Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 66, Issue 9
Displaying 1-20 of 20 articles from this issue
Special Article
  • Therapeutic Targets for the Treatment of Athero-thrombosis in the New Millennium - Clinical Frontiers in Atherosclerosis Research
    Valentin Fuster, Roberto Corti, Juan Jose Badimon
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 783-790
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
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Clinical Investigation
  • A Japanese Clinical Trial
    Shinichi Oho, Akira Ishizawa, Teiji Akagi, Hidemi Dodo, Hirohisa Kato
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 791-794
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    This study reports the results of a Japanese clinical trial of transcatheter closure of atrial septal defects (ASD) using the Amplatzer septal occluder (ASO). Thirty-five patients with secundum ASD underwent transcatheter closure using the ASO at a median age of 12.9 years (range, 3.2-29.2 years) and a median weight of 39.2 kg (range, 11.6-65.1 kg). The ASO was successfully implanted in 34 patients. The mean ASD diameter of the 34 patients measured by transesophageal echocardiography was 11.7±4.2 mm (range, 5.0-20.8 mm) and the mean balloon stretched diameter was 16.8±4.2 mm (range, 9-25 mm). The mean ASO size was 16.9±4.3 mm (range, 9-26 mm). Complete closure rate at 1 day and 1 year after closure was 91% and 97%, respectively. One patient developed a transient second-degree atrioventricular block during the implantation procedure. No other complications occurred. Transcatheter closure of ASD using the ASO is effective and safe. (Circ J 2002; 66: 791 - 794)
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  • Michiko Ishida, Junjiro Kobayashi, Osamu Tagusari, Ko Bando, Kazuo Niw ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 795-799
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    For the first time in Japan, off-pump coronary artery bypass grafting (OPCAB) was compared with the conventional on-pump technique, retrospectively examining the morbidity associated with coronary artery bypass grafting (CABG) and assessing the efficacy of OPCAB. In 2000, 158 patients underwent CABG: 95 patients (60%) had OPCAB (Group I) and 63 patients (40%) had conventional CABG (Group II). The operating time, length of intensive care unit (ICU) stay, ventilation time, postoperative bleeding, transfusion, postoperative renal function, occurrence of stroke, and early graft patency were examined in both groups. There were no hospital deaths in either group. The operating time, ICU stay, and ventilation time were significantly (p<0.0001, p=0.013, and p<0.0001, respectively) shorter in Group I (351±85 min, 3.0±1.4 days, and 5.1±2.8 h) than in Group II (449±112 min, 3.6±1.8 days, and 13.7±18.0 h). The postoperative blood loss within 12 h and the transfusion volume were significantly (p=0.0004 and p<0.0001, respectively) smaller in Group I (480±210 ml and 300±490 ml) than in Group II (720±430 ml and 1,230±1,180 ml). Peak serum blood urea nitrogen and creatinine concentrations (excluding patients with preoperative chronic renal failure, ie a preoperative serum creatinine >1.5 mg/dl) were significantly (p<0.0001 and p<0.0001, respectively) lower in Group I (16.2±15.2 mg/dl and 0.81±0.72 mg/dl) than in Group II (19.2 ±7.6 mg/dl and 0.92±0.28 mg/dl). There were no perioperative strokes in Group I, but 6.4% of Group II patients suffered a stroke. There was no significant difference in graft patency between the groups (95.6% vs 94.9%). OPCAB reduced the mortality and morbidity of coronary revascularization, with a shorter operating time and more rapid recovery from surgery. (Circ J 2002; 66: 795 - 799)
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  • Kensuke Fujiwara, Yoshikazu Hiasa, Takefumi Takahashi, Koji Yamaguchi, ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 800-804
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The purpose of the present study was to examine the influence of diabetes mellitus (DM) on the clinical and angiographic outcomes in 62 diabetic and 152 nondiabetic patients with acute myocardial infarction (AMI) treated with primary coronary stenting within 12 h of the onset of symptoms. The diabetic patients had a greater incidence of hyperlipidemia, prior myocardial infarction (MI) and multivessel disease. There were no statistically significant differences in other variables. Procedural success was similar in the 2 groups. At a mean follow-up of 2.1±0.6 years, 13% of diabetic and 11% of nondiabetic patients had died (p=0.70). The percentage of target vessel revascularization (TVR) was 37% of diabetic and 20% of nondiabetic patients (p=0.003). Rates of major adverse cardiac events (MACE: death, non-fatal MI, TVR) were 50% of diabetic and 32% of nondiabetic patients (p=0.007). On multivariate analysis, DM was not a predictor of death. Independent predictors of death were age, multivessel disease, TIMI ≤2 and cardiogenic shock. However, DM and age were independent predictors of MACE. In conclusion, DM is not an independent predictor of death in patients with AMI after stenting, but diabetic patients had a higher incidence of TVR, making DM an independent predictor of MACE. (Circ J 2002; 66: 800 - 804)
