JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
46 巻, 4 号
選択された号の論文の17件中1~17を表示しています
  • YASUHISA UEDA, MASANOBU HONDA, MAKOTO TSUCHIYA, HIDETO WATANABE, YOICH ...
    1982 年 46 巻 4 号 p. 317-322
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    The effect of potassium loading on plasma adrenocortical hormones concentrations in 9 patients with essential hypertension (EH) was investigated. The plasma renin activity (PRA), plasma concentrations of growth hormone (GH), ACTH, cortisol, deoxycorticosterone (DOC), 18-hydroxy-deoxycorticosterone (18-OH-DOC) and aldosterone, and serum electrolytes were measured before and after potassium chloride (KCl) infusion (0.33 mEq/kg/h, for one hour). The KCl infusion caused significant increases in serum potassium levels and plasma levels of GH, ACTH, cortisol, DOC, 18-OH-DOC and aldosterone, while PRA remained unchanged. Regression analysis at 30 min revealed significant positive correlations between c ΔACTH and Δcortisol, between ΔACTH and ΔDOC, between ΔACTH and Δ18-OH-DOC. However, the relationship between ΔACTH and Δaldosterone was not statistically significant. These results suggest that (1) acute potassium loading causes a significant increase in the plasma ACTH level and increased levels of adrenocortical hormones may be produced by increased ACTH secretion, and (2) it may be considered that a part of the increased level of plasma aldosterone following acute potassium loading may arise from increased ACTH secretion in EH.
  • YASUMI UCHIDA, TORU HANAI, MINORU TAKAHASHI, KICHINORI HASEGAWA, KAZUK ...
    1982 年 46 巻 4 号 p. 323-328
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Percutaneous transluminal coronary angioplasty (PTCA) was performed on 12 patients with angina pectoris. PTCA reduced the percentage of stenosis of the coronary artery from 75.6 ± 10.1 (mean ± SD) to 32.6 ± 19.5. In addition, anginal attacks per week was reduced from 8.4 ± 3.2 to 2.5 ± 0.7. No life-threatening complications were produced by PTCA. The result indicates the effectiveness of PTCA as a treatment for angina pectoris.
  • EIICHI SENNARI, YUICHI SATO, YUJI MATSUOKA, KAZUHIRO YAMAMOTO, TAKAHIR ...
    1982 年 46 巻 4 号 p. 329-333
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Anomalous origin of a single coronary artery from the pulmonary artery is exceedingly rare. Clinical and necropsy findings in a 17-month-old boy with anomalous origin of a single coronary artery from the pulmonary artery are described. In our case, no areas of infarction or ischemic changes were found as well as in 4 of the 5 previously reported cases. It is most important that surgical treatment be performed without delay.
  • MASAYA SUGIURA, SATORU MATSUSHITA, KEIJI UEDA
    1982 年 46 巻 4 号 p. 337-345
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    The incidence and etiological classification of valvular diseases were examined on 358 cases from 3, 000 consecutive autopsyes of more than 60 years of age. The incidence of valvular disease was 11.9% (358 out of 3, 000 cases). Mitral stenosis was found in 23 cases (6.4%), of which 21 cases were rheumatic and the remaining 2 were mitral ring calcification (MRC). Mitral regurgitation was observed in 126 cases (35.3%): 69 of papillary muscle dysfunction, 26 of mitral valve prolapse (MVP), 16 of MRC, 9 of ruptured chordae tendineae, 3 of rheumatic and 3 of congenital. Aortic stenosis was noted in 33 cases (9.2%): 27 of calcified, 5 of rheumatic and one of congenital. Aortic regurgitation was found in 169 cases (47.2%): 112 of degenerative, 47 of syphilitic, 7 of rheumatic and 2 of aortitis syndrome. There were 6 cases ( 1.7%) of tricuspid regurgitation. Etiological classification revealed 6 cases (1.7%) of congenital, 36 (10%) of rheumatic, 49 (1 3.7%) of syphilitic, 27 (7.5%) of MVP, 69 (19.3%) of ischemic and 166 (46.4%) of degenerative valvular disease. The results emphasize the high incidence of non-inflammatory valvular diseases including those of degenerative etiology in the cases studied.
