Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 67 , Issue 2
Showing 1-17 articles out of 17 articles from the selected issue
Review Article
  • Yasuaki Hayashino, Mahbubur Rahman, Tsuguya Fukui
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 103-106
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Japan's contribution to the research on cardiovascular disease in the past decade was analyzed by accessing journal articles published in 1991-2000 in the MEDLINE database. The number of articles having an affiliation with a Japanese institution was counted and summed up as a whole and also separately for each journal with statistical time trend analysis. The proportions of randomized controlled study (RCT), case - control/cohort study, and case reports in articles from Japan were also determined. Of the total articles, Japan's contribution to the research on cardiovascular disease was 8.9% and ranked 2nd in the world. The recent increase in the contribution was not significant (p=0.25). Compared with other countries, the proportions of RCT (2.3%) and case - control/cohort study (2.3%) were smaller and that of case reports was similar (5.7%). Although the overall contribution from Japan in the field of cardiovascular disease is satisfactory, high-quality clinical research is as meager as in other clinical fields. (Circ J 2003; 67: 103 - 106)
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Clinical Investigation
  • Yuichi Sato, Katsuo Kanmatsuse, Fumio Inoue, Toshiyuki Horie, Masahiko ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 107-111
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Although the excellent spatial resolution of multislice spiral computed tomography (MSCT) enables the coronary arteries to be visualized, its limited temporal resolution results in poor image reproducibility because of cardiac motion artifact (CMA) and hence limits its widespread clinical use. A novel retrospectively ECG-gated reconstruction method has been developed to minimize CMA. In 88 consecutive patients, the scan data were reconstructed using 2 retrospectively ECG-gated reconstruction methods. Method 1: the end of the reconstruction window (250 ms) was positioned at the peak of the P wave on ECG, which corresponded to the end of the slow filling phase during diastole immediately before atrial contraction. Method 2 (conventional method): relative retrospective gating with 50% referred to the R-R interval was performed so that the beginning of the reconstruction window (250 ms) was positioned at the halfway point between the R-R intervals of the heart cycle. The quality of the coronary artery images was evaluated according to the presence or absence of CMA. The assessment was applied to the left main coronary artery (LMCA), the left anterior descending artery (LAD, segments #6, #7 and #8), the left circumflex artery (LCx, segments #11 and #13) and the right coronary artery (RCA, segments #1, #2 and #3). The first diagonal artery (#9-1), the obtuse marginal artery (#12-1), the posterior descending artery (#4-PD), the atrioventricular node branch (#4-AV) and the first right ventricular branch (RV) were also evaluated. Of the 88 patients, 85 were eligible for image evaluation. Method 1 allowed visualization of the major coronary arteries without CMA in the majority of patients. The LCA system (segments #5-7, #11 and #13) and the proximal portion of the RCA were visualized in more than 94% of patients. Artifact-free visualization of the distal portion of the LAD (segment #8) and RCA (#4PD and #4AV), and side branches (#9-1, #12-1 and RV) was also achieved in more than 80% of patients. On the other hand, CMA occurred frequently on images obtained by Method 2. The LCx and RCA systems were the most affected by CMA, revealing only 41% artifact-free visualization of the segment #13, 39% of #1, 15% of #2 and 32% of #3. Thus, Method 1, which avoids the ventricular motion occurring during the rapid filling and atrial contraction phases, gives superior image quality over the conventional ECG-gated reconstruction method. (Circ J 2003; 67: 107 - 111)
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  • Hiromi Muta, Teiji Akagi, Kimiyasu Egami, Jun Furui, Yoko Sugahara, Ma ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 112-115