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  • Kunihiro Kinjo, Hiroshi Sato, Hideyuki Sato, Issei Shiotani, Toshiya K ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 805-810
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The association between Helicobacter pylori (H. pylori) infection and coronary artery disease, as well as the association between H. pylori infection and classic coronary risk factors, is controversial in patients from Western countries. The high prevalence of H. pylori infection in Japanese subjects enables an examination of these associations in a large population, especially in young patients, because coronary risk factors may be more strongly associated with younger individuals than with older individuals. The IgG seropositivity to H. pylori was assessed in 618 cases with acute myocardial infarction (AMI) and in 967 controls. The prevalence of seropositivity to H. pylori was similar between cases and controls, but in subjects younger than 55 years, the rate was significantly higher in cases than in controls (58.7% vs 43.3%, p=0.009). After adjustment for age, gender, diabetes mellitus, hypertension, smoking, body mass index, total cholesterol, and high density lipoprotein cholesterol, the odds ratio for acute myocardial infarction was 2.97 (95% confidence interval, 1.37-6.41; p=0.006). Worsening of classic coronary risk factors was not associated with H. pylori infection in subjects younger than 55 years. These results suggest that in younger individuals in Japan, H. pylori infection is significantly associated with AMI independent of the classic coronary risk factors. (Circ J 2002; 66: 805 - 810)
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  • Akira Ito, Kensuke Egashira, Takahiro Narishige, Kouhei Muramatsu, Aki ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 811-815
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The renin - angiotensin system plays an important role in the elevation of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, in hypertensive patients, so the present study was designed to examine whether angiotensin-converting enzyme (ACE) activity is also involved in the mechanism of ADMA elevation in type 2 diabetes mellitus (NIDDM). A crossover study was performed to determine if ACE inhibition with perindopril (4 mg/day) for 4 weeks decreases serum ADMA concentration and plasma von Willebrand factor (vWF) level (a marker of endothelial injury) in 11 patients with NIDDM. None of the patients was treated with insulin or oral hypoglycemic drugs, and none had major diabetic complications. Before the protocol began, serum ADMA and plasma vWF were significantly higher in the 11 NIDDM patients, when compared with 8 control subjects without diabetes. Perindopril did not affect blood pressure or glucose metabolism, but did significantly decrease serum ADMA and plasma vWF. These results suggest that endothelial injury associated with ADMA elevation may be present even in patients with non-complicated NIDDM, and that increased activity of ACE may be involved in such endothelial dysfunction. (Circ J 2002; 66: 811 - 815)
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  • Postoperative 12-month Follow-up Results
    Mitsumasa Hata, Jai Raman, Siven Seevanayagam, David Hare, Brian F Bux ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 816-818
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The 12-months' follow-up results for radial artery harvest in relation to complications are reported and compared with the postoperative 3-months' results. The postoperative wound problems of 155 patients who underwent coronary artery bypass grafting with radial artery harvesting were assessed using a questionnaire at 3 and 12 months after surgery. The questionnaire contained 9 statements concerning hand and forearm problems in daily life. The answers were graded in 7 levels. An answer of higher than grade 3 (mild symptoms) was regarded as a significant symptom. No hand ischemic complications was observed. In the 12 month-study, 152 patients (98.1%) were normal. Hand pain and numbness occurred in 25 patients (16.1 %) and 33 patients (21.3%), respectively, at 3 months and were markedly improved at 12 months (pain: 13 (8.4%), p=0.045, numbness: 20 (12.9%), p=0.069). Total scores for all questions also significantly decreased at 12 months (10.2±3.5) compared with 3 months (11.1±3.9) postoperatively (mean ± SD, p=0.0003). Radial artery harvest was quite acceptable from the patient's perception, although a few patients had numbness and pain in the 3 months after surgery. Those complications significantly improve in the later postoperative phase. (Circ J 2002; 66: 816 - 818)
