Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 68 , Issue 1
Showing 1-18 articles out of 18 articles from the selected issue
Clinical Investigation
  • Takeshi Soeki, Yoshiyuki Tamura, Hisanori Shinohara, Koichi Sakabe, Yu ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 1-5
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Vascular endothelial (VE)-cadherin, a Ca2+-dependent cell adhesion molecule, is expressed in atherosclerotic lesions by endothelial cells and is associated with neovascularization, although the relationship between circulating VE-cadherin and coronary artery disease has not been studied. Methods and Results The plasma concentration of VE-cadherin was measured in peripheral blood (femoral artery) and the coronary sinus of 24 patients with acute myocardial infarction (AMI), 26 with stable angina pectoris (AP), 18 with old myocardial infarction (OMI), and 30 control subjects (Control) who had no coronary artery stenosis on angiography. For the patients with AMI, blood samples were obtained in the acute (day 1) and chronic (day 21) phases. The plasma concentration of VE-cadherin was measured by enzyme-linked immunosorbent assay. The correlation between the plasma VE-cadherin concentration and the Gensini score was also determined as an index of the severity of coronary atherosclerosis. The plasma concentrations of VE-cadherin (ng/ml) in both the peripheral and coronary sinus blood were higher in patients with AMI, AP, and OMI than in the control subjects, and were similar in the 3 groups with coronary artery disease (femoral artery: AMI 5.1±2.5, AP 4.7±2.4, OMI 4.5±3.3, Control 2.6±2.3; coronary sinus: AMI 5.6±2.6, AP 5.0±2.3, OMI 5.0±2.9, Control 2.4±2.1, respectively). Plasma VE-cadherin concentrations were higher in the coronary sinus than peripheral blood samples in patients with AMI (p<0.01), AP (p<0.01), and OMI (p<0.05). The plasma VE-cadherin concentration was the same in the acute and chronic phases in patients with AMI. In the 3 groups of patients with coronary disease, both the peripheral plasma VE-cadherin concentration and the coronary sinus concentration correlated with the Gensini score (r=0.32, p<0.01 and r=0.42, p<0.001, respectively). Multiple regression analysis revealed that the plasma VE-cadherin concentration predicted the Gensini score independently of sex, age, hypertension, diabetes mellitus, smoking, and the lipid profiles. Conclusion Increased secretion of VE-cadherin from the epicardial arteries is associated with the degree of coronary atherosclerosis, indicating the presence of atherosclerosis rather than disease activity. (Circ J 2004; 68: 1 - 5)
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  • Akira Kawamura, Shin-ichiro Miura, Takahiro Murayama, Atsushi Iwata, B ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 6-10
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Cell adhesion molecules have been implicated in the adhesion of leukocytes to endothelial cells and therefore play a role in atherosclerosis, which is a frequent cause of morbidity and mortality in patients with coronary artery disease (CAD) or undergoing hemodialysis (HD). The levels of expression of leukocyte adhesion molecules were evaluated in patients with CAD or HD. Methods and Results The expression of leukocyte (ie, neutrophil, monocyte and lymphocyte) surface CD11a, CD18, intracellular adhesion molecule-1 (ICAM-1), very late antigen-4α (VLA-4 α) and L-selectin was investigated by flow cytometry in 20 patients who were initially diagnosed with CAD (CAD group), 15 patients with coronary re-stenosed vessels (RESTE group), 20 undergoing HD (HD group) and 20 without CAD (CONT group). Monocyte surface expression of both CD11a and ICAM-1 in the CAD group was significantly higher than in the CONT group. Interestingly, when 15 patients with RESTE were analyzed, they showed monocyte CD11a and ICAM-1 expression levels comparable to those in the CONT group. On the other hand, there were no significant differences in the expression of CD11a, CD18, L-selectin or VLA-4α between the HD group and CONT group, but monocyte L-selectin was increased in the CAD group compared with the CONT group. Conclusions Because CD11a and CD18 are expressed on the cell surface as a heterodimer and ICAM-1 is a ligand for CD11a/CD18, this increased expression of CD11a and ICAM-1 may affect the development of initial atherosclerotic coronary stenosis, but not re-stenosis. (Circ J 2004; 68: 6 - 10)
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  • Hiroshi Yatsuya, Koji Tamakoshi, Hiroaki Hattori, Rei Otsuka, Keiko Wa ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 11-16
