JAPANESE CIRCULATION JOURNAL
Online ISSN : 1347-4839
Print ISSN : 0047-1828
ISSN-L : 0047-1828
48 巻, 3 号
選択された号の論文の13件中1~13を表示しています
  • MASAKAZU MOTOMURA, YOSHIHIRO KAWAGUCHI, MATSUHIKO SAWAMURA, MASAHIKO K ...
    1984 年 48 巻 3 号 p. 201-211
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Fifty patients with or without coronary artery disease were studied. Twelve of them showed no coronary artery obstruction, while 38 demonstrated obstruction of the left anterior descending artery (LAD). Of the latter 38, 16 had obstruction at LAD alone, 6 at LAD and right coronary artery (RCA), 8 at LAD and left circumflex artery (LCx) and 8 at LAD, RCA and LCx. Vectorcardiography, selective coronary cineangiography and left ventricular cineangiography were undertaken in all subjects. The vectorcardiogram (VCG) was recorded on a magnetic tape and QRS area vector (A^^→qrs), T area vector (A^^→t) and ventricular gradient (G^^→) were calculated by micro-computer. From left ventriculogram (LVG) "score" was computed to express the grade of impairment of the wall motion. Correlations between various vectorcardiographic parameters and this score were examined. The score correlated significantly (p<0.001) with azimuth of A^^→qrs (r=-0.545), azimuth of A^^→t (r=0.661), magnitude of G^^→ (r=-0.705), azimuth of G^^→ (r=0.533), G/Aqrs (r=-0.645), spatial angles between A^^→qrs and A^^→t (r=0.591) and between max R^^→ and max T^^→ (r=0.595) and X component of G^^→ (r=-0.758). These results suggested the usefulness of ventricular gradient to grasp the grade of coronary artery disease.
  • HIROSHI YAMABE, KATSUYA KOBAYASHI, TOMOO INOUE, EIICHI TAJIRI, KAZUHIR ...
    1984 年 48 巻 3 号 p. 212-218
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Four patients with old myocardial infarction (OMI) revealed exertional hypotension in the treadmill exercise test. All had a multivessel disease, severe left ventricular dysfunction and exercise-induced ST depression or angina to indicate additional myocardial ischemia. After 5 mg of oral isosorbide dinitrate (ISDN), the response of blood pressure was improved with a delayed onset of ST depression or angina. To confirm the effect of ISDN on the pressure response to exercise, 26 patients with OMI were further studied. In patients without ST depression and angina (Group I), the systolic blood pressure (SBP) at the matched work load was significantly decreased after ISDN. However, in patients with ST depression or angina (Group II), SBP at the matched work load was not altered after ISDN. The increment of change in SBP due to ISDN, namely from the resting level to the matched work load, was significantly larger in Group II than in Group I. In addition, the patients with marked left ventricular dysfunction in Group I revealed a more change in SBP due to ISDN than the others in Group I. It was concluded that exertional hypotention or supressed pressure response of OMI could be corrected by 5 mg of oral ISDN due to its favorable effects on the exercise-induced myocardial ischemia and preexisting left ventricular dysfunction.
  • MAKOTO KONDO, SCHUNICHI MIYAZAKI, MAMORU TAKAHASHI, YUKIO SHIMONO
    1984 年 48 巻 3 号 p. 219-224
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    The viability of the myocardial regions corresponding to pathologic Q waves was evaluated .Thirty-four patients with prior myocardial infarction underwent serial thallium-201 scintigraphy during treadmill exercise testing. On the delayed images, 8 of the initial 85 segmental defects (8 patients, 9%) showed total redistribution (RD) and 11 (6 patients, 13%) showed partial RD. In contrast, 66 segments showed persistent defect. The segments with total RD were more likely to be associated with normal or hypokinetic wall motion than the segments with persistent defect (p<0.05). Six of the 38 segments (13%) with collateral vessels showed total RD and 10 (21%) showed partial RD. However, 35 of 38 segments (92%) without collateral vessels showed persistent defect. There was a significant difference (p=0.02) in myocardial thallium uptake patterns when the segments with and without collateral vessels were compared. It is concluded that (1) Exercise-induced thallium RD may occur in patients with prior myocardial infarction, and myocardial infarct regions with total RD are highly associated with good contractility; these suggest the presence of viable but jeopardized myocardium within the infarct zone, and (2) collateral vessels may play a role in limiting infarct size.