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    The purpose of this study was to investigate the incidence and clinical features of atrial septal defect (ASD) in school children in Japan who were diagnosed by heart disease screening. From 1989 to 1998, a questionnaire, electrocardiography (ECG) and phonocardiogram were obtained from school children when they entered their first year of elementary school (n=86,142) or junior high school (n=80,632). In this program, 33 asymptomatic ASD patients were newly diagnosed (0.020%). The ECG findings showed incomplete right bundle-branch block (79%), right axis deviation (55%), and right ventricular hypertrophy (9%). An ejection systolic murmur was audible in 30 patients (94%) and mid-diastolic murmur in 10 patients (30%). Thirty patients (90%) showed fixed split of second heart sound. Using echocardiography or catheter observation, 31 patients (94%) were judged to require closure of the ASD. Although the medical care is widely available in Japan, undetected ASD patients were not rare and importantly, most of them required closure of the defect even if they were asymptomatic. (Circ J 2003; 67: 112 - 115)
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  • Miki Miyamoto, Chiharu Kishimoto, Keisuke Shioji, Jong-Dae Lee, Hiroma ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 116-118
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Cutaneous microangiopathic lesions exist in patients with heart failure, and heart failure is associated with increased oxidative stress. Thioredoxin (TRX) is stress-inducible and has a cytoprotective effect against oxidative stress. Accordingly, to investigate whether arteriolar TRX expression was increased in the skin of patients with congestive heart failure (CHF), skin biopsies were taken at the time of cardiac catheterization, and the results were compared with those of control subjects. The diagnosis of CHF was done by cardiac catheterization with reference to elevated plasma concentrations of TRX and brain natriuretic peptide (BNP). Increased TRX expression was found in the skin biopsies of 29 of the 35 patients with CHF, but in none of the 8 control subjects; the semiquantitative grade of arteriolar TRX immunoreactivity was 2.5±1.0 in patients with CHF and 1.0±0.0 in controls, respectively (p<0.01). The severity of arteriolar TRX expression did not correlate with the New York Heart Association functional class. These results indicate that cutaneous arteriolar TRX expression in patients with CHF may reflect the excessive oxidative stress of the peripheral circulation associated with the condition. (Circ J 2003; 67: 116 - 118)
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  • Jinyao Liu, Kazuya Murata, Takashi Fujino, Kayo Ueda, Kazumi Kimura, Y ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 119-124
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Dobutamine improves systolic as well as diastolic function, but its effect on left ventricular (LV) asynchrony is unknown. An on-line automated segmental motion analysis (A-SMA) system was developed, based on an automatic border detection technique, to evaluate the effect of dobutamine on LV asynchrony in patients with LV hypertrophy (LVH). Low dose (5 μg · kg -1 · min-1) dobutamine stress echocardiography was performed in 15 patients with LVH and in 15 healthy subjects. Short-axis LV views were obtained and divided into 4 wedge-shaped segments using A-SMA. The time - area curve and its first derivative curve in each segment were displayed. Total normalized peak filling rates (nPFR) were obtained. Systolic and diastolic asynchronies were assessed from the coefficient of variation (CV) of the regional time intervals from end diastole to the peak ejection rate (T-PER), and from end systole to the peak filling rate (T-PFR), respectively. At baseline, the CV of T-PER and T-PFR in patients with LVH were greater than those in healthy subjects (CV-T-PER: 18.8±9.2 vs 9.6±4.3%, CV-T-PFR: 19.5±7 vs 8.1±4.1%, both p<0.01). During dobutamine infusion, differences among groups at baseline disappeared and systolic and diastolic asynchronies improved (CV-T-PER: 7.3±4.8 vs 5.7±2.1%, CV-T-PFR: 6.8±3.5 vs 5.1±1.3%, both p>0.05). Total nPFR increased (from 3.2±1.0 /s to 5.6±1.3 /s, p<0.01) with dobutamine infusion in patients with LVH. Dobutamine improved LV diastolic asynchrony, as evaluated by A-SMA, in patients with LVH demonstrating that the lusitropic effect of dobutamine improved LV regional diastolic asynchrony, playing an important role in the improvement of global LV diastolic filling. (Circ J 2003; 67: 119 - 124)
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  • Erdulfo J. Galeano, Akihiro Yoshida, Yoshio Ohnishi, Katsunori Okajima ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 125-128
