at 1 and 10 min after aortic declamping (reperfusion samples). There were no increase in the SA, cTnT, Mb and CK-MB concentrations before aortic cross-clamping, but there was considerable release of these markers within 10 min after aortic declamping: cTnT release was significantly higher compared with baseline values before aortic cross-clamping. In contrast to SA, Mb, and CK-MB, the difference between baseline and release values for cTnT at 1 min after aortic declamping was not significant. The rate of increase for SA was significantly higher than for Mb, CK-MB and cTnT. SA is a unique and novel marker that could be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. (Circ J 2002; 66: 1019 - 1023)
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  • Yasuhiro Yoshiga, Akihiko Shimizu, Toshihiko Yamagata, Tomoko Hayano, ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1024-1028
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Bepridil is effective for intractable cardiac arrhythmia, but in rare cases will induce torsades de pointes (TdP) associated with QT interval prolongation. Beta-blockers will effectively prevent TdP in some clinical settings, so the effect of β-blocker on the change in QT interval, QT dispersion and transmural dispersion of repolarization (TDR) induced by bepridil was investigated in 10 patients (7 male, 3 female; 62±6 years old) with intractable paroxysmal atrial fibrillation. The QTc interval, QTc dispersion and TDR were measured before and after 1 month of administration of bepridil, and then a β-blocker was added and the QTc interval, QTc dispersion and TDR re-measured 1 month later. Bepridil significantly prolonged the QTc interval (0.42±0.05 to 0.50±0.08; p<0.01), and increased both the QT dispersion (0.07±0.05 to 0.14±0.08; p<0.01) and TDR (0.10±0.04 to 0.16±0.05; p<0.01). The addition of a β-blocker decreased the QTc interval (0.50±0.08 to 0.47±0.04; p=0.09) and significantly decreased both the QTc dispersion (0.14 ±0.08 to 0.06±0.02; p<0.01) and TDR (0.16±0.05 to 0.11±0.04; p<0.001). Compared with the control, the combination therapy significantly prolonged the QTc interval, but did not increase either QTc dispersion or TDR, and so was effective in all patients with intractable AF. The findings suggest that β-blocker reduces the increase in QT dispersion and TDR induced by bepridil, and combined therapy with bepridil and β-blocker might thus be useful for intractable atrial fibrillation. (Circ J 2002; 66: 1024 - 1028)
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  • Kenan Sonmez, Fikret Turan, Murat Gencbay, Muzaffer Degertekin, Ahmet ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1029-1033
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    The early and late results of percutaneous transluminal coronary angioplasty in elderly patients are well known, but although stent implantation has become the most frequent percutaneous coronary intervention in many centers, little information exists about its long-term outcome in elderly patients. The aim of this study was to evaluate the long-term clinical and angiographic follow-up results of intracoronary stenting in a study cohort of 120 patients (92 male) over 65 years of age, who underwent successful coronary stenting between June 1995 and December 1997. The target coronary artery was 48% left anterior descending, 21% circumflex and 31% right coronary artery. Stent implantation was elective in 54%, suboptimal in 32% and bailout in 14% of the patients. Long-term (34±14 months) clinical and angiographic follow-up was completed in 78% and 56% of the patients, respectively. The following end-points were considered: death, non-fatal myocardial infarction (MI), target and non-target lesion revascularization. Angiographic restenosis was detected in 31% of the patients. During the long-term follow-up period, 14% of the patients died and 11% developed a new MI. Target lesion revascularization was done in 19.4%, non-target lesion revascularization was done in 21%, and the survival rate was 86%. Although the restenosis rates did not deviate greatly from the expected long-term figures in younger populations, they do indicate that the potential for major cardiac events is still high among elderly subjects, in spite of developments in stent technology and medication. (Circ J 2002; 66: 1029 - 1033)
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  • Hisatomi Arima, Yutaka Kiyohara, Yumihiro Tanizaki, Yusaku Nakabeppu, ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1034-1036
