Clinical characteristics relevant to myocardial cell apoptosis: analysis of pericardial fluid.

We investigated the pro-apoptotic potential of pericardial fluids from patients with different clinical conditions on cultured neonatal rat cardiomyocytes. Pericardial fluids were obtained during open heart surgery from 88 patients with ischemic heart disease (n=44), valvular heart disease (n=32), or aortic disease (n=12). The terminal deoxynucleotidyl transfer-mediated end labeling fragmented nuclei assay was performed on primary cardiac myocytes from neonatal rats in the presence of 1% pericardial fluid from each patient.

Central cannulation for type A acute aortic dissection.

We present a simple new method for establishing cardiopulmonary bypass to treat type A acute aortic dissection. Antegrade blood flow in the true lumen is theoretically best to prevent malperfusion and retrograde embolization. Central cannulation can be performed in the true lumen of the dissected ascending aorta using an ultrasonographically guided puncture technique such as 'Seldinger's method'.

Multislice computed tomography accurately quantifies left atrial size and function after the MAZE procedure.

Background: Although the MAZE procedure allows for the recovery of sinus rhythm and left atrial (LA) mechanical function in the great majority of patients with chronic atrial fibrillation (AF), the effects of MAZE on the precise LA geometry and wall motion remain to be elucidated. We hypothesized that LA size and mechanical function in patients with chronic AF and mitral valvular disease are well restored after MAZE.

Methods And Results: We studied 14 patients (MAZE group: mean+/-SD age, 63.

Marked elevation of vascular endothelial growth factor and basic fibroblast growth factor in pericardial fluid of patients with angina pectoris.

Although we reported that basic fibroblast growth factor (bFGF) levels in pericardial fluid of patients with unstable angina are apparently increased, it was unclear whether vascular endothelial growth factor (VEGF) is also increased in patients with myocardial ischemia. Using an enzyme-linked immunosorbent assay, we measured the concentrations of VEGF and bFGF in pericardial fluid of 51 patients with open heart surgery. Patients were divided into group A (n=10) with class III unstable angina (Braunwald's classification), group B (n=24) with class I or II unstable angina or stable angina and group C (n=17) with non-ischemic heart disease.

Myocardial ischemia enhances the expression of acidic fibroblast growth factor in human pericardial fluid.

Acidic fibroblast growth factor (FGF) is a potent mitogen that can induce angiogenesis in vivo. We have recently reported a marked increase of basic FGF in the pericardial fluid of patients with severe coronary stenosis and an increase in vascular endothelial growth factor (VEGF) in the pericardial fluid of patients with severe myocardial ischemia. The purpose of this study was to evaluate whether acidic FGF levels in the pericardial fluid are associated with severe myocardial ischemia.

[A surgical case of acute massive pulmonary embolism associated with a giant free-floating inferior vena cava thrombus].

The risk and mortality of pulmonary embolism is high in patients with free-floating inferior vena cava thrombi. We present a successful surgical case of a 70-year-old male who had acute massive pulmonary embolism associated with a giant free-floating inferior vena cava thrombus extending above the renal veins. Emergent thrombectomy of the pulmonary artery and the inferior vena cava using cardiopulmonary bypass was carried out because he was considered at high risk for fatal recurrent pulmonary embolism.

Development of enzyme-linked immunosorbent assay for acidic fibroblast growth factor and its clinical application.

We have developed, for the first time, an enzyme-linked immunosorbent assay (ELISA) system for the measurement of human acidic fibroblast growth factor (aFGF). Anti-bovine aFGF rabbit IgG was conjugated with N-hydroxysuccimidobiotin, and the resulting IgG-biotin conjugate was used as the second antibody. This assay was highly specific and reproducible, enabling us to detect aFGF at a concentration as low as 1 microg/l without any prior processing of samples.

Oxygen concentration regulates NO-dependent relaxation of aortic smooth muscles.

Nitric oxide (NO) functions as an endothelium-derived relaxation factor and regulates vascular resistance. Recent studies in this laboratory(Arch.Biochem.

[A surgical case of cardiac malignant lymphoma in right atrium].

We reported a case of malignant lymphoma originating from the right atrium. The patient was a 71-year-old man who had no symptoms associated with heart failure and arrhythmias. At the time of admission the patient was suggested the presence of a tumor in the right atrium by an echocardiogram accidentally.

Marked elevation of brain natriuretic peptide levels in pericardial fluid is closely associated with left ventricular dysfunction.

Objectives: The purpose of this study was to investigate whether atrial and brain natriuretic peptides (ANP and BNP, respectively) represent autocrine/paracrine factors and are accumulated in pericardial fluid.

Background: ANP and BNP, systemic hormones produced by the heart, have elevated circulating levels in patients with heart failure. Recent evidence suggests that the heart itself is one of the target organs for these peptides.