  • SHOICHI FURUTA, YASUHIKO WANIBUCHI, TAKASHI INO, KEIICHI AOKI
    1982 年 46 巻 4 号 p. 346-351
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Non-rheumatic mitral regurgitation was found in 9.1% (27 patients) of all patients with a secundum atrial septal defect (298 patients) who were operated on during a 13-year period at the Mitsui Memorial Hospital. This combined lesion was more frequent in female (12.3%, 19 patients) than male (5.6%, 8 patients), and the incidence tended to increase with age. Inspection at operation revealed a marked fibrous thickening of the anterior and posterior mitral valve leaflets with a localized bulging into the left atrium in the posteromedial commissural area. Similar, but less prominent change was found in nearly all patients above 20 years of age without mitral regurgitation, although the small area where the commissural chordae were attached was not involved. A friction between anterior and posterior mitral leaflets due to abnormal left ventricular motion secondary to the right ventricular volume overload might be responsible to the genesis of this lesion. Mitral annuloplasty was performed on 21 of 27 patients with a satisfactory result without operative mortality. Except one case of early death from cerebral thromboembolism they were all restored to a functional status of class I by NYHA standard within one year after operation, and there were no late death during a follow-up period of as long as 12 years. We propose a new entity ASD, MR complex for this combined lesion, as it demonstrates a specific pathophysiology, and necessitates a different procedure for surgical correction from that of a secundum atrial septal defect without other anomalies.
  • KENJI NAKAMURA, HITOSHI KOYANAGI, KOSHICHIRO HIROSAWA
    1982 年 46 巻 4 号 p. 352-361
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    One hundred and thirty patients at our Heart Institute with infectious endocarditis during the past 5 years were reviewed to provide an overview of the spectrum of infective endocarditis and to assess the accuracy of echocardiography in detecting the infective valvular and endocardial lesions. Of the 130 patients, 36 (28%) had had previous cardiovascular surgery. The mean age of the patients was 34 years, and only 11% of the patients were over 50 years of age. Of the 94 patients who had no cardiovascular surgery before developing infective endocarditis, 6 underwent urgent surgery, 49 had elective surgery and the remaining 39 were followed up with medical treatment. The mortality rate of the 55 patients who were operated on was 5.5% as against 18.0% in 39 without surgery. Half of the 36 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of the 5 patients with bioprosthetic valve endocarditis, only one survived as a result of prompt medical and surgical treatment. Streptococci were still commonly found, about 75% in the group without surgery and 50% in the group with surgery. Gram-negative bacilli and fungi were found in patients with prosthetic valve endocarditis. In 61 patients, morphologic abnormalities confirmed at surgery or necropsy were compared with the preoperative echocardiograms. Vegetations were identified preoperatively in 50 (95%) of the 53 valves involved, and valve destruction was correctly predicted in all 23 cases. Mycotic aneurysm was detected preoperatively in only 3 of the 12 patients in whom it occurred. Thirteen patients, in whom vegetation was recorded, were treated successfully with antibiotics alone and they needed no surgical intervention during the 2-year follow up period. The presence of a vegetation in an echocardiography does not necessarily require surgical intervention in itself or predict the ultimate course.