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Phospholipid transfer protein (PLTP) can generate pre-β high-density lipoprotein (HDL), an efficient acceptor of peripheral cholesterol, by mediating a process called HDL conversion. The transfer of phospholipids to immature HDL is also essential in maintaining reverse cholesterol transport. The phospholipid transfer activity of PLTP has been associated with various patho-physiological conditions; however, little information is available concerning the relationship between PLTP mass and disease. Methods and Results Using a sandwich enzyme-linked immunosorbent assay, PLTP concentration was measured and related to the risk of developing cardiovascular disease in a worksite-based cohort of Japanese men (n=2,567). Multiple linear regression analysis showed significant associations between PLTP and HDL cholesterol, triglycerides, low-density lipoprotein cholesterol, and body mass index (standardized β=0.395, -0.191, -0.064, and -0.064, respectively; R2=0.31). During the follow-up period, there were 10 cases of coronary heart disease (CHD) and 7 of stroke. The multivariate adjusted relative risk of CHD was 0.46 (95% confidence interval, 0.20-1.07) for an increase of 1 standard deviation in the PLTP value (p=0.071). PLTP concentration was not related to the risk of stroke. Conclusions The results of this prospective study indicate that the serum PLTP concentration would serve as a predictor of CHD, independent of HDL cholesterol, triglycerides and other established risk factors. (Circ J 2004; 68: 11 - 16)
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  • Shuichi Takagi, Yoichi Goto, Eiki Hirose, Masahiro Terashima, Satoru S ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 17-22
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Although vasospastic angina usually responds well to treatment with calcium antagonists and/or nitrates, there have been anecdotal case reports of refractory vasospastic angina resistant to intensive treatment with high doses of calcium antagonists and nitrates. Methods and Results Four patients with vasospastic angina, which was refractory to intensive treatment with high doses of calcium antagonists and nitrates, were completely controlled after administration of corticosteroids. Although none of the 4 patients showed eosinophilia, all had bronchial asthma or chronic thyroiditis, and in 2 cases, the activity of vasospastic angina corresponded with that of bronchial asthma. Conclusions These findings suggest that in these patients, coronary spasm may have been induced by arterial hyperreactivity because of local inflammation in the coronary arterial wall and that the corticosteroids suppressed the arterial hyperreactivity by alleviating the inflammation. Corticosteroids may be considered as a treatment choice for patients with refractory vasospastic angina, particularly when the patient has an allergic tendency, such as bronchial asthma. (Circ J 2004; 68: 17 - 22)
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  • Hiroshi Nakashima, Toshiro Katayama, Yukiharu Honda, Shin Suzuki, Kats ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 23-28
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Experimental evidence indicates that magnesium sulfate may have potential cardioprotective properties as an adjunct to coronary reperfusion. The present study was designed to examine the hypothesis that magnesium might have beneficial effects on left ventricular (LV) function and coronary microvascular function in patients with acute myocardial infarction (AMI). Methods and Results The study population of 180 consecutive patients with a first AMI (anterior or inferior) underwent successful primary coronary intervention. Patients were randomized to treatment with either intravenous magnesium (magnesium group, n=89) or normal saline (control group, n=91). Pre-discharge left ventriculograms were used to assess LV ejection fraction (LVEF), regional wall motion (RWM) within the infarct-zone and LV end-diastolic volume index. The Doppler guidewire was used to assess coronary flow velocity reserve (CFVR) as an index of coronary microvascular function. Magnesium group subjects showed significantly better LV systolic function (LVEF 63±9% vs 55±13%, p<0.001; RWM: -1.01±1.29 SD/chord vs -1.65±1.11 SD/chord, p=0.004), significantly smaller LV end-diastolic volume index (63±17 ml/m2 vs 76±20 ml/m2, p<0.001), and significantly higher CFVR (2.95±0.76 vs 2.50±0.99, p=0.023) than controls. Conclusion Magnesium sulfate as an adjunct to primary coronary intervention shows favorable functional outcomes in patients with AMI. (Circ J 2004; 68: 23 - 28)