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  • Taigo Kintaka, Takao Tanaka, Makoto Imai, Itaru Adachi, Isamu Narabaya ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 819-825
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Homozygous or compound heterozygous mutation of the CD36 gene (CD36-/-) in humans results in severe defects of the uptake of long-chain fatty acids (LCFAs) in the heart. Because the effect of a single mutation of this gene (CD36+/-) on the LCFA uptake is not known, it was evaluated in 29 subjects with the CD36 wild-type gene (WT) (6 healthy subjects, 10 patients with heart disease), CD36+/- (4 healthy subjects, 5 patients) and CD36-/- (4 patients). The CD36 genotype was identified in the coding region of genomic DNA, and the expression of CD36 protein was examined by flow cytometry after staining with monoclonal anti-CD36 antibody. The LCFA uptake in the heart was assessed as the radioactivity accumulation ratio of heart to mediastinum after intravenous administration of iodine-123 15-(p-iodophenyl)-3-R, S-methylpentadecanoic acid (H/M ratio). The H/M ratios in WT, CD36+/- and CD36-/- were 2.28±0.10, 1.90±0.06 and 1.40±0.11, respectively (p<0.0001, among groups). The H/M ratio between healthy subjects and patients with heart disease for WT and CD36+/- did not differ significantly (ie, those of WT and CD36+/- in healthy subjects and patients were 2.29±0.08 vs 2.27±0.12 and 1.90±0.07 vs 1.89±0.05, respectively). Not only CD36-/- but also CD36+/- resulted in a significant reduction of the LCFA uptake in the heart independent of heart disease, suggesting genotype dependency and that CD36 might be a fundamental determinant of myocardial LCFA uptake. (Circ J 2002; 66: 819 - 825)
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  • Shozo Sueda, Hiroaki Kohno, Katsuji Inoue, Hiroshi Fukuda, Jun Suzuki, ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 826-830
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    This study sought to clarify the effectiveness of intracoronary administration of a thromboxane (TX) A2 synthase inhibitor, Ozagrel Na, to relieve coronary spasms induced by intracoronary injection of acetylcholine (ACh). An ACh spasm provocation test was performed in 92 consecutive patients with coronary spastic angina using incremental doses of 20, 50, and 80 μg into the right coronary artery, and 20, 50, and 100 μg into the left coronary artery within 20 s. A coronary spasm was defined as TIMI 0 or 1 flow and an intracoronary injection of 20 mg Ozagrel Na was administered when it was provoked. Within 2 min of the administration of the TXA2 synthase inhibitor, ACh-induced coronary spasms were relieved (TIMI 3 flow) in 88.1% of procedures without complications. In only 4 cases (4.3%), it took more than 3 min to relieve the coronary spasms. Intracoronary administration of 20 mg Ozagrel Na when ACh-induced spasms occurred, shortened the spasm relief time in all 7 patients (200±59 s vs 111±23 s, p<0.01), improved the maximal ST segment elevation in 5 of them (3.9±3.7 mm vs 0.7±1.5 mm, p<0.05), and stopped chest pain in 4 patients. In 4 patients who had ACh-induced coronary spasm of the left anterior descending artery, the TXB2 concentration in the coronary sinus decreased after intracoronary administration of Ozagrel Na into the left coronary artery (463±562 vs 96±45, p<0.01). In conclusion, intracoronary administration of a TXA2 synthase inhibitor can relieve ACh-induced coronary spasms by inhibiting TXA2 synthesis in the local coronary circulation. (Circ J 2002; 66: 826 - 830)
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  • Hui Zhang, Yutaka Otsuji, Keiko Matsukida, Shuichi Hamasaki, Shiro Yos ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 831-836
