Clinical implications of distal embolization during coronary interventional procedures in patients with acute myocardial infarction: quantitative study with Doppler guidewire.

Objectives: This study sought to investigate the timing and amount of embolic particles generation during the percutaneous coronary intervention (PCI) procedure and studied the relationship between embolic burden and coronary blood flow and myocardial damage.

Background: Distal embolization is a major complication of PCI. The Doppler guidewire (DGW) can detect the embolic particles as high-intensity transient signals (HITS) during the PCI procedure.

Nicorandil treatment in patients with acute myocardial infarction: a meta-analysis.

Background: It is controversial as to whether nicorandil would have cardioprotective effects in patients with acute myocardial infarction (AMI) who are undergoing reperfusion therapy. A meta-analysis was performed to study the impacts of nicorandil on functional outcomes after AMI.

Methods And Results: Randomized prospective cohort or retrospective cohort publications were identified up to October 2007 by means of a computer search of MEDLINE and Google Scholar databases.

Coronary microcirculatory dysfunction in aortic stenosis: myocardial contrast echocardiography study.

Background: The aims of this study were to quantify the microcirculatory dysfunction in aortic stenosis (AS) and to measure the changes in transmural perfusion after aortic valve replacement (AVR), using quantitative myocardial contrast echocardiography.

Methods: Myocardial contrast echocardiography was used to quantify the myocardial blood flow in both the subendocardium and subepicardium in 22 patients with AS (A group), before, 2 weeks after, and 1 year after AVR. Healthy volunteers (C group, n = 10) and patients with mitral regurgitation (M group, n = 10) were included as controls.

Primary malignant pericardial mesothelioma presenting as pericardial constriction.

A 55-year-old man with a history of pericardiocentesis for massive pericardial effusion of unknown etiology was admitted to our hospital because of shortness of breath and systemic edema in September 2005. Transthoracic echocardiography demonstrated the massive PE 2 cm in diameter and with several areas of thick hyperrefractile echoes arising from the pericardium. Computed tomography (CT) demonstrated a large mediastinal mass encasing the heart; a pressure of the right ventricle (RV) showed a pattern of dips and plateaus on cardiac catheterization.

Successful surgical management for severe mitral regurgitation unmasked after pericardiectomy for chronic constrictive pericarditis.

A 78-year-old cachectic woman who previously had repair of atrial septal defect was admitted to the hospital for congestive heart failure. Cardiac workup revealed chronic constrictive pericarditis; no evidence of coronary or valvular disease was found. She underwent corrective surgery for pericardiectomy.

Chronic expanding intrapericardial hematoma after coronary artery bypass surgery presenting with congestive heart failure.

We report the successful treatment of a rare case of chronic expanding intrapericardial hematoma that had slowly developed into a large mass after coronary artery bypass surgery. An 85-year-old man with a history of coronary artery bypass surgery presented with dyspnea on exertion and leg edema in 2006. Chest roentgenograph demonstrated right pleural effusion and severe pulmonary edema.

Severely calcified constrictive pericarditis simulating a mediastinal tumor and obstructing the right ventricular inflow tract.

We report a rare case of constrictive pericarditis that stimulated a large mediastinal tumor obstructing the right ventricular inflow tract. A 58-year-old woman was referred to our hospital because of a recent increase of dyspnea and facial edema. Computed tomography revealed severely thickened calcification, including a low-density area, presenting as a mediastinal tumor, compressing the right ventricular inflow tract.

Comparison of two- versus three-dimensional myocardial contrast echocardiography for assessing subendocardial perfusion abnormality after percutaneous coronary intervention in patients with acute myocardial infarction.

Myocardial contrast echocardiography (MCE) visualizes myocardial perfusion abnormalities after acute myocardial infarction. However, the limited view of 2-dimensional echocardiography reduces its ability to estimate perfusion abnormalities, especially in the subendocardial region. Three-dimensional echocardiography provides images of the left ventricular endocardium directly.