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    The comparative usefulness of 10 min of beat-to-beat 12-lead QT dispersion (QTd) and QT interval variability index (QTVI) analysis for identifying patients with organic heart disease (OHD) at risk for ventricular arrhythmias was assessed in 86 subjects: 54 had OHD without a history of ventricular arrhythmias, 15 had OHD with documented ventricular tachycardia, and there were 17 controls. The following parameters were analyzed among the groups: (1) the average QTd (mean QTd), (2) the difference between the maximum and minimum QTd observed over the recording time (QTd variation), (3) the maximum difference of QTd between consecutive beats (QTd maximum), (4) the QTd standard deviation (QTd variability), and (5) QTVI, calculated in lead I or II according to an established formula: log 10 [(QTv/QTm2) / (HRv/HRm2)]. All the analyzed parameters were significantly increased in the patients with and without ventricular tachycardia when compared with the controls. QTd variation, QTd maximum and QTd variability were the only variables that remained significantly increased in the group of patients with documented ventricular tachycardia, compared with those without arrhythmia. Thus, beat-to-beat fluctuations of both the QT interval and QTd may be markers of temporal electrical instability in patients with OHD. (Circ J 2003; 67: 125 - 128)
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  • Reiko Hori, Junichiro Hayano, Hirokazu Monou, Kazuhiro Kimura, Hirohit ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 129-132
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    The Japanese Coronary-prone Behavior Scale (JCBS) is a questionnaire developed by the Eastern Collaborative Group Study (ECGS), a multi-center study of coronary-prone behavior among Japanese men in Japan. From the JCBS, a subscale was extracted consisting of 9 items that were independently associated with the presence of coronary artery disease (CAD) in patients undergoing coronary angiography (CAG). The subscale, named Scale C, represents job-centered lifestyle, social dominance, and suppressed overt type A behavior. To further validate the association of Scale C with CAD among Japanese men, the present study examined if such an association would be observed in a newly sampled population. The JCBS was carried out by 311 men undergoing CAG. The association between Scale C score and the presence of CAD was evaluated with logistic regression analysis that included established coronary risk factors. The Scale C score was significantly higher in subjects with CAD than in those without and stepwise multivariate logistic regression showed that the Scale C score was associated with the presence of CAD independent of age, low-density lipoprotein cholesterol, diabetes mellitus, and obesity. These results indicate that the Scale C score is independently associated with the presence of CAD even among a newly sampled population of Japanese men undergoing CAG. Scale C may reflect an important feature of coronary-prone behavior among Japanese men. (Circ J 2003; 67: 129 - 132)
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  • Shinichi Niwano, Yuko Wakisaka, Jisho Kojima, Yoshihiro Yumoto, Kimiat ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 133-138
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    It is important to clarify how electrical remodeling develops in clinical cases of paroxysmal atrial fibrillation (PAF), because it has been suggested that this electrophysiological phenomenon promotes an increase in the frequency of PAF. In the present study, the f-f interval during PAF was analyzed from the ambulatory ECG recordings of 21 patients with PAF (total PAF duration >2/24 h with normal atrial size) to monitor the atrial electrophysiological changes. The patients were clinically followed-up for 6 months without any antiarrhythmic drugs. Before and after the follow-up period 24-h Holter monitoring was carried out and the duration of both the PAF and the f-f intervals during the PAF episode were evaluated. In selected cases, the atrial effective refractory period (ERP) was evaluated in an electrophysiologic study before and after the follow-up period. The total PAF duration was prolonged from 187±50 to 223±79 min (p=0.034) and the f-f interval was shortened from 0.14±0.03 to 0.12±0.02 ms (p=0.003). There was an inverse relationship between the changes in total PAF duration and f-f interval (p=0.027). The ERP was shortened from 214±15 to 194±5 ms (n=5, p=0.025) and there was a direct correlation between the changes in ERP and f-f interval (p=0.048). In clinical cases, the prolongation of the PAF was related to the shortening of the f-f interval during the PAF episodes and to the shortening of the atrial ERP. Electrical remodeling plays a role in promoting the development of the atrial fibrillation in patients with PAF. (Circ J 2003; 67: 133 - 138)