  • KOUJI IMATAKA, NOBUO TAKAHASHI, AKIRA SEKI, JUN FUJII
    1982 年 46 巻 4 号 p. 362-368
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    The present paper describes peculiar lesions in papillary muscles and mitral valves produced by vagal manipulations. In the 109 rabbits killed one week after clipping or crushing of their cervical vagi, papillary muscle and mitral valve lesions were found in 53 (48.6%) and 52 (47.7%) hearts respectively. The lesions were identified by visible deposits of colloidal carbon which had been injected intravenously during the first 3 postoperative days. The left ventricular free wall, interventricular septum and right ventricle were free of carbon deposits. The papillary muscles involved were characterized by swelling and increased stiffness which corresponded to degeneration of the myocardial cells and interstitial fibrosis on microscopic observation. Hydroxyproline content of the papillary muscles involved was 1.4 times more than that of normal hearts, while there was no significant difference in hydroxyproline content of either interventricular septum or left ventricular free wall between the manipulated and the normal preparations. Heart murmurs were heard in 23 animals studied. Phonocardiograms revealed mid to late systolic murmurs with or without midsystolic click. These results indicate that the vagus nerve plays an important role in the pathogenesis of some forms of papillary muscle and mitral valve lesions.
  • SEIKI NAGATA, HIROSHI SAKAKIBARA, TAISEI MIKAMI, SHINTARO BEPPU, YUNG- ...
    1982 年 46 巻 4 号 p. 369-376
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Mitral valve prolapse is diagnosed in real-time two-dimensional echocardiograms when there are discrepancies in the coaptation zone of the anterior mitral leaflet and the posterior mitral leaflet. Out of the 100 cases of mitral valve prolapse diagnosed in this way, 65 had prolapsed anterior mitral leaflets, 28 prolapsed posterior mitral leaflets and 7 prolapses of both the anterior and posterior mitral leaflets. In addition to the cases with mitral valve prolapse, 23 cases of ruptured chordae tendineae of the mitral valve, including 15 cases which had undergone surgery, were investigated. The frequent site of mitral valve prolapse was the posteromedial commissure in the anterior leaflet and the posteromedial and anterolateral commissures in the posterior leaflet. These sites coincide with those where rupture of the chordae tendineae of the mitral valve was apt to occur. An investigation of the relation between age and mitral valve prolapse showed that the number of cases of prolapsed anterior leaflet did not increase with age, but there was an age-related increase in the number of cases of prolapsed posterior leaflets. It was also found that the degree of the prolapse progressed with age. Many of the cases of ruptured chordae tendineae of the mitral valve were in their forties or fifties, and there appeared to be some relation between the progress of the prolapse and age. Mitral regurgitant murmurs were recorded on phonocardiograms, and the severer the degree, the wider the range of the prolapse. Mitral regurgitation was more likely to occur in cases of prolapsed posterior leaflets than in those with prolapsed anterior leaflets, even if the degree and the range of the prolapse were mild.
  • HIROHIDE MATSUO, HISAKI MORITA, SHOICHI SENDA, AKIRA KITABATAKE, MASAT ...
    1982 年 46 巻 4 号 p. 377-388
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Regurgitant flows in valvular diseases were evaluated by a pulsed Doppler flowmeter combined with an electronic beam sector scanning echocardiograph. The apparatus which was newly developed by us allowed the simultaneous demonstration of a sample site on a two-dimensional echocardiogram with flow measurement. Doppler signals of regurgitant now were recorded as uni-directional or bidirectional wide frequency band signals. The locations, where regurgitant flow signals were detected, were depicted on the corresponding two-demensional echocardiogram. This procedure was referred to as "a flow mapping technique" for non-invasive visualization of the distribution of regurgitant flow. In 12 patients with mitral regurgitation due to mitral valve prolapse detected by the pulsed Doppler technique, the regurgitant flow was distributed to the opposite side of the prolapsing mitral leaflet. The transmission of the regurgitant murmur was well consistent with the direction of the regurgitant flow. In 14 patients with aortic regurgitation, the distribution of aortic regurgitant flow visualized by the flow mapping technique closely coincided with that obtained by cineaortography. Based on the distribution of the regurgitation, the severity of the regurgitation could be precisely evaluated by the Doppler technique. Regurgitant flow signals were detected in the right atrium in all 13 patients with tricuspid regurgitation diagnosed by right ventriculography. We found 4 patients who did not show Carvallo's sign but in whom were detected regurgitant flow signals by the Doppler technique. In all of them, tricuspid regurgitation was proven at surgery. These results indicate that the Doppler technique presented here has an obvious clinical advantage in detecting and evaluating regurgitant flow in valvular diseases.