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Differentiation of normal from pseudonormal/restrictive mitral flow is not necessarily easy. Pseudonormal/restrictive flow is usually associated with left ventricular (LV) dysfunction, which can be detected using the TEI index, combining systolic and diastolic function. The purpose of this study was to test the feasibility of using the TEI index to differentiate pseudonormal/restrictive from normal mitral flow. In 33 patients with mitral flow E/A ≥1 and LV mid-diastolic pressure measured by catheterization, the LV volumes, mitral E and A velocity, deceleration time of the E velocity, and the TEI index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated using Doppler echocardiography. Pseudonormal/restrictive mitral flow was defined as mitral flow E/A ≥1 associated with LV mid-diastolic pressure >12 mmHg. There were 22 and 11 patients with normal and pseudonormal/restrictive mitral flow, respectively. Among the indices of LV function, the TEI index achieved the best correlation with LV mid-diastolic pressures (r2 = 0.63, p<0.0001). By setting the TEI index ≥0.65 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had sensitivity, specificity, and accuracy of 82%, 96%, and 91%, respectively. TEI index allows noninvasive differentiation of pseudonormal/restrictive from normal mitral flow. (Circ J 2002; 66: 831 - 836)
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  • Atsushi Katoh, Hisao Ikeda, Yoshinori Takajo, Nobuya Haramaki, Toyoaki ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 837-840
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Impairment of endothelium-derived nitric oxide (EDNO) has been demonstrated in patients with coronary risk factors in some studies, as well as impaired platelet-derived nitric oxide (PDNO) in other studies. However, no study has examined whether these impairments coexist. In 24 patients with coronary risk factors, femoral vascular endothelial function was assessed with acetylcholine (ACh: 50, 100, 200 and 400 μg/min) and endothelium-independent vascular function with nitroglycerin (NTG; 50, 100, 200 μg/min) using a Doppler flow-wire technique, as well as ADP (5 μmol/L)-induced PDNO release with an NO-specific electrode. The ACh-mediated percent change in femoral vascular resistance index (% change of FVRI) and PDNO release had a significant correlation with the number of risk factors. The ACh-mediated % change of FVRI, but not that with NTG, significantly correlated with the PDNO release. Both EDNO and PDNO bioactivities are impaired in patients with coronary risk factors and there is a common mechanism. (Circ J 2002; 66: 837 - 840)
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Experimental Investigation
  • Yasuko Tsuchiyama, Ken Kasamatsu, Takuzo Hano, Ichiro Nishio
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 841-845
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Although ET-1 antagonists have been beneficial in the treatment of heart failure (HF), their involvement in the effect on the sympathetic nervous system in HF remains unknown. The present study investigated the role of endogenous endothelin (ET) in the sympathetic nervous system in HF by observing the effect of ET AB antagonist (TAK-044) on renal sympathetic nerve activity (RSNA) in conscious rats with HF (n=7). HF was induced by left coronary artery ligation and 6 weeks later, TAK-044 was intravenously administered in the conscious and freely moving rats. RSNA, mean arterial pressure (MAP) and heart rate were compared with rats with sham operations (sham; n=7). MAP was significantly decreased in both groups; however, RSNA was significantly decreased only in the HF group at 5 min after administration, and this change continued until 10 min. There was also an effect of TAK-044 on the arterial baroreflex function indicated by the slope of RSNA to the changes in MAP during phenylephrine and nitroprusside injection in both groups. Compared with the sham group, the HF group showed impaired arterial baroreflex control of RSNA during phenylephrine injection, and intravenous administration of TAK-044 normalized this abnormality, whereas the function in the sham group was not changed. These data show that ET AB antagonist suppressed renal sympathetic activity in rats with HF, and improved arterial baroreflex function. The beneficial effect of endothelin antagonist on heart failure may involve improvement of the increased sympathoexcitation and impaired arterial baroreflex function in HF. (Circ J 2002; 66: 841 - 845)
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  • Toru Yatsuhashi, Ichiro Hisatome, Yasutaka Kurata, Norihito Sasaki, Ka ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 846-850