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  • Takashi Nozawa, Hiroshi Inoue, Atsushi Iwasa, Ken Okumura, Lee Jong-da ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 29-34
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Elevation of hemostatic markers may account for the increased risk of ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to determine the effects of anticoagulation intensity on hemostatic markers in patients with NVAF. Methods and Results In 509 patients with NVAF, comprising 263 patients treated with warfarin and 246 patients without warfarin, the hemostatic markers of prothrombin fragment F1.2 (F1.2), fibrin D-dimer, platelet factor 4 (PF4), and β-thromboglobulin were determined and compared with those in 111 patients with sinus rhythm. F1.2 was inversely related with anticoagulation intensity and D-dimer increased with age. All hemostatic markers, except F1.2, were greater in patients with NVAF than in patients with sinus rhythm. F1.2 and D-dimer were significantly lower in patients with international normalized ratio (INR) ≥1.5 than in NVAF patients without warfarin and were not different between NVAF patients with INR of 1.5-1.9 and with INR ≥2.0. Conclusions Low intensity of anticoagulation (INR 1.5-1.9) suppresses the elevated concentration of F1.2 and D-dimer in patients with NVAF, and might be favorable in Japanese patients with NVAF in view of the balance between prevention of thromboembolism and the adverse effect by warfarin (ie, bleeding). (Circ J 2004; 68: 29 - 34)
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  • Takayuki Inomata, Tohru Izumi, Makoto Kobayashi
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 35-40
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background The cost-effectiveness of β-blocker use in patients with chronic heart failure (CHF) has never been elucidated in a Japanese study. Methods and Results A Markov model for outpatients with CHF was constructed to simulate remaining life expectancy and expected medical costs for each patient. Each patient was assumed that they received either carvedilol in addition to conventional therapies (ie, digitalis, diuretics, and angiotensin-converting enzyme inhibitors) or conventional therapies alone. Analyses were conducted both for each patient's remaining lifetime and for a period of 5 years. Analyses were performed from the perspective of Japanese healthcare insurance. Analysis for treatment over the course of each patient's expected life span with carvedilol plus conventional therapies versus conventional therapies alone yielded expected medical costs of ¤3.5 million and ¤5.5 million respectively, and a life expectancy of 121 months and 88 months, respectively. The analysis of a 5-year period yielded ¤1.4 million and ¤2.8 million in expected medical costs and 49 and 45 months life expectancy, respectively, for carvedilol versus conventional therapy. Conclusions Carvedilol treatment for CHF patients is a highly cost-effective method of therapy in the Japanese medical environment. (Circ J 2004; 68: 35 - 40)
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  • Masakazu Washio, Ryoko Hayashi, the Fukuoka Heart Study Group
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 41-46
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Obesity is an important risk factor for the occurrence of coronary artery disease (CAD) in Western countries and furthermore, it often coexists with other CAD risk factors such as hypertension, dyslipidemia and diabetes mellitus. However, it is uncertain whether obesity is a CAD risk factor in Japan because Japanese are relatively thin on average. Methods and Results The CAD risk associated with obesity (body mass index ≥25.0) 10 years before as well as at the time of the survey was assessed in a case - control study of acute myocardial infarction (AMI), which compared 660 AMI patients aged 40-79 years and 1,277 community controls, matched to each case by sex, year of birth, and residence. The prevalence of current obesity did not show any material difference between cases and controls, but compared with controls, past obesity was much more frequent in cases. Even after controlling for other CAD risk factors, past obesity was associated with a 2-fold increase in the risk of AMI. Past obesity was associated with an increased risk of AMI even without current obesity. Conclusion Past obesity is a CAD risk, even after weight reduction. (Circ J 2004; 68: 41 - 46)
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  • Masanobu Yanase, Fumimaro Takatsu, Takayuki Tagawa, Tomoko Kato, Kosuk ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 47-52