  • MITSUSHIGE OHTA, TOSHIO YAMAGUCHI, HIROAKI NAITO, TAKAHIRO KOZUKA, KAT ...
    1982 年 46 巻 4 号 p. 389-394
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    An angiocardiographical analysis of the rheumatic mitral valvular changes was performed on 344 patients examined during the period from October, 1977 to July, 1980. The following results were obtained: 1) In the analysis of the mitral apparatus, the mitral orifice projection which enables us to observe the mitral annulus as en face and the long axial projection enabling us to observe the profile was particularly useful for the diagnostic validity. 2) Mitral orifice projection was useful for the diagnosis of stenosis dominant lesion, while long axial projection was beneficial for the diagnosis of regurgitation dominant lesion. 3) The measurements of mitral apparatus were carried out through these projection methods. It was found that the diameter of annular ring as well as the area of posterior leaflet were markedly increased in the mitral regurgitation group.
  • KEIKO AMANO, TSUGUYA SAKAMOTO, YOSHIYUKI HADA, TSUNEO YAMAGUCHI, TOSHI ...
    1982 年 46 巻 4 号 p. 395-401
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Contrast echocardiography with simultaneous M-mode echocardiography was performed in 77 cases of tricuspid regurgitation (TR) and 168 cases having no TR (non-TR). The echocardiographical characteristics of TR were as follows: 1) By the subxiphoid approach, a contrast appeared in the inferior vena cava during systole. In some cases of non-TR, a similar appearance was noted but limited to the atriosystolic or late systolic-to-early diastolic phases. Such confusing cases should be excluded by the simultaneous observation of the M-mode contrast echogram. 2) By apical four-chamber view, a negative contrast echo above the tricuspid valve and subsequent back and forth movements of the contrast across the valve were useful. This movement, however, may be misleading on two-dimensional echo and the M-mode echocardiogram was also necessary to obtain the exact timing and the direction of regurgitant flow. 3) Presence of the dilated inferior vena cava The sensitivity of this method was extremely high, and the specificity was also excellent for TR.
  • HARUO TOMODA, MITSUMOTO HOSHIAI, SEIYA MATSUYAMA
    1982 年 46 巻 4 号 p. 402-406
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    Forty-two patients with valvular heart diseases were studied with a third-generation computed tomographic system. The cardiac chambers (the atria and ventricles) were evaluated semiquantitatively, and valvular calcification was easily detected with computed tomography. Computed tomography was most valuable in revealing left atrial thrombi which were not identified by other diagnostic procedures in some cases.
  • YASUNARU KAWASHIMA, SUSUMU NAKANO, SHIGEO SATO, KEI SAKAI, TAKESHI NAK ...
    1982 年 46 巻 4 号 p. 407-414
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    There has been a continuing controversy between reconstructive valve surgery and replacement. In this paper, an analysis of clinical and hemodynamic late results of the patients undergoing open mitral commissurotomy (OMC, 135 patients), repair of mitral regurgitation (MAP, 32 patients), and combined valvuloplasty (62 patients) was presented. 1) OMC: The 10-year actuarial survival rate was 86.5% Postoperatively. None of the patients required reoperation in this series. Clinical and hemodynamic improvements mainly depended upon the anatomical severity of a stenosed mitral valve. 2) MAP: The 10-year actuarial survival rate was 94% postoperatively. Especially, good to excellent results were obtained in the patients with mitral regurgitation due to ruptured chordae or dilated annulus. 3) Combined valvuloplasty: The 10-year actuarial survival rates postoperatively were 90% in OMC + tricuspid annuloplasty group (31 patients), 100% in MAP + tricuspid annuloplasty group (7 patients), and 87.2% in OMC + aortic commissurotomy group (24 patients). The reconstructive valve surgery provides very small operative risk, very low late mortality and morbidity. Therefore, it should be the treatment of choice for most of the patients with symptomatic valve disease.