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Previous studies have suggested that archival materials from formalin-fixed paraffin-embedded blocks are unsuitable for most molecular techniques because the extracted DNA can be severely degraded. Therefore, the present study was designed to investigate the accuracy of genotyping for the insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) gene from paraffin-embedded tissues of autopsy cases from Hisayama Town, Japan. The genotype was determined using the double polymerase chain reaction method and to test the accuracy of the method, the polymorphism was investigated using paraffin-embedded tissues from 18 cases whose ACE genotypes (6 cases for each genotype) were known in advance from analysis of fresh-frozen tissue samples. Genotyping using paraffin-embedded tissues was then determined for 968 autopsy subjects. The genotype could be determined in 16 of the 18 test samples (88.9%) and there was no discrepancy with the results obtained from the fresh-frozen tissues. Of the 968 autopsy cases, the frequency of the DD, ID, and II genotypes was 12.4%, 47.3%, and 40.3%, respectively, a distribution that did not deviate from the Hardy-Weinberg equilibrium (χ22df = 0.67, p=0.72). These findings suggest the accuracy of the present method of ACE genotyping from paraffin-embedded tissues. (Circ J 2002; 66: 1034 - 1036)
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  • Pang H Chong, Robert Kezele, Cory Franklin
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1037-1044
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Low levels of high-density lipoprotein cholesterol (HDL-C) are currently considered to be a major risk factor for the development of coronary artery disease (CAD). Deficiencies in the HDL metabolic pathway promote atherosclerosis and contribute to CAD. Low HDL-C levels are included in the Framingham 10-year risk assessment for CAD although they are not yet targeted for therapy. Recent clinical trials have shown benefits from raising HDL-C, particularly in patients with lower baseline levels. The statin class of drugs, used primarily to lower the level of low-density lipoprotein-cholesterol, may be able to raise the HDL-C level as well. Statins could potentially affect HDL-C by different modes of action, most importantly by altering reverse cholesterol transport. Among the currently available statins, simvastatin has demonstrated the most consistent ability to raise HDL-C level, but further large-scale studies at an early stage will be needed to prove the antiatherogenic effects of this class of drugs. (Circ J 2002; 66: 1037-1044)
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Experimental Investigation
  • Yasuyuki Shimada, Suba Gunasegaram, Hiroyuki Yokoyama, Metin Avkiran
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1045-1053
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Left ventricular (LV) hypertrophy increases susceptibility to reperfusion arrhythmias and the angiotensin-converting enzyme inhibitor, ramipril, may reduce that susceptibility via regression of LV hypertrophy. Rats (n=12 per group) were subjected to abdominal aortic constriction (AC) or sham-operation (SH) and from 3 to 6 weeks after surgery, 3 AC groups received ramipril (0.01, 0.1, or 1 mg/kg per day po) while the SH and 1 AC group received vehicle. Six weeks after surgery (ie after 3 weeks of treatment), the hearts were excised and subjected to independent Langendorf perfusion of left and right coronary beds. The left coronary bed was then subjected to ischemia (7 min) and reperfusion (5 min). Hypertrophied hearts from the vehicle AC group showed a significant increase in the incidence of reperfusion-induced ventricular fibrillation (VF) compared with control hearts from the SH group (92%* vs 33%: *p<0.05); this difference was abolished by ramipril (42%, 50%, and 42%, at 0.01, 0.1, or 1 mg/kg per day, respectively). The LV weight/body weight ratio was significantly increased in all AC groups (regardless of ramipril treatment) relative to the SH group. At the cellular level, myocyte length was significantly increased in the vehicle AC group, but was normalized by ramipril treatment (1 mg/kg per day). At the molecular level, atrial natriuretic factor (ANF) mRNA expression was also significantly increased in the vehicle AC group, but was again normalized by ramipril treatment (1 mg/kg per day). In conclusion, short-term treatment with ramipril reduced susceptibility to severe ventricular arrhythmias in hypertrophied rat hearts. This protection was achieved in the absence of a significant reduction in LV weight, but was accompanied by regression of myocyte hypertrophy, as reflected by reductions in cell size and ANF expression. (Circ J 2002; 66: 1045 - 1053)