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Insulin resistance and hyperinsulinemia are important risk factors for coronary artery disease (CAD) and cardiovascular event (CVE). However, their independent relationship to new CVE in patients with normal glucose tolerance (NGT) and CAD is not known. Methods and Results Subjects of this 3-year observational study were 102 patients with CAD. Plasma glucose and insulin concentrations were determined at 2 time points (baseline and post oral glucose tolerance test [OGTT]. The fasting plasma glucose <110 mg/dl and post-OGTT <140 mg/dl was diagnosed as NGT (World Health Organization criteria). Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). Of the 102 patients, 23 had onset of new CVE, including 19 with new CAD. They had significantly higher fasting and post-OGTT insulin levels and HOMA-IR than those without new CVE (P<0.01, 0.031 and <0.01, respectively). Using the univariate Cox proportional hazards model, fasting and post-OGTT insulin values, HOMA-IR and high density lipoprotein (HDL) cholesterol differed significantly between the 2 groups. The multivariate Cox model showed that the effect of fasting plasma insulin and HOMA-IR remained significant and independent of HDL cholesterol. Conclusion Fasting hyperinsulinemia and high insulin resistance increased the risk of new CVE in patients with NGT and CAD. (Circ J 2004; 68: 47 - 52)
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  • Katsuji Inoue, Mareomi Hamada, Tomoaki Ohtsuka, Jitsuo Higaki
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 53-58
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background The hypothesis that myocardial blood volume is associated with left ventricular (LV) dysfunction and future cardiovascular events in patients with idiopathic dilated cardiomyopathy (IDC) was tested using intravenous myocardial contrast echocardiography (MCE). Methods and Results Thirty-five patients with IDC and 10 age-matched healthy control subjects were enrolled. Using MCE, background-subtracted and peak myocardial contrast intensity (calibrated PMCI) were calculated as measures of myocardial blood volume. LV ejection fraction (LVEF) was calculated using the modified Simpson method. Patients with IDC were stratified into 2 groups according to the median value of the calibrated PMCI [high value group (n=17): calibrated PMCI ≥ -22.7 dB, low value group (n=18): calibrated PMCI < -22.7 dB]. The calibrated PMCI was markedly reduced in patients with IDC compared with the control subjects (p=0.0025) and closely related to LVEF (r=0.688, p<0.0001). In the multivariate model, calibrated PMCI was the independent variable that predicted cardiac events in patients with IDC. According to the Kaplan-Meier analysis, cardiac event-free rates were significantly lower in the low-value group than in the high-value group (p<0.01). Conclusions Myocardial blood volume is closely related to LV dysfunction and future cardiac events in patients with IDC. (Circ J 2004; 68: 53 - 58)
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  • Kinji Ishikawa, Masaru Miyataka, Akio Kimura, Norihiro Takeda, Yutaka ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 59-67
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Although the favorable effects of β-blockers in the treatment of myocardial infarction (MI) have been repeatedly demonstrated in Western countries, administration of this drug has been limited in Japan. Methods and Results The study group of 1,896 patients with MI was retrospectively divided into 1,029 patients treated by β-blockers and 867 not treated by β-blockers, and the incidences of cardiac events, consisting of recurrent MI, death because of worsening heart failure, and sudden death, and cardiovascular events, comprising cardiac events and stroke, were compared in both groups. There were 45 cardiac events (4.4%, 30.1 patients/1,000 patients · year) among the β-blocker group, which was significantly less than the 56 cardiac events (6.5%, 52.3 patients/1,000 patients · year) among the no-β-blocker group (p<0.05). The total mortality was 92 (8.9%, 61.6 patients/1,000 patients · year) and 124 (14.3%, 115.8 patients/1,000 patients · year), respectively, and cardiac death occurred in 42 (4.1%, 28.1 patients/1,000 patients · year) and 53 (6.1%, 49.5 patients/1,000 patients · year), respectively, indicating that both these events occurred significantly less in the β-blocker group (p<0.01 and p<0.05). Conclusions Beta-blockers prevent cardiac events in Japanese patients with MI. However, a placebo-controlled, double-blind, multicenter, clinical trial conducted on a large scale in Japan would further contribute more precise information of the useful effects of β-blockers. (Circ J 2004; 68: 59 - 67)