Remodeling of the radial artery anastomosed to the internal thoracic artery as a composite straight graft.

Objective: The internal thoracic artery remodels its diameter in response to flow requirements. The purpose of this study was to elucidate the remodeling of the radial artery as a composite straight graft with the internal thoracic artery.

Methods: We studied 39 patients who underwent coronary artery bypass grafting.

[Assessment of coronary heart diseases by echocardiography].

Echocardiography plays an important role in deciding the operative indication in patients with coronary artery diseases. On deciding the indication of coronary artery bypass graft, dobutamine stress echocardiography provides accurate information on presence or absence of myocardial ischemia and of myocardial viability in each coronary artery territory. Assessment of the coronary blood flow velocity using high-frequency Doppler enables us to examine the presence of coronary stenosis and the patency of bypass graft.

Rapid ventricular pacing can reduce heart motion and facilitate stent deployment to the optimal position during coronary artery stenting: initial experience.

Aims: We have sometimes encountered difficulty in stent positioning, and managed to achieve optimal positioning of the stent by luck when there was extensive movement of the stent delivery system in association with the cardiac cycle. We assessed the safety and efficacy of rapid ventricular pacing in order to achieve precise positioning of the stent in this percutaneous coronary intervention (PCI) situation.

Methods And Results: Among 363 patients who underwent PCI, difficulty in positioning of the stent was encountered in 7 consecutive patients due to extensive movement of the stent delivery system.

Visualization of a cluster of embolic particles causing angiographic no-reflow during percutaneous coronary intervention.

Angiographic no-reflow occurs occasionally during percutaneous coronary intervention in patients with acute myocardial infarction. Recently, we reported that coronary embolic particles can be detected as high-intensity transient signals with the Doppler guidewire. In the present study, the Doppler guidewire revealed that embolization of a cluster of embolic particles liberated by balloon inflation was responsible for angiographic no-reflow.

Progression of left coronary artery dissection during and after aortic replacement in acute type A aortic dissection: a case report.

A 69-year-old man was transferred to our hospital with a diagnosis of acute type A aortic dissection. In the emergent operation, the dissection was found to extend to the orifice of the left coronary artery, but not to the coronary artery itself. The false lumen was closed using glue and sutures with felt strips, and graft replacement of the ascending aorta was performed.

Clinical impact of metabolic syndrome and its additive effect with smoking on subsequent cardiac events after acute myocardial infarction.

Little information is available regarding the clinical effect of metabolic syndrome (MS) or its combined effect with smoking on subsequent cardiac events after acute myocardial infarction (AMI). To examine whether MS independently predicts cardiac events (cardiac death and nonfatal reinfarction) and to assess the combined effect of MS and smoking on cardiac events after AMI, we studied 3,858 survivors of AMI registered in the Osaka Acute Coronary Insufficiency Study (OACIS). During a median follow-up of 725 days, the incidence of cardiac events was higher in patients with MS than in those without MS (p=0.

Detection and quantification of embolic particles during percutaneous coronary intervention to stable plaque: it correlates to coronary flow dynamics and myocardial damage.

Objectives: We detected embolic particles liberated from plaque during percutaneous coronary intervention (PCI) as high-intensity transient signals (HITS) with a Doppler guidewire and studied their impact on coronary flow dynamics and the myocardium in patients with stable angina pectoris.

Background: These embolic particles during PCI may cause myocardial injury. However, this was difficult to confirm because it was impossible to detect embolic particles.

[Intermediate results of aortic valve replacement using 19 mm bioprosthetic valve].

Pre- and postoperative hemodynamic parameters and activity of daily life were reviewed to estimate the effectiveness of the valve in 12 cases of single aortic valve replacement (AVR) using 19 mm bioprosthesis. All implanted prostheses were stented-valves. Carpentier-Edwards pericardial valve was used in 7 cases and Mosaic valve in 5.

