Serum HDL-cholesterol level and lipoprotein fraction were studied in 50 patients with Kawasaki disease (acute mucocutaneous lymph node syndrome), ranging in age from 4 months to 7 years, with an average of 2 years and 6 months. There were 31 males and 19 females. In 7 of these patients coronary arterial aneurysms were revealed by aortogram. In all 50 patients analysis were carried out periodically from the onset of the disease to the convalescent stage, and the following results were obtained: 1) Serum total cholesterol level showed mild change throughout the course of the disease. 2) Average HDL-cholesterol level was 29.6 ± 11.0 mg/dl in the first week of the disease, 26.8 ± 8.9 from 1 to 2 weeks and 47.9 ± 12.6 after 6 weeks. There was significant difference between the HDL-cholesterol levels of first 2 weeks and after 4 weeks (p < 0.01). 3) The recovery of HDL-cholesterol level was slow in both clinically severe patients and the patients with coronary aneurysms as compared with that in clinically mild patients (p < 0.05). These findings suggest that there may be some relationships between the alteration of serum lipoprotein and the severity of systemic vasculitis in Kawasaki disease, especially which may play some role in clinical severity and the occurrence of coronary arterial lesions. However, further study is needed to clarify the cause of changes in serum HDL-cholesterol and lipoprotein.

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On 37 patients with acute myocardial infarction (AMI), M-mode echocardiography was performed sequentially from the onset of the disease for more than 20 days in order to study the significance of a B-B' step of the anterior mitral valve in AMI. The following results were obtained: 1) A B-B' step was observed in 60% of the patients studied, and the incidence was higher in anteroseptal than postero-inferior infarction. 2) A B-B' step was especially noticed in the patients who had left ventricular failure. 3) The prognosis of the patients with a B-B' step was worse than that of the patients without it. A B-B' step, which either persisted for longer than 10 days or developed into a more definite form with the course of time, was a sign of an unfavorable prognosis. 4) The patients with a B-B' step had higher mean pulmonary arterial pressure than the patients without it. These results suggest that serial observations of the B-B' step in patients with AMI were a useful means to evaluate the left ventricular function and to determine prognosis in this disorder.

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Electrophysiological delineation of the specialized conduction system was performed under cardiotomy on 64 patients: 51 with ventricular septal defect (VSD), 11 with tetralogy of Fallot (TOF) and 2 with transposition of the great arteries (TGA, III). Some histological study was done for confirmation. In large VSD of type II or III, superficial location of the His bundle was shown by a tall H deflection recorded along the inferior rim, coinciding with a high incidence of conduction disturbance in this malformation. One characteristic in TOF was a deflection recorded along the posteroinferior rim rather exclusively on the left ventricular side, coinciding with the anatomic course of the His bundle. A defiection was frequently recorded at an area a few mm posterior to the muscle of Lancisi (ML) or the Lancisi equivalent structure (LES); it was relatively common in ordinary types of VSD, and presumed as the penetrating site of the right bundle branch (RBB) and/or near the bifurcated portion of the His bundle. The second portion of the RBB was not clearly delineated in general, particularly in TOF, but always found within the septomarginal trabecle when delineated. Our conclusion, together with histological study, was that one may use the ML or the LES as a rough marking for the course of the RBB. By this recognition, the surgically induced complete right bundle branch block has been diminished significantly. Variation of the course of conduction system as well as limits of this diagnostic measure are described herein.

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In 10 patients following open heart surgery, adrenaline, dobutamine and dopamine were administered, and the changes in hemodynamic parameters and renal blood flow (RBF) were examined. RBF was determined by the local thermodilution method. Prior to the application of this method in clinical measurement, reliability of the method was checked using a model circuit. The correlation between the actual flow and flow obtained with this method was high (r = 0.999, p < 0.005, n = 8). Reproducibility in repeated measurements was excellent, r = 0.997 (p < 0.005, n = 8) in the model circuit and r = 0.985 (p < 0.005, n = 89) in the clinical measurement. Adrenaline at rates of 0.02-0.08 μg/kg/min showed a marked inotropic action without any significant change in RBF. With 0.04 μg/kg/min of adrenaline, the RBF/CO (cardiac output) ratio declined significantly. We conclude that adrenaline is often effective in patients following open heart surgery, but renal vasoconstriction is the major disadvantage. After a 10-min administration of 2, 4 and 8 g/kg/min of dobutamine, cardiac index (CI) and stroke volume index (SVI) showed a stepwise increase in accordance with an increase of dosage, and RBF also increased with CO. Consequently, no significant change in RBF/CO was found. Mean left atrial pressure (LAP) or mean pulmonary arterial wedge pressure (PAWP) decreased in 4 of 7 patients with 8.0 g/kg/min of dobutamine. Thus, dobutamine is an excellent ₁-adrenergic agonist with a weak -action on both peripheral and renal vessels. With 2.0-2.5 g/kg/min of dopamine, RBF increased by 15.5% (p < 0.05), while no significant increase appeared in CI. With 4.0 g/kg/min or more of dopamine, CI and SVI increased. With 16-20 g/kg/min of dopamine, RBF increased by up to 44.8%. Significant increase of mean LAP or mean PAWP was observed with 8.0-10.0 g/kg/min or more of dopamine. These findings indicate that the potential increase of LVEDP (left ventricular end-diastolic pressure) with 8- 10 g/kg/min or more of dopamine exerts a disadvantageous effect in patients following open heart surgery. However, the effect on the renal hemodynamics, especially with small doses of dopamine, is unique and not observed with adrenaline or dobutamine.