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The present study investigated the protective effects of L-cysteine on the oxidation-induced blockade of Na+ channel α-subunits, hH1 (cardiac) and hSkM1 (skeletal), expressed in COS7 cells. Na+ currents were recorded by the whole-cell patch clamp technique (n = 3-7). L-cysteine alone blocked hH1 and hSkM1 in a dose-dependent manner, with saturating L-cysteine block at 3,000 μmol/L. Hg2+, a potent sulfhydryl oxidizing agent, blocked hH1 with a time to 50% inhibition (Time50%) of 20 s. Preperfusion of COS7 cells with 100 μmol/L L-cysteine significantly slowed the Hg2+ block of hH1 (Time50% = 179 s). L-cysteine did not prevent Hg2+ block of hSkM1 (Time50% = 37 s) or the C373Y hH1 mutant (Time50% = 43 s). As for other sulfo-amino acids, homocysteine prevented the Hg 2+ block of hH1, with the Time50% (70 s) being significantly smaller than that of L-cysteine, whereas methionine did not prevent the Hg2+ block of hH1. L-cysteine did not prevent the Cd2+ block of hH1. These results indicate that L-cysteine selectively acts on heart-specific Cys373 in the P-loop region of hH1 to prevent Cys373 from the oxidation-induced sulfur-Hg-sulfur bridge formation. (Circ J 2002; 66: 846 - 850)
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  • Masanori Ozaki, Seinosuke Kawashima, Tomoya Yamashita, Tetsuaki Hirase ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 851-856
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Endogenous nitric oxide (NO) inhibits the contractile response to β-adrenergic stimulation, but its effect on cardiac hypertrophy mediated by β-adrenoceptors remains unclear. The present study was designed to determine whether overproduction of endothelial NO synthase (eNOS) could inhibit cardiac hypertrophy induced by chronic isoproterenol (ISO) infusion (30 mg/kg per day) using eNOS overexpressing (eNOS-Tg) mice and wild-type (WT) mice. In a separate group, WT mice were treated with ISO and hydralazine to decrease blood pressure to the same levels in eNOS-Tg mice. The eNOS expression, NOS activity, and cGMP levels in the heart were remarkably higher in eNOS-Tg mice than in WT mice. ISO increased both heart weight and the heart/body weight ratio, which were significantly attenuated in eNOS-Tg mice compared with WT or hydralazine-treated WT mice. Histological examination revealed that the extent of fibrosis was not significantly different among the 3 groups, and that the increase in myocyte size was more than 10% lower in eNOS-Tg than in the other groups. In addition, up-regulated expression of atrial natriuretic peptide mRNA associated with cardiac hypertrophy was significantly inhibited in eNOS-Tg mice during ISO infusion. These results indicate that endogenous NO might act as a negative modulator for the hypertrophic response to β-adrenergic stimulation. (Circ J 2002; 66: 851 - 856)
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  • Hiroshi Yoshida, Atsushi Sugiyama, Yoshioki Satoh, Yuko Ishida, Kiyota ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 857-862
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    This study was designed to assess the effects of typical class I drugs on the terminal repolarization process of the in situ heart, which is a useful marker of the potential of drug-induced long QT syndrome. Disopyramide (0.3 and 3.0 mg/kg per 10 min, n=6) or mexiletine (0.3 and 3.0 mg/kg per 30 s, n=6) was intravenously administered to halothane-anesthetized beagle dogs under the monitoring of multiple cardiovascular parameters. Antiarrhythmic concentrations were obtained with the high dose of each drug. The low dose of disopyramide or mexiletine hardly affected any of the electrophysiological parameters assessed. The high dose of disopyramide prolonged the monophasic action potential duration (MAP90) and effective refractory period (ERP) to a similar extent, thus displacing the terminal repolarization period backward, which might provide a potential proarrhythmic substrate, particularly at a slow heart rate. On the other hand, the high dose of mexiletine shortened the MAP90, but prolonged the ERP, resulting in the disappearance of the terminal repolarization period, which could prevent premature excitation with its associated conduction slowing. These electrophysiological effects of disopyramide and mexiletine on the terminal repolarization phase may at least in part explain their clinically described antiarrhythmic and proarrhythmic properties. (Circ J 2002; 66: 857 - 862)
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Case Report
  • Isao Nishi, Toshiyuki Ishimitsu, Tomoko Ishizu, Yukihiro Ueno, Akihiro ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 863-865