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  • Eishun Horibe, Kazuhiko Nishigaki, Shinya Minatoguchi, Hisayoshi Fujiw ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 68-72
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Sarpogrelate, a serotonin receptor blocker, increases collaterals via a platelet anti-aggregation effect and/or vasodilatation. However, a recent report showed a preconditioning effect of sarpogrelate that enhances the translocation of PKC-ε of cardiomyocytes, followed by opening of the mitochondrial KATP channel via inhibition of serotonin release from platelets during ischemia, protecting against cellular injury in rabbit hearts without collaterals. The present study used a percutaneous coronary intervention (PCI) model to define the protective effect of sarpogrelate against ischemic injury and its mechanism in human coronary artery disease. Methods and results The study enrolled 20 patients with single vessel disease of 75% or 90% stenosis in the proximal left anterior descending (LAD) artery on coronary angiography (CAG). Patients were randomly divided into a control group (n=10) and a sarpogrelate group (n=10). The STmax (maximum ST elevation) and ΣST (sum of ST elevation) on the 12-lead ECG recorded in the late stages (ie, 90 s and 120 s) after inflation were significantly smaller in the sarpogrelate group than in the controls. There was no significant difference in collaterals on the right and left CAG or between the 2 groups. Conclusions Sarpogrelate improves ischemic injury during PCI and may be related to a preconditioning-like mechanism rather than to stimulating collateral development. (Circ J 2004; 68: 68 - 72)
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  • Kaoru Okishige, Kazutaka Aonuma, Yasuteru Yamauchi, Kouji Azegami, Kou ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 73-76
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background Radiofrequency catheter ablation (RF-CA) of common atrial flutter (AFL) requires the creation of a transmural incision to create a bidirectional conduction block in the cavotricuspid isthmus (ITH). Methods and Results RF-CA of the ITH using a cooled-tip system was carried out in 40 patients. In the `conventional' mode (CONV) of the system, RF energy was applied for 2 min with the temperature set at 60°C and power of up to 50 W, and in the failed cases the `cooled-tip' mode (COOL) was utilized at 45°C with up to 30 W (with a 15 ml/min saline flow rate). Of the 40 patients, 29 crossed over from the CONV to the COOL after a failed ablation of the AFL. As a result, in all 40 patients a complete linear incision could be created with either the COOL or the CONV, resulting in the successful abolition of the AFL. Complete bi-directional block was successfully created in all patients. No significant side effects occurred. Conclusions The COOL was found to be more effective and just as safe as the CONV for AFL ablation, thus facilitating the rapid and complete elimination of the AFL. (Circ J 2004; 68: 73 - 76)
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  • Satoshi Kurisu, Ichiro Inoue, Takuji Kawagoe, Masaharu Ishihara, Yuji ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 77-81
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Background The time course of the electrocardiographic (ECG) changes in patients with tako-tsubo syndrome remains unknown. Methods and Results In the present study, 16 patients with tako-tsubo syndrome and 15 patients with anterior acute myocardial infarction with minimal enzymatic release (minimal AMI) were evaluated. Left ventricular dysfunction dramatically resolved approximately 2 weeks later in both groups. In the patients with tako-tsubo syndrome, the admission ECG usually showed ST segment elevation, especially in leads V3-6. T wave inversion deepened progressively to its first negative peak, which occurred at approximately 3 days. The T wave was shallow for several days and then deepened again, the second negative peak occurring at approximately 2-3 weeks. The QT interval was prolonged as the T wave deepened, and shortened as the T wave became shallow. In the patients with minimal AMI, a similar time course of ECG changes was observed after reperfusion. In general, at 3 days or later during the early phase, T wave inversion was deeper and the QTc interval was longer in tako-tsubo syndrome than in minimal AMI. Conclusions Because the time course of the ECG changes, as well as that of the left ventricular dysfunction, is similar between tako-tsubo syndrome and minimal AMI, these 2 cardiac disorders must be carefully differentiated. (Circ J 2004; 68: 77 - 81)