  • KEN-ICHI ASANO
    1982 年 46 巻 4 号 p. 415-419
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    By careful and aggressive managements throughout the follow-up period, the actuarial survival rate of the patients who underwent valve replacement was improved to 88.5% after 5 years and 83% after 10 years. Hereafter, it is expected that the over-all survival rate will be improved much more by the progress of the treatment in the early stage following the operation.
  • TSUYOSHI FUJITA, KOHEI KAWAZOE, SHINTARO BEPPU, HISAO MANABE
    1982 年 46 巻 4 号 p. 420-426
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    In severe mitral valvular disease with a giant left atrium, there occur such abnormal findings as the compression and bending of the basal portion of the posterior wall of the left ventricle accompanied by its paradoxical movement. Following mitral valve replacement in this group of patients, it was found that the strut of the artificial valve is apt to lean against the ventricular septum and the inflow stream of blood was directed toward outflow tract of the left ventricle, appearing to be obstructed by the ventricular septum. Here, we devised a new surgical method, para-annular plication, for patients with a giant left atrium. By this procedure, the compression and bending of the basal portion of the posterior wall of the left ventricle and the paradoxical movement were all relieved. The abnormal angle of the mitral valvular ring was corrected, the strut of the artificial valve was free from contact with the ventricular septum and the inflow stream of blood was directed toward the apex of the ventricle in usual manner. The overall operative result for giant left atrium has been markedly improved by this procedure.
  • SHIGERU TERAMOTO, SHUNJI SANO, KAZUHIDE AOKAGE, MASAHARU SHIGENOBU, TA ...
    1982 年 46 巻 4 号 p. 427-432
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    A clear correlation expressed by the following equation was observed between the preoperative left ventricular end-systolic eccentricity (&s) and the percentage change of the left ventricular dimension (%ΔD) in chronic valvular heart diseases: %ΔD = 88.37 &s - 48.16 (r = 0.66, p < 0.001). Therefore, &s may function as an index for predicting the postoperative cardiac performance independent of the affected valvular locations and the morphology of the lesions.
  • SHIGETAKE SASAYAMA, AKIRA OHYAGI, JONG-DAE LEE, HIROSHI NONOGI, TSUNET ...
    1982 年 46 巻 4 号 p. 433-441
    発行日: 1982/04/20
    公開日: 2008/04/14
    ジャーナル フリー
    The hemodynamic response to afterload reduction by sodium nitroprusside was assessed in 5 patients with mitral regurgitation and in 7 with aortic regurgitation. The drug significantly lowered left ventricular systolic pressure, end-diastolic pressure and end-diastolic volume. In patients with mitral regurgitation, significant decreases in regurgitant volume (74 ± 10 to 44 ± 7 ml) and regurgitant fraction (60 ± 4 to 41 ± 5%) were associated with substantial increases in cardiac output (4.18 ± 1.18 to 5.43 ± 1.18 L/min) and forward stroke volume (49 ± 10 to 64 ± 9 ml). In patients with aortic regurgitation, vasodilator therapy was effective in increasing forward output only in 2 patients who had an initially elevated end-diastolic pressure which was reduced only to levels slightly above normal with nitroprusside. In patients with a lower level of end-diastolic pressure, further reduction in the filling pressure resulted in no benefit or rather a fall in forward stroke volume, despite a significant increase in pump function (ejection fraction being augmented from 55 4 to 61 5%). Experiments in dogs confirmed that nitroprusside reduced the amount of mitral regurgitation by virtue of diminishing the regurgitant orifice size, as a result of the reduction in size of the left heart chamber. These observations also support the concept that it is ultimately important to maintain filling pressure at an optimal level during administration of a vasodilating agent, otherwise effects due to afterload reduction tend to be offset.
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