To estimate the severity of tricuspid regurgitation, we developed a new mathematical model of the circulatory system, in which the right atrium and the right ventricle were represented by a single mixing chamber and tricuspid regurgitation was expressed as a reverse flow from the right ventricle to the right atrium with a time delay equivalent to one cardiac cycle. The actual dilution curves obtained from the right atrium and the right ventricle following rapid intravenous injection of Technetium-99m-macroaggregated human albumin were fitted to the theoretical curves based on the above-described model. The use of macroaggregated albumin avoided the contamination of the dilution curves by radio-activity from the left heart or by the recirculation of the tracer due to left to right shunt. Mean transit times and percentage of regurgitation, as given by the ratio of regurgitant flow to total outflow from the right ventricle, were determined by an analog computer. The correlations of these results with the findings of other examinations, including contrast echocardiography, demonstrated that the present method may be useful in detecting tricuspid regurgitation and in grading its severity.

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In spontaneously hypertensive rats (SHR), the hypotensive effect of captopril (30 mg/kg/day per os for 4 days), which inhibits the converting enzyme when given orally, was significantly potentiated rather than suppressed by aprotinin (100, 000 KlU/day s.c. for 7 days), but was not affected by indomethacin. These findings suggest that neither the kallikrein-kinin system nor the prostaglandin system is involved in any of the hypotensive actions of captopril in SHR other than the inhibition of the converting enzyme.

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An extensive myocardial fibrosis due to progressive systemic sclerosis (PSS) was described in a 36-year-old normotensive woman without pulmonary hypertension. An electrocardiogram showed low voltage and a pseudo-infarctional pattern in leads V₁ through V₃. Right ventricular dilatation and generalized left ventricular hypokinesis were present, but her pulmonary artery pressure was normal. Serum creatine kinase (CK) was elevated to 2305 U/L and CK-MB isoenzyme was as high as 7.1%. Simultaneously performed isoenzyme analysis of CK from the homogenate of the skeletal muscle of the patient showed a similar pattern, thus confirming that serum CK originated mainly from the skeletal muscle lesions. Autopsy findings demonstrated diffuse myocardial fibrosis and relatively unremarkable changes in the lungs and the kidneys. Our case serves as a warning that primary myocardial fibrosis could be, in some cases, so extensive that it might lead to a rapidly aggravated myocardial dysfunction and eventual death.

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Recently, Kawasaki disease has been attracting more attention as a new acquired heart disease in pediatrics, but the etiology of this disease has still not been established. In this study, the authors performed throat cultures not only on the patients themselves but also on their parents in order to investigate its etiology. No abnormal and specific bacterium was found in the present study. However, there have been many reports which may suggest bacterial or viral involvement at the onset of this disease. Therefore, it may be necessary to continue bacteriological analysis more systematically.

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Following epidemic upper respiratory infection, carriers of Type 4 strains of group-A β-hemolytic streptococci were observed in high incidence among the children of a religious organization in Kyoto City. Serum antistreptococcal antibodies (antistreptolysin 0, antideoxyribonuclease B and antistreptococcal polysaccharide) were analyzed and the interrelations among these antibody titers were studied.

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Erythromycin is accepted as the second drug of choice for streptococcal infections. The incidence of macrolide resistance in streptococcal strains has been low and the previously reported macrolide-resistant strains were almost all serotype T-12. In a 2-year survey conducted from 1979 to 1980, the strains isolated from a wide variety of geographic locations throughout Japan were studied for their macrolide-resistance. The resistance to erythromycin was correlated with the T-type of these strains and its minimum inhibitory concentrations were determined. Serotype T-12 strains isolated during this period were highly resistant to erythromycin. In addition, resistant strains were found in T-4 and T-1, the two other frequently isolated serotypes. Two point eight percent strains were moderately resistant with MICs of 1.56 to 12.5 μg per ml and 25.5% of the strains were highly resistant with 100 μg MIC or more.