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have been found at autopsy in some patients with this condition and have been demonstrated in the left or right ventricles on 2-dimensional echocardiography. A 23-year-old woman presented with peripartum cardiomyopathy and biventricular thrombi on echocardiography. The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile, suggesting that they were fresh. She was treated with conventional heart failure therapy and anticoagulants. Four days later, the apical thrombi within both ventricles had disappeared and there was no evidence of embolism on physical examination. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction most likely led to the formation of biventricular thrombi. (Circ J 2002; 66: 863 - 865)
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  • A Case Report
    Takeshi Shirayama, Keiji Inoue, Takashi Sakamoto, Midori Yamamura, Hir ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 866-868
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    A 64-year-old male was admitted to hospital because of repeated episodes of syncope and palpitation. Ambulatory monitoring revealed paroxysmal atrial fibrillation (AF) as the cause of palpitation; he did not have structural heart disease. The induction of AF by rapid pacing (50 Hz for 1 s) in an upright position provoked syncope with a vasodepressor response. Atropine sulfate blocked the induction of syncope. The possible etiology was neurally mediated syncope that manifested only during AF, which suggests that the abnormal vagal activity during AF in this case exaggerated the vasodepessor response while upright. (Circ J 2002; 66: 866 - 868)
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  • Toshio Kaneda, Junzo Iemura, Iwao Michihata, Zhi-Wei Zhang, Hiroshi Ok ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 869-871
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    A free-floating ball thrombus in the left atrium is an unusual occurrence that may cause fatal systemic emboli or left ventricular inflow obstruction, often resulting in sudden death. The first of 2 cases was a 59-year-old female with mitral stenosis and chronic atrial fibrillation who presented with severe dyspnea. Transthoracic echocardiography revealed a free-floating ball thrombus and emergency thrombectomy and mitral valve replacement were performed successfully. A second thrombus, which was not found at preoperative examination, was attached to the anterior mitral leaflet and may have been the source of the free-floating ball thrombus. The second case was a 79-year-old female with chronic renal failure who underwent mitral valve replacement 11 years prior to admission. She had been dependent on hemodialysis for 10 years, and had suffered several recent transient cerebral ischemic attacks. Computed tomography showed a ring-shaped, high-density area in the left atrium and transthoracic echocardiography revealed a floating ball thrombus in the left atrium. Thrombectomy was performed, but the patient died as a result of postoperative pneumonia 2 months later. Case 2 appears to be the first reported case of a ball thrombus in a hemodialysis patient who had previously undergone mitral valve replacement. (Circ J 2002; 66: 869 - 871)
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  • Hiroshi Wada, Takanori Yasu, Seiichiro Murata, Masahiro Ohta, Norifumi ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 872-873
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    This report presents the first case of anterolateral papillary muscle rupture caused by a diagonal branch occlusion only. Although the patient was in shock on admission, he was successfully treated by emergency surgery after hemodynamic stabilization by a percutaneous cardiopulmonary support system. This case implies that the anterolateral papillary muscle has a single blood supply and that it can rupture by an occlusion of only one diagonal branch even after balloon angioplasty. (Circ J 2002; 66: 872 - 873)
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Rapid Communication
  • Ichiro Watanabe, Riko Masaki, Kimie Ohkubo, Yasuo Okumura, Takeshi Yam ...
    Article type: scientific monograph
    Subject area: None
    2002 Volume 66 Issue 9 Pages 874-875
    Published: 2002
    Released on J-STAGE: August 25, 2002
    JOURNAL FREE ACCESS
    The effect of rapid atrial pacing on the rate adaptation of the atrial action potential duration was studied in humans. The right atrial monophasic action potential (RAMAP) of 5 patients was recorded before and after 30 min of rapid atrial pacing. The pacing cycle length (CL) was 146±9 ms, the shortest duration at which 1:1 capture was possible. The RAMAP duration at 90% repolarization (RMAPD) was measured. CL-dependent changes in RAMAPD (CL 600 ms - CL 300 ms) before and after rapid atrial pacing were 51.8±10.7 ms and 30.8±7.6 ms (p<0.05), respectively. (Circ J 2002; 66: 874 - 875)
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