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This study was undertaken to investigate the significance of stenotic lesion of an unoccluded vessel in a manifestation of myocardial "ischemia at a distance" during acute coronary occlusion. The left anterior descending artery (LAD) was ligated in dogs in which constriction of the circumflex artery (LCx) of different degrees was carried out beforehand. Ischemic changes were detected by epicardial and intramyocardial electrocardiograms. Systemic and coronary hemodynamics were monitored. In dogs without LCx constriction (Group-I) and those with LCx constriction of such a degree as to reduce the percent repayment of the blood flow debt to 150% (Group-II), the LAD-ligation produced no ischemic changes in the LCx area. In dogs with severe constriction of LCx such as eliminating reactive hyperemia (Group-III), an expansion of ischemic damage to the LCx area was observed. Ventricular fibrillation was observed more frequently in Group-III as compared to Group-I and Group-II. After LAD-ligation LCx blood flow was increased in Group-I and Group-II, but remained unchanged in Group-III. After LAD ligation, distal coronary perfusion pressure (DCPP) of LCx remained unchanged in Group-I, while further decrease of DCPP was observed in both Group-II and Group-III. Some dogs in Group-III showed a sudden reduction of the flow associated with a decrease of DCPP after the ligation. These results show that hemodynamic changes, especially a sudden decrease in coronary perfusion pressure after LAD-ligation, play a significant role in inducing ischemic changes in the area perfused by the unoccluded coronary artery with severe stenosis (LCx).

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Conjugated estrogens injected into the lateral brain ventricle in awake rats elicited behavioral excitation and vasopressor responses. Magnitude of pressor responses was greater in spontaneously hypertensive rats (SHR) than in normotensive Kyoto Wistar rats (WKY). Pressor responses in SHR were abolished by central pretreatments of either captopril or angiotensin II analog. Under urethane anesthesia, conjugated estrogens still produced greater pressor responses in SHR, but accompanying increases in sympathetic nerve firings were the same in both WKY and SHR. These results suggest that while centrally-administered estrogens may activate the brain renin-angiotensin system to increase sympathetic nerve firing and thereby elevated blood pressure, SHR have larger pressor responses only because peripheral vascular reactivity has been increased.

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The length-passive tension relationship was compared in helically-cut strips of the basilar, renal and mesenteric arteries and the aorta isolated from Kyoto Wistar (WKY) rats and stroke-resistant (SHRSR) and stroke-prone spontaneously hypertensive rats (SHRSP). Passive tension developed by the same magnitude of rapid stretch was greater in basilar arteries than in the other arteries and aortae. The length-tension curve shifted toward the tension axis in basilar arteries and aortae isolated from SHRSP as compared with those isolated from WKY, whereas the curves in mesenteric and renal arteries from SHRSP, SHRSR and WKY were not significantly different. It is concluded that the distensibility of various arteries isolated from rats differs, and the cerebral artery becomes less distensible during the persistence of hypertension and the rat become prone to stroke.

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Several vasodilating agents have been used for the treatment of primary pulmonary hypertension (PPH). However, no effective therapy is currently available for this distressful disease. We tried to use an angiotensin-I converting enzyme inhibitor, captopril, for one woman suffering from PPH. Her initial treatment with furosemide, digoxin and spironolactone had shown little effect. Further administration of captopril improved her clinical condition from NYHA IV to II and made it possible to treat her at our out-clinic. No adverse effect has been found. We would like to appreciate captopril as one of the effective drugs in the treatment of PPH.