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  • Kenji Harada, Masahiro Nomura, Akiyoshi Nishikado, Kouzoh Uehara, Yuta ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 139-145
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Dihydropyridine Ca antagonists cause reflex tachycardia related to their hypotensive effects. Efonidipine hydrochloride has inhibitory effects on T-type Ca channels, even as it inhibits reflex tachycardia. In the present study, the influence of efonidipine hydrochloride on heart rate and autonomic nervous function was investigated. Using an electrocardiogram and a tonometric blood pressure measurement, autonomic nervous activity was evaluated using spectral analysis of heart rate/systolic blood pressure variability. Three protocols were used: (1) a single dose of efonidipine hydrochloride was administered orally to healthy subjects with resting heart rate values of 75 beats/min or more (high-HR group) and to healthy subjects with resting heart rate values less than 75 beats/min (low-HR group); (2) efonidipine hydrochloride was newly administered to untreated patients with essential hypertension, and autonomic nervous activity was investigated after a 4-week treatment period; and (3) patients with high heart rate values (≥75 beats/min) who had been treated with a dihydropyridine L-type Ca channel inhibitor for 1 month or more were switched to efonidipine hydrochloride and any changes in autonomic nervous activity were investigated. In all protocols, administration of efonidipine hydrochloride decreased the heart rate in patients with a high heart rate, reduced sympathetic nervous activity, and enhanced parasympathetic nervous activity. In addition, myocardial scintigraphy with 123I-metaiodobenzylguanidine showed significant improvement in the washout rate and H/M ratio of patients who were switched from other dihydropyridine Ca antagonists to efonidipine hydrochloride. Efonidipine hydrochloride inhibits increases in heart rate and has effects on the autonomic nervous system. It may be useful for treating hypertension and angina pectoris, and may also have a cardiac protective function. (Circ J 2003; 67: 139 - 145)
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  • Yoshiyuki Takami, Hiroshi Ina
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 146-148
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Abnormal signal-averaged electrocardiography (SAECG) reflects slow and heterogeneous myocardial conduction, predicting ventricular arrhythmia and sudden cardiac death in patients with ischemic heart disease. The purpose of this study was to investigate the quantitative effect of coronary artery bypass grafting (CABG) on SAECG, which is still controversial, and to identify the factors that are related to it. Pre- and postoperative SAECGs were recorded in 100 patients who underwent CABG. Compared parameters included filtered QRS duration (dQRS), root mean square voltage in the terminal 40 ms of the QRS complex (RMS40), and duration of the terminal low-amplitude signal less than 40 μV (LAS40). All 3 parameters in SAECG improved significantly after CABG (dQRS: 105±21 ms→99±18 ms, RMS40: 55±45 μV→65±41 μV, LAS40: 29±19 ms→25±12 ms). The improvements in SAECG were greater in patients who underwent complete revascularization and in those without prior myocardial infarction. In conclusion, CABG improved SAECG quantitatively, even in patients with normal SAECG. However, this improving effect was variable and closely related to the presence of prior myocardial infarction and the completeness of revascularization. (Circ J 2003; 67: 146 - 148)
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Experimental Investigation
  • Masao Moroi, Taro Izumida, Toshisuke Morita, Junko Tatebe, Chikara Ish ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 149-153