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  • Shin-ichiro Miura, Takehiro Okamoto, David P Via, Keijiro Saku
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1054-1056
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Antisense oligodeoxynucleotides (AS-ODNs) are a new generation of therapeutic agents for gene therapy. To develop a new approach in regulating the expression of endothelin (ET) receptor, N,N-dipalmitylglycyl-apolipoprotein E (129-169) peptide (dpGapoE), an efficient gene delivery system, was used to transfect phosphorothioated AS-ODNs against nucleotides of human ET type A (ETA) receptors in human coronary smooth muscle cells (HCSMCs) and type B (ETB) receptors in human coronary endothelial cells (HCECs). After transfection, translocation to the nuclei and concentration in nuclear structures were observed in approximately 40% of HCSMCs and 60% of HCECs, respectively, at 48 h by fluorescence microscopy. Both the cellular ETA mRNA concentration in HCSMCs and ETB mRNA concentration in HCECs significantly declined. This approach may enable gene regulation in vivo and could be used to regulate vascular tone and constriction through ET receptors. (Circ J 2002; 66: 1054 - 1056)
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  • Tomoya Yamashita, Seinosuke Kawashima, Masanori Ozaki, Masayuki Namiki ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1057-1059
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Genetically modified hyperlipidemic mice provide important information on the pathogenesis of atherosclerosis, but most experimental designs are limited to in vitro or ex vivo examinations. The present study was designed to detect atherosclerotic lesions in situ in apolipoprotein E-knockout (apoE-KO) mice using a newly developed angiography system, synchrotron radiation (SR) microangiography, which uses monochromatic SR as an X-ray source and a high definition camera or video system as a detector. Digital microangiography with 7 mm pixel sizes was carried out and atherosclerotic lesion in small arteries less than 500 μm in diameter were detected. Moreover, the coronary artery stenotic lesion of an apoE-KO mouse was detected in situ with the angiography system. The new SR microangiography system is a powerful tool for investigating atherosclerotic lesions in situ in genetically engineered mice and will promote the basic study of atherosclerotic disease. (Circ J 2002; 66: 1057 - 1059)
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  • Toshio Imanishi, Takuzo Hano, Tatsuya Sawamura, Shigeho Takarada, Ichi ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1060-1064
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Under normal conditions, vascular endothelial cells are resistant to Fas-mediated apoptosis, although they express detectable Fas on their cell surface. Because oxidized Low density lipoprotein (Ox-LDL) is thought to promote atherogenesis, the potential role that Ox-LDL may play in Fas-mediated apoptosis was investigated in human umbilical vascular endothelial cells (HUVECs), focusing particularly on the involvement of the lectin-like Ox-LDL receptor-1 (LOX-1). HUVECs were treated with agonistic anti-Fas antibody (CH11) and Ox-LDL and then the degree of apoptosis was determined by cell death ELISA. Ox-LDL concentration-dependently sensitized Fas-mediated apoptosis. Flow cytometry demonstrated that Ox-LDL dose-dependently up-regulated cell surface Fas expression. On the other hand, treating HUVECs with Ox-LDL did not lead to any significant change in the expression of death mediators, including Fas, Fas ligand (FasL), FADD, and FLICE as assessed by multiplex polymerase chain reaction amplification. More importantly, these effects of Ox-LDL on Fas-mediated apoptosis were significantly blocked by a neutralizing LOX-1 monoclonal antibody, which can block LOX-1-mediated cellular uptake of Ox-LDL. Ox-LDL may be an important factor involved in the regulation of Fas-induced apoptosis via Ox-LDL/LOX-1 interaction in vascular endothelial cells. The results may provide insights into the pathogenesis of accelerated atherosclerosis in patients with hyperlipidemia. (Circ J 2002; 66: 1060 - 1064)
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Case Report
  • Hirokazu Shiraishi, Kazuya Ishibashi, Norifumi Urao, Masaki Tsukamoto, ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1065-1067