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The determination of anti-deoxyribonuclease-B (ADN-B) is very important for the diagnosis of antecedent streptococcal infection because almost all of group A streptococci have this antigen and a strong elevation of the antibody is observed in patients with acute rheumatic fever, acute glomerulonephritis and other streptococcal infections. Moreover, ADN-B titers are elevated in cases with streptococcal skin infection, whereas anti-streptolysin O (ASO) titers are rarely elevated in these cases. So the determination of ADN-B is recommended as the second streptococcal antibody test to ASO detection (manual of WHO). In our study, the upper limits of ADN-B in normal subjects were 1 : 60 in preschool age, 1 : 480 in school age and 1 : 340 in adult age groups. In acute rheumatic fever, ADN-B titers were elevated in 87% of the cases and also 87% of the patients with acute glomerulonephritis had high ADN-B titers. In inactive rheumatic fever, 72% of the patients had high ADN-B titers, while, ASO titers were elevated in only 22% of the cases. In streptococcal carrier states, 39% of the children had high ADN-B titers but ADN-B was positive only 8% in non-carrier children.

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Titers of anti-strepto-polysaccharide (ASP), antistreptolysin-O, antistreptokinase and antideoxyribonuclease-B were studied from the sera of 184 healthy school children. The upper limit of normal ASP titers in school children was 1 : 32 in this study, and titers of 1 : 64 or more were considered abnormal . The correlation coefficients between ASP and other antibodies against extracellular antigens were r = -0.04 to 0.06, and therefore it can be considered that ASP shows an independent value from other antibodies.

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We measured the circulating immune complex levels in patients with rheumatic fever using the following three methods: the C₁q binding test, the conglutinin binding test and Raji cell radioimmunoassay. Thirty-four samples from 21 patients with rheumatic fever were examined, and circulating immune complexes were detected in 47.6% of the patients by one or more of these methods. Especially by the C₁q binding test, the sera obtained in the acute phase were found to contain the circulating immune complexes with higher frequency than those obtained in the post-acute phase. Therefore, the C₁q binding test was more likely to be useful in the acute phase of this disease. The present study suggests that the circulating immune complexes are related to the pathogenesis of rheumatic fever.

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Inbred strains of A/J, BALB/c, C3H/He, C57BL/6 and DBA/2 mice were inoculated with the M variant of encephalomyocarditis virus having a titer of 100 TCID₅₀/0.1 ml. Myocardial lesions were seen in 73 of 150 BALB/c mice (48.7%), 160 of 259 C3H/He mice (61.8%) and 115 of 174 DBA/2 mice (66.1%). No pathologic findings were noted in A/J and C57BL/6 mice. In C3H/He and DBA/2 mice, dilatation and hypertrophy of the heart accompanying myocardial lesions persisted up to the 8th month after virus inoculation. The present study revealed that myocardial lesions similar to those in congestive (dilated ) cardiomyopathy persisted for a long period after viral infection.

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The spontaneous occurrence of perimyocardial calcification localized in the right ventricle has been reported in an inbred strain of DBA/2 mice. In this paper we examined the correlation between the myocardial uptake ratio of technetium-99m pyrophosphate (^99mTc-PYP) and pathological findings in these mice ranging in age from one to 12 months. The ^99mTc-PYP myocardial uptake ratio was highest at 2 months and became lower with age, while calcification and fibrosis in the perimyocardium of the right ventricle became more prominent in aged mice. This may be due to an insidious onset of degeneration with calcification and fibrosis in spontaneously occurring perimyocardial lesions in these mice. Persistent abnormal uptake of ^99mTc-PYP observed in the present study suggests the usefulness of such scintigrams in the diagnosis of chronic perimyocardial disease.

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Keshan disease is a chronic endemic cardiomyopathy, which was first discovered in the rural areas of China. The author proposes that Keshan disease is a nutritional bio-geochemical disease. The differences between the endemic and non-endemic areas consist of the water-soil factors (bio-geochemical elements) in the natural environment. The etiological factor of the natural environment in the endemic region acts on the human body by way of the food consumed. Those who lived on a "single type of food", which was produced from their own fields, were liable to suffer from Keshan disease. Young females of child-bearing age and children after lactation were the most frequent victims of the disease. The use of soy-beans to improve the diet and oral administration of sodium selenite will prevent Keshan disease. Experiments on animals fed on cereals and vegetables from the endemic areas have shown that there might be some myocardial necrotizing factor and/ or growth inhibition factor in the watersoil elements.