  • KINJI ISHIKAWA, TAKEO HAYASHI, YASUYUKI KOHASHI, SHOHEI OTANI, KEN KAN ...
    1984 年 48 巻 3 号 p. 225-232
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Left ventricular size is one of the major determinants of myocardial oxygen consumption, therefore if oxygen inhalation reduces myocardial oxygen demand, such might be beneficial in the treatment of acute myocardial infarction. Routine diagnostic biplane left coronary cineangiograms were obtained during air or oxygen breathing in 11 patients with old myocardial infarction or angina pectoris. Coordinates of the points on the left coronary artery were measured and throughout one cardiac cycle frame by frame .The spatial distance (segment length: L) between any two of these points was calculated. Segment length at R wave on the electrocardiogram (LECG R) and minimum value (Lmin) for each segment were calculated. Arterial pO2 was elevated by oxygen breathing from 91 ±4 (±SE) to 427 ±18 mmHg. Left ventricular segment length was significantly reduced by oxygen breathing: LECG R being reduced following oxygen breathing from 62.3±3.0 to 60.6±3.0 mm (a decrease of 3.3 ±0.8%) and Lmin also being reduced from 55.9±2.8 to 54.4±2.8 mm (a decrease of 3.1±1.0%). These figures indicate that left ventricular size was reduced. Reduction in left ventricular size through oxygen inhalation, by reducing myocardial oxygen demand, should therefore be beneficial in coronary artery disease.
  • KOUICHI TAMIYA, MOTOAKI SUGAWARA, RONALD W. MILLARD
    1984 年 48 巻 3 号 p. 233-246
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    A canine papillary muscle is loaded to mimic the load of the myocardium in the wall of the left ventricle with atrio-ventricular valvular insufficiency .This mechanical model which simulates the atrio-ventricular valvular regurgitation is based on two simple assumptions. The assumptions arranged for the papillary muscle experiment are as follows: 1) the force that the myocardium encounters during muscle shortening is proportional to the muscle shortening velocity due to regurgitation through a narrow regurgitant orifice; and 2) the myocardium exerts a constant force while the aortic valve is open. The muscle shortening except the isotonic phase is ascribed solely to regurgitation since the aortic valve is closed during these phases. In the combined antegrade/retrograde ejection phase, which is characterized by a constant muscle force, the shortening velocity due to regurgitation is constant because of the assumed functional relation between the muscle force and shortening velocity. The amount of shortening assigned to regurgitation in this phase is given by the duration of this phase. The present in-vitro studies offer an alternative explanation for decrease in the regurgitant fraction as total load was reduced at a constant preload. The regurgitant fraction decreased as preload was increased at a constant total load in the present study. The regurgitant fraction also decreased by either isoproterenol or CaCl2 administration via the coronary artery.
  • MASATOSHI UKAI, KOUICHI OGAWA
    1984 年 48 巻 3 号 p. 247-252
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    The effect of the left anterior descending (LAD) coronary artery ligation on myocardial cyclic nucleotides and the role of these nucleotides in the development of ventricular fibrillation (VF) were studied in 135 mongrel dogs by means of sequential punching biopsies from the left ventricle. VF occurred in 50% of the non-premedicated groups. Significant increases of cyclic AMP (c-AMP) concentrations in the ischemic zone were observed after the ligation in VF group. C-AMP concentrations in the ischemic zone were significantly higher after the ligation compared with the border and non-ischemic zone as well as with the non-VF group. They also increased significantly from 30 sec before the onset of VF compared with 2 to 25 min before. No significant change was observed in the control group. In 41 dibutyryl cyclic AMP (DBc-AMP) premedicated dogs, the incidence of VF significantly increased, and c-AMP concentrations were significantly higher than in the non-premedicated group before and after the ligation. They were significantly higher in the ischemic zone 10, 15 and 20 min after the ligation than in the non-ischemic zone. There was a discrepancy of c-AMP concentration between the ischemic zone and the non-ischemic zone in VF induced group, whether DBc-AMP was premedicated or not. Significantly decreased cyclic GMP (c-GMP) levels in the ischemic and the non-ischemic zone were observed after the ligation. C-GMP concentrations with the DBc-AMP premedicated were significantly lower after the ligation compared with the non-premedicated group. Thus, it was concluded that increased c-AMP concentrations in the ischemic zone compared with in the non-ischemic zone had a dangerous tendency to induce VF.