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Tachycardia-induced cardiomyopathy is a well-known and reversible condition, but the left ventricular dysfunction caused by frequent isolated premature ventricular complexes (PVCs) has been rarely reported. Apparent dilated cardiomyopathy was resolved in a patient after the focal source of PVCs was eliminated by radiofrequency catheter ablation. Echocardiography showed progressive improvement of the abnormal wall motion. Frequent PVCs could be the cause of left ventricular dysfunction in a subset of patients with dilated cardiomyopathy and radiofrequency ablation should be the choice of therapy in those patients. (Circ J 2002; 66: 1065 - 1067)
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  • Masakuni Kido, Hajime Otani, Hideki Kawaguchi, Hideki Ninomiya, Shoji ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1068-1069
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    A 57-year-old woman who had a dual chamber pacemaker implanted in June 1990 for sick sinus syndrome had developed heart failure since 1993. Although fluoroscopy revealed that the proximal J-shaped retention wire of the lead had fractured and had protruded through the outer insulation in 1994, and also that the distal J-shaped retention wire of the lead had protruded through the outer insulation in 1997, a transthoracic echocardiographic examination diagnosed tricuspid valve regurgitation, suggesting that the right atrial-aortic fistula might have been overlooked. In an attempt to avoid migration of the J-shaped retention wire from the lead and to repair the tricuspid regurgitation, it was decided that an operation be performed; however, intraoperative transesophageal echocardiography showed a right atrial-aortic fistula. Intraoperative inspection also revealed that the right atrial-aortic fistula and penetration of the superior vena cava had been caused by the Accufix atrial J-shaped retention wire. Under total cardiopulmonary bypass and induced cardiac arrest, a right atriotomy was performed and the atrial and ventricular leads were removed from the tips. The atrial orifice of the fistula and the aortic orifice were closed. Finally, a new dual-chamber pacing system with bipolar epicardial pacing leads was implanted. Postoperative inspection revealed that the proximal retention wire had fractured, the tip of the retention wire had protruded through the outer insulation, and the distal J-shaped outer insulation was damaged. (Circ J 2002; 66: 1068 - 1069)
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  • Masahiro Ito, Yasuhiko Tanabe, Kaoru Suzuki, Makoto Kumakura, Yoshifus ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1070-1072
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    A 73-year-old heavy drinker was admitted to hospital in a state of shock. He had been suffering from frequent angina at rest, causing him to drink more heavily in an effort to overcome his anginal chest pain. He had been drinking hard each day and had not eaten for 4 weeks. His hemodynamic state on admission showed high-output heart failure. Echocardiography revealed hyperkinesis of the left ventricle and mid-ventricular obstruction with peak intraventricular gradients of 30 mmHg. Although no improvement was seen despite administering the maximal dose in catecholamine therapy, his condition improved rapidly after vitamin B1 was administered. Cardiac catheterization revealed mid-ventricular obstruction with an apical aneurysm. Coronary artery spasm was induced by injecting acetylcholine in the distal site of the left anterior descending artery, which perfused the area of the apical aneurysm. In the present case, both left ventricular hyperkinesis caused by shoshin beriberi and apical myocardial infarction caused by frequent coronary spasms produced mid-ventricular obstruction with an apical aneurysm. (Circ J 2002; 66: 1070 - 1072)
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  • Masafumi Takahashi, Takeshi Mitsuhashi, Toru Hashimoto, Katsuto Ebisaw ...
    Type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 11 Pages 1073-1075
    Published: 2002
    Released: October 25, 2002
    JOURNALS FREE ACCESS
    Atrioventricular (AV) block following radiofrequency (RF) ablation for the treatment of AV nodal re-entrant tachycardia (AVNRT) is a rare but serious complication of this procedure. Almost all such cases occur during or immediately after radiofrequencey (RF) energy application, followed by prompt recovery. The present report describes a 22-year-old woman with first-degree AV block on electrocardiography, who developed complete AV block 1 week after RF ablation for the treatment of the uncommon form of AVNRT (slow/slow). The patient's complete AV block persisted for another 1 week before she recovered. (Circ J 2002; 66: 1073 - 1075)
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