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To clarify the etiology of atherosclerosis in collagen disease, the prevalence and quality of coronary arterial lesions was examined histopathologically. The materials consisted of 68 autopsy cases, including 10 of rheumatoid arthritis (RA), 28 of systemic lupus erythematosus (SLE), 8 of progressive systemic sclerosis (PSS), 5 of dermatomyositis (DM) and 17 of miscellaneous collagen disease (MD). As a control group (C), 9 age-matched cases of hematologic disorders were chosen. In order to conduct systematic research on coronary arteries, tissue blocks were taken, according to the method proposed by the "Vascular Lesion of Collagen Disease Research Committee" in Japan. To estimate the narrowing of the coronary arterial lumen quantitatively, the coronary stenosis index (CSI), which was the sum of the grade of three main coronary arterial narrowing scores, were used. Significant coronary stenosis (more than 75% occlusion of the lumen) was observed in 8 cases of SLE, one of PSS, 2 of DM and 4 of MD. Stenosis was due to atherosclerosis except in 3 cases of MD. The degree of stenosis expressed by the CSI was higher in MD, SLE and DM than in C (p<0.05). Atherosclerotic lesions in collagen disease tended to have a higher population of cellular components than did those in C. There were no statistical correlations between the CSI and some risk factors (age, hypertension, hypercholesterolemia and long-term corticosteroid administration). In the 12 cases with significant stenosis due to atherosclerosis, only 4 patients received corticosteroid hormone for more than one year. Active vasculitis with prominent inflammatory cell infiltration was observed in 2 cases of RA, 3 of SLE and 9 of MD. In cases of vasculitis in SLE examined by the serial section method, luminal narrowing caused by intimal fibrocellular proliferation seemed to have a close relationship with inflammatory cell infiltration in the media and the adventitia. It was concluded that prolonged stimulation of the injured intima by the common risk factors played an important role in the acceleration of coronary atherosclerosis and this intimal change should be reconsidered as a preceding lesion of coronary atherosclerosis.

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Two cases of myocarditis, who had suffered from ventricular extrasystole, leucocytosis and elevated serum enzyme for a long period died from congestive heart failure and/or arrhythmias. The biopsy specimens from the right ventricle in one of them showed a positive reaction against Coxsackie B virus ( 1, 3, 4 and 5) in the fluorescent antibody method. One case of virus pericarditis had 5 recurrences over a five-year period. He suffered from dyspnea, chest oppression and general fatigue at each recurrence. Cardiomegaly on a chest X-ray, electrocardiographic abnormalities, leucocytosis and elevated serum enzyme appeared. However, serum neutralizing antibody titers against Coxsackie B₂ had not risen significantly except during the first attack. Interferon administration inhibited its recurrence successfully .

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Sixteen cases of acute myocarditis, proven by endomyocardial biopsy, of possible viral origin which were described in a previous paper have been followed up for up to 5 years. The cases were divided into 3 groups according to the electrocardiographic (ECG) patterns: with conduction disturbance at the early stage (Group I, 9 cases); without conduction disturbance (Group II, 4 cases); early death cases in which the follow-up could not be carried out (Group 111, 3 cases). In Group I, 2 cases revealed persistent complete A-V block, 4 showed incomplete recovery of right bundle branch and/or fascicular blocks, and 3 showed complete recovery of the ECG abnormalities. In Group II, all 4 cases showed a pseudoinfarction pattern which consisted of abnormal Q waves, poor R wave progression and ST elevation. These findings disappeared during the follow-up period. All patients of Groups I and II are still alive after a follow-up period of up to 5 years.

