We assessed the function of sympathetic nerves distributed to skeletal muscles by measuring the uptake of iodine 123 metaiodobenzylguanidine (MIBG), and examined the relationship to pressor responses during exercise. A total of 24 patients with heart disease performed treadmill exercise, and whole body delayed MIBG imaging was carried out. Based on the leg to brain ratio of MIBG (L/B), subjects were classified into two groups consisting of 10 with low L/B and 14 with preserved L/B. Results: 1) The peak systolic blood pressure (BP) during exercise was higher in the group with low L/B than in the group with preserved L/B. 2) There were no differences in plasma noradrenaline levels between the two groups. Conclusion: These results suggest that denervation supersensitivity may influence the BP response to exercise in patients with heart disease.

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Intraoperative detection of deeply embedded coronary arteries is difficult, especially in off-pump coronary bypass surgery. From July 2010, we introduced high-frequency epicardial ultrasound for assessing embedded arteries during off-pump coronary bypass surgery. Between July 2010 and July 2011, 89 consecutive patients underwent isolated coronary bypass surgery in our institution. In 10 patients (11.2%, 10/89), the target vessels could not be identified either visually or on palpation. All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during operation. High-frequency epicardial ultrasound is useful in detecting embedded coronary arteries in off-pump coronary bypass surgery.

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Sixty-nine year’s old male admitted to our hospital for electrocardiographic abnormality pointed out from medical checkup, and was revealed the occlusions of left anterior descending artery (LAD) by coronary CT angiogram. We diagnosed myocardial viability was remained because of spared anterior wall motion from trans-thoracic echocardiogram. Then we planned angioplasty. At first, we performed micro-catheter tip-injection at the beginning of occlusion in LAD. This selective angiogram showed distal true lumen, and we recognized existence of micro channels in occlusive lesion. This channels had a bend like a epsilon shape toward diagonal branch. Next, we used 0.010 guidewire with a tiny acute tip bend. It could lead to get distal lumen successfully. Finally, we performed balloon dilatation and stent implantation. In summary, we could make succeed of guidewire passing through the chronic total occlusive lesions, since we made selective projection of micro channels using by micro-catheter tip-injection and we visualized micro channels runway.

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Purpose: The purpose of this study is to predict the mechanism of cardiac sudden death (CSD) by analyzing the fatal events associated with acute myocardial infarction (AMI). Methods and Results: To predict the mechanism of CSD, clinical characteristics were analyzed in 5 AMI cases which presented early ventricular tachyarrhythmia over the 7 months from January, 2011. Case 1; 30-year-old (y/o) male underwent primary percutaneous coronary intervention (PCI) for acute inferior MI. He was wearing an ambulatory electrocardiography 2 days before the onset of AMI. ST segment depression with prolonged QTc interval followed by ventricular tachycardia (VT) was shown in the recording at night. Intracoronary injection of acetylcholine revealed multivessel spasm with subsequent prolonged QTc and ventricular ectopy. Case 2 and 3; two 67 y/o males were treated with primary PCI after direct current (DC) shock for ventricular fibrillation (VF). Case 4; 62 y/o male whose VF was treated with DC shocks in the emergency room (ER), and died of pulseless electrical activity (PEA) with heart rupture after successful PCI for acute anterior MI. Case 5; 71 y/o female with acute inferior MI due to stent thrombosis presented cardiogenic shock and VF which was treated in the ER. Conclusions: The fatal events associated with AMI were VF, VT induced by prolonged QTc via multivessel spasm, and PEA due to heart rupture. Coronary spasm is also suspected to be an important factor to induce VT, resulting in CSD.

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A 61-year-old male patient with diabetes mellitus and chronic kidney disease, suffered from transient syncope during periodical hemodialysis due to hypotension. Cardiac echocardiography showed poor left ventricular function with its ejection fraction of 30%. Coronary angiography (CAG) revealed a total occlusion in segment 6 of left anterior descending artery (LAD) and a 90% stenosis in segment2 of right coronary artery. Although coronary artery bypass grafting (CABG) was recommended for his diseased coronary condition, distal runoff of LAD could not been recognized at all by CAG. However, it was possible to describe distal part of LAD distinctly as a target vessel, using 64 row multi-detector computed tomography. We could perform off pump CABG uneventfully.

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With the recent aging of society, the number of elderly people with impaired physical function is increasing, and the number of cases in which conventional outpatient cardiac rehabilitation (CR) is difficult to implement is increasing. Although cardiac patients who are unable to attend outpatient treatment services are transitioned to care at home, home-visit rehabilitation may not provide adequate intervention for severe cardiac patients due to risk for cardiac diseases. Thus, adequate CR intervention cannot be undertaken easily in cardiac patients with impaired physical function who are unable to attend outpatient treatment services. At our hospital, we started a home-visit CR program for such patients. This program targets cardiac patients who are unable to attend outpatient treatment services and are expected to be difficult to treat by home-based services. Our rehabilitation doctors and physiotherapists directly visit the patients at home. In the home-visit CR program, training for rehabilitation exercises within the safety range allowed by the disease condition are provided; in addition, lifestyle guidance is provided, and the living environment is adjusted. We consider that sharing this information with patients, their families, and other home-based caregivers will reduce their anxiety and may be helpful for home-based healthcare of severe cardiac patients.

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