  • SEIBU MOCHIZUKI, SHIN-ICHIRO ISHIKAWA, MASAKAZU ABE
    1984 年 48 巻 3 号 p. 255-265
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Difficulty of some patients to maintain adequate cardiac output following the termination of cardiopulmonary bypass remains a significant problem in cardiac surgery. The patients with diabetes mellitus frequently fail to respond to therapy after the cardiopulmonary bypass. However, little is known about the relationship between the control of diabetes mellitus and myocardial performance. The purpose of the present study was to look at the effect of diabetes and insulin treatment upon ventricular function and myocardial microcirculation in isolated perfused rat heart. Experimental diabetes was induced by injecting streptozotocin and some of them were treated by insulin injection. Severe form of ischemia was induced in heart from acute form of diabetes and functional recovery was compared among the control, diabetic and insulin treated groups. In chronic form of diabetes, myocardial function and microcirculation which was measured by local H2 generation method were studied during aerobic perfusion and mild form of ischemic perfusion. The hearts from experimental diabetes were more susceptible to ischemia and insulin pretreatment protected the functional alterlations. This beneficial effect of insulin was associated with improved glucose and fatty acid metabolism. Myocardial microcirculation in hearts from diabetes was significantly less than in control, however, this was not correctable by the insulin treatment.
  • SHUNEI KYO, HIDETO EMOTO, HIDEO YAMANAKA, SHINICHI TAKAMOTO, YUJI YOKO ...
    1984 年 48 巻 3 号 p. 266-275
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Dynamic patch artificial myocardium (D-PATCH) has been developed to replace the damaged left ventricular (LV) wall in severe cardiogenic shock patients with a massive myocardial infarction. This study was undertaken to demonstrate the effects of (1) single D-PATCH support on the global cardiac function (group 1, 12 dogs, whole heart model), (2) single D-PATCH support on the LV function and myocardial metabolism (group 2, 6 dogs, right heart bypass model), and (3) the concomitant support of D-PATCH and aortic counterpulsation (CP) on the regional myocardial function of the residual LV wall (group 3, 6 dogs, right heart bypass model with ultrasonic piezoelectric crystals). In group 1, mean aortic pressure and cardiac output were increased 20-36% (p<0.01) and 17-50% (p<0.01) respectively, and mean left atrial pressure was decreased 16% (p<0.01) by D-PATCH assist. In group 2, under constant preload volume, afterload pressure and heart rate, tension time index (TTI) was decreased 21-26% (p<0.01) and myocardial oxygen consumption was also decreased 24-29% (p<0.001) by D-PATCH assist. In group 3, although peak LVP was increased by single D-PATCH assist, when heart was assisted concomitantly by D-PATCH and CP peak LVP was significantly decreased (18%, p<0.01). Percent LV segmental shortening was not increased by CP assist, but increased 143% (p<0.02) by D-PATCH assist. In conclusion, D-PATCH can improve the global LV function and myocardial metabolism of the ischemic failing heart, also improve the regional myocardial function of the residual LV wall. Thus, D-PATCH is effective for the salvage of ischemic myocardium while maintaining the global cardiac function.
  • TAKAO IDA, NOBORU YAMATE, SHINICHI OSAKA, HIROSHI TAKEI, MASATOSHI IKE ...