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anese children with non-rheumatic myocarditis were investigated with regard to left ventricular hypertrophy (LVH), which was assessed electrocardiographically. Follow-up periods ranged from 12 to 58 months with a mean of 22.8 months. Left ventricular posterior wall thickness (LVPW_T) evaluated echocardiographically was compared to the electrocardiographic findings of LVH. The overall prevalence of LVH was 30.2% (16 patients). In 3 patients, LVH was detected during the first examination. In the other patients, however, LVH was detected later during the follow-up periods. In all but 2 patients, LVH disappeared during the follow-up periods. The development into hypertrophic cardiomyopathy was evident in only one patient. The LVPW_T showed no definite relation to the presence of LVH. Thus, LVH on an electrocardiogram appears to be a common finding in children with non-rheumatic myocarditis.

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Sixty patients with Kawasaki disease in the acute phase were studied using a two-dimensional echocardiography. Coronary lesions in Kawasaki disease were characterized echocardiographically by an increase of echo density of the coronary artery and by dilatation or aneurysm of the coronary artery. These findings appeared in the sequence mentioned above in patients who were studied serially. In the group treated with corticosteroid, 62% of the patients showed a disappearence or an improvement of the coronary dilatation or aneurysm, while only 33% of untreated patients showed such an improvement. In patients with coronary aneurysms on the initial echocardiogram, 53% of the pulse therapy group showed an improvement, but none of the untreated group did. A similar result was obtained by an analysis of its therapeutical effect, according to the number of vessels involved. Thus, corticosteroid pulse therapy was shown to be effective for the prevention of coronary arterial aneurysms in Kawasaki disease, if it was given in a sufficient dose in the acute phase of this disease.

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Left ventricular muscle volume (LVMV) was measured echocardiographically in 688 normal children ranging in age from 5 to 15. Lean body surface area (BSA) was obtained from height and lean body weight, which was estimated using triceps skinfold thickness, upper arm circumference and body weight. Regression lines of LVMV against BSA or lean-BSA were compared between boys and girls. There was statistically significant sex difference in regression lines when LVMV were plotted against BSA (p<0.005), but this difference disappeared when plotted against lean-BSA. We conclude that the sex difference of LVMV with a similar BSA originates from the difference of lean body weight between boys and girls.

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Under the Heart Disease Program for elementary school children and junior high school students in Osaka City, the cardiac patients found through mass examination are supposed to be checked annually by the program's staff. After their graduation from junior high school, however, the cardiac patients leave our medical jurisdiction. In order to gather information from those graduates, we have mailed and continue to mail questionnaires to them once every 5 years. By analyzing that information, we sought to describe the natural history of congenital heart disease in young adults. The study revealed that among graduates older than 20 years of age as of March 31, 1978, 17.5% underwent initial cardiac surgery; 1.8% were found to have no more cardiac lesions due to spontaneous healing; 12.3% answered that they had no significant changes; 2.0% were found to have deteriorated cardiac lesions and 2.1% of the graduates had died. Eight point one per cent of the graduate did not answer, although minimum data as to whether they were alive or not was gathered. The mortality rates were calculated by using all follow-up data. It was revealed that the mortality rate for cardiac patients under 14 years of age, for those between 15 and 20 years of age and for those older than 21 years of age are 14 times, 6 times and 3 times as high as the general population in each age group, respectively. The mortality rate for those with mild cases of cardiac lesions is 3 times higher than the general population. It is 13 times higher among moderate cases and 77 times higher among severe cases when compared to the general population.

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After the revision of the School Health Law in Japan the systems for heart disease screening for school children showed a great advance and the computerized devices for automatic evaluation of selected leads ECG and PCG were developed rapidly and have been improved in Japan. Two systems of heart disease screening for school children have been developed, that is, the Tokyo system and the "ECG-PCG for all children system". The Tokyo system utilizes a questionaire, a physical examination by school physicians and a chest X-ray for the primary screening procedure and ECG-PCG for the secondary procedure. The "ECG-PCG for all children system" utilizes a questionaire, a chest X-ray and ECG-PCG. The superiority of the ECG-PCG system was shown in comparison with the Tokyo system. Nearly twice as many cases of congenital heart disease were detected by the ECG-PCG system as compared with the Tokyo system, and many cases were disclosed for the first time. The "ECG-PCG for all children system" will probably be more popular in the near future in accordance with the advance of computerized systems.

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