Clinical application of transluminal endovascular graft placement for aortic aneurysms.

Background: In recent years, transluminal endovascular graft placement techniques have been developed for the treatment of aortic aneurysms. We report our initial clinical experience with endovascular graft placement using a graft developed in our laboratory.

Methods: The procedure was performed in 20 patients with a diagnosed aortic aneurysm.

Elevated basic fibroblast growth factor in pericardial fluid of patients with unstable angina.

Background: Collateral growth is induced by chemical signals from the ischemic myocardium. We hypothesized that angiogenic growth factors are produced by cardiac tissue; they are diffusible, more concentrated in pericardial fluids, and are increased by myocardial ischemia.

Methods And Results: With the use of an enzyme-linked immunosorbent assay, we measured the concentrations of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in pericardial fluids of 12 patients with unstable angina (group 1) and of 8 patients with nonischemic heart diseases (group 2).

Transesophageal echocardiography in the diagnosis of thoracic saccular aortic aneurysm. The value of transesophageal echocardiography during the course of treatment.

Transesophageal echocardiography (TEE) was performed in 17 cases of aortic aneurysms referred to our hospital for further examination and treatment. All 17 cases were treated surgically and TEE was performed as a preoperative examination. In nine of the 17 cases, there were already some signs of bleeding upon admission and in all of these nine cases, rupture of the aneurysm was confirmed during surgery.

[Results of surgical treatment of aortic dissections].

From January 1989 to September 1993, 59 consecutive patients (35 males and 24 females, mean age 59.6 years old) underwent surgical repair of aortic dissection on the cardiovascular surgical unit at Takeda Hospital. The type of aortic dissection were classified according to Stanford University criteria.

[Introduction of intra-aortic balloon pumping catheter through left subclavian artery guided by trans-esophageal echocardiography].

It is very difficult to insert an intra-aortic balloon pumping catheter into the descending aorta through the subclavian artery by the blind technique. But the technique with the guidance by trans-esophageal echocardiography to introduce the balloon into the descending aorta was simple and useful.

[The pitfalls in the clinical diagnosis of dissecting aortic aneurysm].

It is sometimes very difficult to diagnose dissecting aortic aneurysms (DAA), particularly in its early stage, due to manifold signs and symptoms. The purpose of this study is to clarify the reasons for such erroneous diagnoses. A total of 41 patients with DAA were referred to our hospitals for further examination and/or surgery from April 1986 to August 1989.

[Doppler echographic evaluation of pressure gradients of Björk-Shiley valve in the aortic position at rest and with exercise].

Pressure gradient across the Björk-Shiley (B-S) valve in the aortic position was assessed by Doppler echocardiography at rest and with exercise. There was close correlation between peak pressure gradient and area index which is a ratio of geometric orifice area (cm2) to body surface area (BSA) (m2). The correlation coefficient was -0.

[Definitive myocardial blood flow evaluated by contrast echocardiography: experimental and A-C bypass flow studies].

We evaluated the feasibility of a new method for calculating definitive myocardial flow using contrast echocardiography in canine experiments and in patients who had undergone ACBG surgery. The principle for calculating flow was based on Kety-Schmidt method using time-intensity curve analysis between the epicardial and endocardial aspect. Inlet and outlet flows were hypothesized at the epicardium and endocardium, respectively.

[Clinical features of aortic dissection with early thrombosis of the false lumen].

There are cases of dissecting aortic aneurysm in which thrombotic formation occurs in the false lumen at an early stage, preventing dissection of the vessel wall and enlargement of the aneurysm. We studied such early thrombotic obliteration of false lumina in 12 (28.6%) of 42 patients with dissecting aortic aneurysm who underwent transesophageal two-dimensional echocardiography in the acute phase from June 1986 to October 1989.

[Clinical usefulness of transesophageal Doppler echocardiography].

The usefulness of transesophageal Doppler echocardiography (TEE) was assessed in patients with various cardiovascular diseases including 15 patients with dissecting aortic aneurysm (DAA), two with thoracic aneurysm, 16 with ischemic heart disease and 14 with acquired valvular diseases. In dissecting aortic aneurysms, TEE provided clear images of the intimal flaps even in the aortic arch and descending aorta in which clear images could not be obtained by conventional external Doppler echocardiography. The entry site was detected in 11 of the 15 (73%) cases using TEE, but in only three of the 15 cases using conventional Doppler technique.

[Transesophageal Doppler echocardiography in the diagnosis of atrial septal defect].

To assess the usefulness of transesophageal Doppler echocardiography (TEE) in diagnosing atrial septal defect (ASD), we studied eight cases with secundum type ASD, in which the diagnosis was confirmed by cardiac catheterization and surgery. In all cases, TEE provided clear images of the interatrial septum with its defect. Shunt flow through the defect was observed by color Doppler technique, and its velocity was measured using the FFT mode.