    1984 年 48 巻 3 号 p. 276-287
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    OF the patients treated in the CCU of Nippon Medical School for acute myocardial infarction in the past 5 years and 8 months, 44 with cardiogenic shock, 11 with severe heart failure, 7 with ventricular septal perforation and 2 with mitral regurgitation were treated by IABP. The peak effect f IABP on the hemodynamics of patients with cardiogenic shock was noted 24 hours after starting on IABP. When hemodynamics were compared between surviving and dead groups, there was a significant difference in stroke volume index between the two groups. When left ventricular function was compared between them, it was suggested that patients whose left ventricular function does not respond to IABP for 48 hours or longer are more likely to die than responders. Twenty-four of 44 patients became independent of IABP, but no more than 13 patients (30%) survived for 6 months or longer. Isosorbide dinitrate (ISDN) was combined with IABP in 7 patients who had a persistence of heart failure in spite of IABP. Combination therapy with IABP and ISDN elicited a significant increase in cardiac index, a significant decrease in pulmonary capillary wedge pressure, mean pulmonary arterial pressure and total peripheral resistance and a pronounced improvement in left ventricular function, and all 7 patients became independent of IABP. In the patients with acute myocardial infarction complicated with ventricular septal perforation, the mean systolic arterial pressure was 87.7±8.3 mmHg, mean pulmonary capillary wedge pressure 20.3±7.4 mmHg and pulmonary-to-systemic flow ratio, 3.12±0.95 before starting on IABP. When the hemodynamics at 3 hours of IABP were compared to the pre-IABP values, the right atrial pressure, pulmonary capillary wedge pressure and pulmonary-to-systemic flow ratio had a tendency to decline, but the changes were not statistically significant, except for the peak arterial pressure which showed a significant elevation at 3 hours of IABP. Three of the 7 patients became dependent on IABP, and 2 of the 3 patients were saved by emergency operation.
  • HAJIME HIROSE, HIKARU MATSUDA, YASUNARU KAWASHIMA
    1984 年 48 巻 3 号 p. 288-294
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Eighty-seven cases were studied in which IABP was used with open heart surgery, and 19 in which V-A bypass was employed. IABP was used in 31 patients with ischemic heart disease, which had the best survival rate (52%). Recent experience shows that the effects of IABP increase the operability of certain high-risk patients with severely impaired left ventricular function. In valvular heart disease, IABP was used with a survival rate of 34%. In congenital heart disease, the IABP survival rate was the worst among the groups studied because, in addition to left heart failure, many other factors also as cause the low cardiac output syndrome during corrective surgery for complicated cardiac anomalies. In total right heart bypass, or Fontan's procedure, three out of five cases were weaned from IABP; one of them is still alive. IABP was used with success in one case of valvular heart disease with almost no contraction of the right ventricle after repair. Therefore, IABP could be expected to improve the condition of severe postoperative right heart failure, or the equivalent condition, when there is subnormal left ventricular function in the postoperative period and pulmonary vascular resistance is normal. There has been only one successful V-A bypass lasting 11 hours, in valvular heart disease, and another case, in congenital heart disease, where the patient was weaned after V-A bypass lasting four days.
  • TAKASHI INO, YASUHIKO WANIBUCHI, SHOICHI FURUTA
    1984 年 48 巻 3 号 p. 295-301
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    As a mechanical cardiac support, prolonged (over 5 hrs) Veno Arterial Bypass (VAB) with membrane oxygenator was indicated to 13 patients who was profound cardiogenic shock following open heart surgery, among 1700 cases of cardiac surgery (0.8%). In 12 of 13 cases, cardiopulmonary bypass could not be weaned after intracardiac repair, despite maximal pharmacological management with or without IABP support. Another one case was intractable ventricular fibrillation in ICU, two days after operation .Six of 13 patients who were supported by prolonged VAB, survived and discharged from the hospital. In survivors, mean of VAB flow was 900±265 ml/min/m2, in died 7 cases, mean of VAB flow was 1450±550 ml/min/m2 (p<0.05). The longest duration of VAB in survivors was less than 28 hrs. Improvements of anticoagulation and VAB circuits make it safer to manage prolonged VAB. For profound cardiogenic shock, prolonged VAB is an easy and safe mechanical cardiac support not only in surgical cases but in internal medical cases.