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    The p53 tumor suppressor gene may act as an inhibitor of vascular neointima formation in response to injury and in the present study the effects of p53 deficiency on external vascular cuff-induced neointima formation were evaluated. Vascular neointima formation was induced by an external vascular cuff; a polyethylene tube placed around a 2 mm segment of the left femoral artery ensheathed the adventitia, but avoided direct intraluminal injury. Two weeks after cuff placement, the cuff-sheathed and contralateral control arteries without cuff from wild-type (n=10) and p53 deficient (n=8) mice were harvested and analyzed by quantitative morphometry. The areas of the lumen, intima, and media were measured in 10 cross-sections from one edge to the other of the cuffed portion, and in the corresponding 2-mm segment of the contralateral control artery. The volume ratio of the intima to media (I/M) was calculated. The contralateral control arteries without a cuff did not have intima in either wild-type or p53 deficient mice. In the cuff-sheathed arteries, neointima formation of p53 deficient mice with an I/M of 93% was significantly greater than that of wild-type mice with an I/M of 50% (P=0.001). The absence of p53 is associated with increased neointima formation in response to cuff injury. (Circ J 2003; 67: 149 - 153)
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  • Naoki Matsumoto, Ryoji Kishi, Hiroyoshi Kasugai, Tsuneharu Sakurai, Ke ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 154-158
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Experimental in vitro and in vivo studies were performed to assess the effectiveness and safety of the cooled-tip catheter and the Cooled Ablation System, which enables the creation of deeper and wider burn lesions in the myocardial tissue using radiofrequency current. This system was confirmed to consistently create large burns by cooling the catheter tip with circulating water within the catheter, even under unfavorable conditions. On the other hand, unfavorable effects, as a result of over burning, such as explosive vaporization within the tissue (the `pop' phenomenon), tissue carbonization, coronary artery injury and lung injury were identified. `Pop' was difficult to predict, but it is important to know how it can be avoided. No `Pop' was seen without first observing an impedance decrease, thus it was considered safe to decrease the radiofrequency current if the impedance began to decrease. This system will be very effective for ablation of refractory arrhythmias, such as ventricular tachycardia or atrial flutter, but it is recommended that only experienced electrophysiologists use this system to avoid serious complications. (Circ J 2003; 67: 154 - 158)
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  • Yue-Jin Yang, Yi-Da Tang, Ying-Mao Ruan, Pei Zhang, Yan-Wen Zhou, Pei- ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 159-162
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    It has been verified that losartan has beneficial effects on ventricular remodeling (VRM) after acute myocardial infarction (AMI), but the effects of carvedilol alone or in combination with losartan on this condition have not been defined. The present study used rats to compare the effects of carvedilol and losartan alone and in combination for preventing VRM after AMI. After ligation of the left coronary artery, 100 surviving female Sprague-Dawley rats were randomly assigned to 1 of 4 groups: (1) AMI control (n=25), (2) carvedilol (Car, 1 mg · kg-1 · day-1) (n=25), (3) losartan (Los, 3 mg · kg-1 · day -1) (n=25), and (4) Car (1 mg · kg -1 · day-1) + Los (3 mg · kg-1 · day -1) (n=25). A sham-operated group (n=17) was also randomly selected. Drugs were administered by gastric gavage for 4 weeks. After hemodynamic studies, the hearts were fixed and analyzed pathologically. Exclusive of the rats that had died or had an infarct size <35% or >55%, complete data were obtained for 65 rats, comprising AMI control (n=13), Car (n=12), Los (n=13), combination (n=14), and sham (n=13) groups. There were no significant differences in the size of infarct among the 4 AMI groups (45.8~46.7%, all p>0.05). Compared with the sham group, left ventricular (LV) end-diastolic pressure (LVEDP), volume (LVV), weight (LVW) and septal thickness (STh) were all significantly increased (all p<0.001), whereas ±dp/dt was significantly decreased (both p<0.001) in the AMI group. In comparison with the AMI group, LVEDP, LVV, LVW and STh were all significantly decreased (LVEDP: 12.7±2.3, 9.7±2.8, and 8.6±3.5 mmHg vs 20.6±2.7 mmHg, all p<0.001; LVV: 0.74±0.07, 0.76±0.07, and 0.70±0.09 ml vs 0.86±0.05 ml, all p<0.05; LVW: 668.4±52.0, 702.6±45.4, and 683.9±67.7 mg vs 787.3±76.7 mg, p<0.05~0.001; STh: 1.57±0.05, 1.48±0.07, and 1.46±0.07 mm vs 1.71±0.04 mm, all p<0.05), whereas ±dp/dt was significantly increased (all p<0.05) in the Car, Los, and combination groups, with LVEDP decreasing more in both Los and the combination groups than in the Car group alone (p<0.05) and STh decreasing more in the combination group than in the Car group alone (p<0.05). Carvedilol and losartan alone and in combination all prevent VRM after AMI in rats, with almost equivalent effect. (Circ J 2003; 67: 159 - 162)