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A case undergoing conduit procedure for tetralogy of Fallot with pulmonary atresia was complicated postoperatively by bacteremia due to non-fermentative Gram-negative rods and by disseminated intravascular coagulation. He was able to be cured without any sequela. The patient was a 16-year-old male, who had undergone Blalock-Taussig anastomosis in his infancy. The present operation was carried out as follows: ventricular septal defect was closed with a Teflon-patch and discontinuity between the right ventricle and the pulmonary artery was corrected using a Hancock's valved conduit. Two weeks after the operation, pleural effusion in the right chest cavity was shown by a chest X-ray film. On the 32nd postoperative day, high fever with chills occurred, and subsequently developed pulmonary edema, shock and hemorrhagic tendencies with petechia. Pseudomonas aeruginosa, Flavobacterium and Alcaligenes faecalis were detected by the culture of pleural effusion. The platelet count decreased to about 10, 000/μl. Carbenicillin, toburamycin and minocycline were administered for the infection, and heparin and aprotinin were used for disseminated intravascular coagulation. By these treatments for about 6 months, the patient became well and was discharged without any sequela.

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Analysis of the in situ heart performance has been guided by the concepts of pump and muscle mechanics derived from studies on isolated heart and papillary muscle, respectively. It is occasionally beneficial to evaluate the cardiac performance separately on heart as a pump or as a muscle. Cardiac output is determined by the interaction among preload, afterload and contractility. Thus, it is sometimes difficult to estimate the contractile state of the diseased heart simply from hemodynamic measurements. Therefore, it is necessary to compare hemodynamics between rest and stress states or to apply concepts of "afterload mismatch and preload reserve" as well as end-systolic pressure volume relations in quantitative evaluation of the cardiac performance. Regional wall motion measurements are also useful to detect regional myocardial ischemia.

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Phonocardiography and mechanocardiography are indispensable diagnostic tools in clinical cardiology though several limitations are inherently present. They should not be abandoned even in the era of echocardiography, and they are so rewarding in so many cases that we have to consider properly what we can expect and what we cannot prior to answering to the patient's question, "Now, what else are you going to examine, doctor?"

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Both M-mode and two-dimensional echocardiographies are now available in most institutions and hospitals. Correct understanding of the characteristics of M-mode and two-dimensional echocardiography, such as time resolution, will lead us to a successful application of each of these two displays. Detection of changes in ventricular wall and visualization of segmental wall motion are the most unique abilities in echocardiography. These characteristics permit echocardiographic evaluation of left ventricular function. Left ventricular size, shape and function are not independent parameters, but are interrelated. Various parameters on left ventricular function are calculated from the dimensions of the left ventricle. However, these estimations are valid only when the dimensional determination is optimized and all the assumptions on the model of the left ventricle are satisfied. The simultaneous display system of M-mode and two-dimensional echocardiograms on the same frame has been shown particularly useful for an optimization of the measurements. For ischemic heart disease, a knowledge of regional function of the left ventricle and the analysis of segment wall motion are indispensable. One of the major problems in evaluating the left ventricle using echocardiography is a limited acoustic window. A combination of standard parasternal approaches and other approaches is commonly required for obtaining an entire image of the left ventricle.

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Angiographic methods are by far the most frequently used for calculation of left ventricular volume, mass, forces acting within the ventricular wall or for analysis of contractile performance and diastolic property of the overall ventricle, as well as regional myocardial function in the presence of ischemia. A critical review of the theoretical basis and practical methods of calculation of these variables is presented. The left ventricular pressure-volume diagram is constructed which allows for an assessment of the inotropic state of the ventricle from the similar tension-length framework as obtained in the isolated papillary muscle. Computer technology of digital filtering and subtraction provides for an enhancement of the contrast of the ventricular image obtained with minimal doses of contrast medium. On-line methods for edge tracing and subsequent data processing are alleviating much of the tedious and laborious work of manual analysis of angiograms and accuracy of the calculation has been enhanced. Left ventriculography is most useful in diagnosing the presence of abnormal wall motion. Methods of assessing the magnitude and extent of the relative area of localized myocardial dysfunction are discussed. Quantitative information is crucial for evaluating prognosis and determining the application of therapeutic interventions.

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Nowadays there are various kinds of diagnostic examinations in the field of clinical cardiology. In this field, information concerning structure, dimension (hypertrophy and dilatation) and cardiac function is essentially important. For the diagnosis of valvular and congenital heart diseases and of cardiomyopathy, ultrasonic examinations are more useful; for ischemic heart disease, nuclear medicine is superior. Angiocardiography provides us much information but it is invasive. A combination of an exercise-test with the examinations mentioned above is useful for the detection of left ventricular and coronary reserves. The determinants of left ventricular reserve, being related to the prognosis of the patients, can be analyzed by exercise echocardiography. Exercise echocardiography can reveal instantaneous changes in myocardial ischemia during exercise. Regional and global left ventricular performances revealed by exercise radionuclide angiocardiography can lead us to a new interpretation of an exercise ECG.

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