  • HISATERU TAKANO, YOSHIYUKI TAENAKA, TAKESHI NAKATANI, TETSUZO AKUTSU, ...
    1984 年 48 巻 3 号 p. 302-311
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    It is desirable that circulation control of the patient using a left ventricular assist device (LVAD) should be achieved appropriately and safely. We have developed an automatic LVAD system, which can maintain the normal circulation irrespective of the severity of heart failure and can restore the failing heart by decreasing the bypass flow (BF) through the LVAD as the heart recovers. The main part of the control-drive unit is an automatic level control (ALC) system for left atrial pressure (LAP) and total flow (TF). Profound left ventricular failure (LVF) was made by complete interception of blood supply to the extent of 50% (5 goats) and 70% (5 goats) of the LV free wall. The air-driven diaphragm-type LVAD was implanted between LA and aorta. At the beginning of LVAD pumping, BF tended to be very high to keep LAP at the preset level (0-5 mmHg) and to maintain TF at somewhat higher level (120-140 ml/kg/min). The recovering heart was able to decrease LAP gradually. Since the LAP was set at a certain level. During the recovering stage from LVF, preset level of LAP was gradually raised while checking the pulmonary function. When natural heart output exceeded 100 ml/kg/min, LVAD was removed. The 50% LVF group recovered between 17 hours and 3 days, and 70% LVF group between 6th and 16th postoperative day. This LVAD system was then applied to the postoperative profound LVF in a MVR patient whose entire circulation was maintained normal during 14 day pumping. The failed heart gradually recovered and the pump was successfully removed. We consider that the decompression of LV will prevent overextension of impaired myocardium and simultaneously accelerate the solid scar formation. And gradual increase of LV work will promote the compensation ability of the residual myocardium. Continuous LVAD assistance can therefore earn time for the impaired myocardium to recover while maintaining normal circulation.
  • FUMIO IWAYA, SHUNICHI HOSHINO, TSUGUO IGARI, KENJI HONDA
    1984 年 48 巻 3 号 p. 312-318
    発行日: 1984/03/20
    公開日: 2008/04/14
    ジャーナル フリー
    Twenty-seven calves were operated on in our institute for total artificial heart replacement. Thomasu hearts (made by the Thomasu Technical Company, Japan) were used in 21 calves from February 1980 to May 1983. Utah Jarvik 7 hearts were used for the first five calves and the 17th calf. The air-driven Thomasu heart, made of segmented polyurethane, has 95 ml and 85 ml of stroke volume in its left and right sides respectively and showed recognizable function curves in mock circulation systems. There were no satisfactory results in the first 19 cases but the 20th calf survived for 28 days. In 1982, we adopted a new surgical method in which, instead of suturing, a sutureless artificial graft with a stainless steel ring was inserted into the aorta and pulmonary truncus. Since then two out of six calves have survived for more than one month; one of these survived for 66 days. The causes of death after the Thomasu heart replacements were varied. Ten (48%) out of 21 cases had heart trouble and four calves (19%) died through thrombus formation at the inflow and outflow valves. Three calves (14%) died because of mechanical failure of the driving system, two (10%) due to surgical failure, one because of pneumonia, and one due to an abnormal reaction after donor blood transfusion. Our longest surviving calf died after 66 days, because of a broken left blood diaphram though, it remained in excellent condition until its death. There was no thrombus formation in either ventricle, no fibrin net formation and no calcium deposit on the surface of the diaphragm. The surgical technique and establishment of extracorporeal circulation in total artificial heart replacement have been confirmed as successful, especially when a sutureless technique is adopted for the outflow tract, but problems remain with the manufacture and durability of the heart. The resolution of these difficulties lies in the field of engineering science, but with development in this area we can certainly look forward to six-month survival in the calf.
feedback
Top