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Case Report
  • Tetsuro Emori, Keiko Ohta, Kengo Kusano, Hiroshi Morita, Hiromi Matsub ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 163-165
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    A 44 year-old man with severe left ventricular dysfunction resulting from an old myocardial infarction developed clusters of ventricular fibrillation (VF). Although coronary bypass surgery was performed and heart failure was well controlled, the VF recurred during amiodarone therapy. Despite multiple deliveries of shocks by an implantable cardioverter defibrillator, the electrical storm could not be terminated. Some substrate for rapid ventricular tachyarrhythmias, refractory to class III drugs, can lead to death from arrhythmia. (Circ J 2003; 67: 163 - 165)
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  • Nobuyuki Ogasawara, Yoshiyuki Kijima, Shinpei Ike, Yusuke Nakagawa, Ta ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 166-168
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    Protein S is a vitamin K-dependent plasma protein that inhibits the process of blood coagulation via activation of protein C, another vitamin K-dependent plasma protein A 58-year-old man with hereditary protein S deficiency had repeated attacks of acute myocardial infarction at age 52 and 58 years. (Circ J 2003; 67: 166 - 168)
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  • Jun Shiraishi, Tetsuya Tatsumi, Kazutoshi Shimoo, Asako Katsume, Hirok ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 169-171
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    A 59-year-old woman with skin sarcoidosis was admitted to hospital for assessment of complete atrioventricular block. Cross-sectional echocardiography showed that the apical free wall of the right ventricle was thin and dyskinetic with dilation of the right ventricle. Thallium-201 myocardial imaging revealed a normal distribution. Both gallium-67 and technetium-99m pyrophosphate scintigraphy revealed no abnormal uptake in the myocardium. Right ventriculography showed chamber dilation and dyskinesis of the apical free wall, whereas left ventriculography showed normokinesis, mimicking right ventricular dysplasia. Cardiac sarcoidosis was diagnosed on examination of an endomyocardial biopsy specimen from the right ventricle. A permanent pacemaker was implanted to manage the complete atrioventricular block. After steroid treatment, electrocardiography showed first-degree atrioventricular block and echocardiography revealed an improvement in the right ventricular chamber dilation. Reports of cardiac sarcoidosis mimicking right ventricular dysplasia are extremely rare and as this case shows, right ventricular involvement may be one of its manifestations. (Circ J 2003; 67: 169 - 171)
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  • Nobutaka Hirai, Takashi Fukunaga, Hiroaki Kawano, Osamu Honda, Tomohir ...
    Type: None
    Subject area: None
    2003 Volume 67 Issue 2 Pages 172-175
    Published: 2003
    Released: January 25, 2003
    JOURNALS FREE ACCESS
    A 75-year old man was referred to hospital for symptomatic hypoxemia. He did not complain of dyspnea while supine, but while sitting or standing, he experienced dyspnea with severe hypoxemia. He did not have any pulmonary diseases that could cause dyspnea. Transesophageal echocardiography revealed an atrial septal aneurysm with a small atrial septal defect (ASD) and a mild left-to-right shunt through the ASD when the patient was supine. However, when he became upright, a severe right-to-left shunt occurred and the arterial oxygen saturation decreased from 96% to 80% with dyspnea. Cardiac catheterization revealed normal pulmonary artery pressure. He was therefore diagnosed as having platypnea - orthodeoxia syndrome. Magnetic resonance imaging of the chest showed a deformity of the atrium associated with elongation of the ascending aorta. The ASD was closed surgically and the dyspnea and hypoxemia that occurred while he was upright completely resolved. (Circ J 2003; 67: 172 - 175)
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