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Case Report
  • Koichi Nihei, Noriaki Shinomiya, Hirohiko Kabayama, Chikako Ikeda, Tos ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 82-84
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Isolated noncompaction of the ventricular myocardium (INVM) is a rare morphological abnormality caused by cessation of the compaction of the loose interwoven meshwork of myocardial fibers during intrauterine life. Three cases of INVM, including 2 siblings, were diagnosed from 2-dimensional echocardiographic findings of Wolff-Parkinson-White syndrome type B to which INVM can be attributed. (Circ J 2004; 68: 82 - 84)
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  • Masaaki Sugihara, Hideya Yamamoto, Hiroko Matsushita, Futoshi Tadehara ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 85-87
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    A 38-year-old Japanese woman underwent cardiac evaluation to assess an arrhythmia detected after the delivery of her fourth baby. At the age of 22 years, she had undergone cardiac evaluation, including catheter examination, because of a heart murmur. Coronary angiography showed a huge right coronary artery (RCA) draining to the right atrium and a normal left coronary artery. Because the left to right shunt ratio was trivial and the patient was asymptomatic, conservative observation was undertaken. On the current admission to hospital, there was a grade III continuous murmur at the second left sternal border. The patient underwent right and left cardiac catheter examination in March 2000. Selective coronary angiography demonstrated an enlarged lumen of the RCA, an enlarged aneurysmal cavity in the terminal portion of the RCA, and the postero-descending artery being filled by collateral circulation from the left coronary artery. Moreover, 2 new fistulas had appeared from the left coronary system. An oxygen saturation study showed that the pulmonary to somatic flow ratio (Qp/Qs) was 2.2. The patient underwent surgical treatment in July 2000 and on coronary angiography 1 month later, there was no abnormal shunt flow from either coronary artery into the aneurysmal cavity, although the RCA was still enlarged. (Circ J 2004; 68: 85 - 87)
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  • Masayoshi Nishimoto, Shigeto Hasegawa, Kunio Asada, Kotaro Tsunemi, Sh ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 88-90
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    A 66-year-old man was found to have a mycotic aneurysm of the thoracic aorta. It was first suspected to be a pseudoaneurysm of the descending thoracic aorta on computed tomography scan, and the blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). It was subsequently diagnosed as a mycotic aneurysm, but because the patient continued to do so poorly with septicemia, conventional surgery (ie, aortic exclusion and extraanatomic bypass, or surgical placement of in situ graft) was not performed. A stent - graft device composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron was inserted through 21F sheath via the left external iliac artery and aortography showed successful deployment without blood endoleaks. The procedure was completed without incident and the patient has continued to do well. Endovascular stent - grafts may offer significant advantages for patients at high surgical risk. (Circ J 2004; 68: 88 - 90)
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  • Nobuyuki Hashimoto, Junzo Nagashima, Osamu Miyazu, Yoshihiro Akashi, K ...
    Type: None
    Subject area: None
    2004 Volume 68 Issue 1 Pages 91-93
    Published: 2004
    Released: December 25, 2003
    JOURNALS FREE ACCESS
    Among the congenital anomalies of the coronary arteries, a left circumflex artery (LCX) defect is extremely rare. A 49-year-old man who developed an acute anterior infarction underwent coronary angiography, which revealed complete occlusion of the left main trunk, but the territory usually supplied by the LCX had been perfused by the superdominant right coronary artery. Treatment of the left main trunk by percutaneous coronary intervention produced a favorable result. Accurate evaluation of the principal vessels and the extent of compensatory perfusion is important when diagnosing ischemic heart disease accompanied by anomalous coronary arteries and for choosing the best treatment modality. (Circ J 2004; 68: 91 - 93)
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