No-reflow phenomenon and prognosis in patients with acute myocardial infarction.

The rapid restoration of coronary flow to the jeopardized myocardium has become an essential part of therapy after acute myocardial infarction. Despite an open infarct-related artery, breakdown of or obstruction to coronary microvasculature can markedly reduce blood flow to the infarct zone. This effect is known as the no-reflow phenomenon.

Combination study of myocardial perfusion and left ventricular filling provides an excellent prediction of clinical outcomes in patients with reperfused myocardial infarction.

The no reflow phenomenon and left ventricular (LV) diastolic dysfunction are surrogate markers of poor outcomes in patients with myocardial infarction (MI). We studied the relationship between contrast perfusion defects and restrictive filling patterns for predicting prognosis after MI. Mitral inflow velocity and myocardial contrast perfusion were studied 2 weeks after reperfusion in 226 consecutive patients with acute MI.

Marshall vein as arrhythmogenic source in patients with atrial fibrillation: correlation between its anatomy and electrophysiological findings.

Background: Atrial fibrillation (AF) may originate from catecholamine-sensitive vein of Marshall (VOM) or its ligament in addition to pulmonary veins (PVs). The anatomy of VOM and its relation to arrhythmogenic foci in the left atrium are unknown. We studied the anatomy of VOM and its relation to foci in patients with AF.

Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation.

Effective regurgitant orifice area is a useful index of the severity of mitral regurgitation (MR). The calculation of regurgitant orifice area using the proximal isovelocity surface area (PISA) method has some technical limitations. Three-dimensional reconstruction of the MR jet was performed using the Live 3D system on a Sonos 7500 to measure regurgitant orifice area directly in 109 cases of MR.

Usefulness of high-resolution real-time three-dimensional echocardiography to visualize the left ventricular endocardial surface in myocardial infarction.

High-resolution real-time 3-dimensional echocardiography (RT3DE) allows observation of the left ventricular endocardial surface in vivo. This study was performed to characterize the endocardial surface structure and its contractile function in the myocardial infarction (MI) zone in relation to the healing stage. RT3DE was performed in 90 subjects: 10 normal subjects, 50 patients with Q-wave MI 2 weeks after onset (acute MI), and 30 patients >2 months after onset (healed MI).

[Thrombus aspiration therapy for acute coronary syndrome].

Reducing thrombus burden before percutaneous coronary intervention (PCI) may lead to better myocardial reperfusion in patients with acute myocardial infarction (AMI). Thus, several types of devices have been developed to remove intracoronary thrombus during reperfusion therapy, which includes X-sizer, AngioJet, and aspiration devices. There are two important randomized studies by using X-sizer and AngioJet to evaluate the efficacy of thrombus removal, which implied the possible benefit in myocardial tissue reperfusion, but could not prove the beneficial impact on clinical outcomes.

Effect of reactive hyperemia after coronary recanalization on myocardial tissue reperfusion by thrombolysis in myocardial infarction flow grade in acute myocardial infarction.

Thrombolysis In Myocardial Infarction (TIMI) flow grade is widely used to evaluate myocardial tissue reperfusion in acute myocardial infarction (AMI), but the current grading system is incomplete. Therefore, we clarified the regulation of epicardial coronary flow velocity with the progression of microvascular dysfunction in AMI. We studied 36 patients with first anterior AMI.

Effect of high-frequency jet ventilation on oxygenation during one-lung ventilation in patients undergoing thoracic aneurysm surgery.

Purpose: To evaluate the effect of high-frequency jet ventilation (HFJV) and continuous positive airway pressure (CPAP) on oxygenation and the shunt fraction (Qs/Qt) during one-lung ventilation (OLV).

Methods: Twenty-five patients who were undergoing resection of a descending aortic aneurysm were studied. Arterial oxygenation, Qs/Qt, and hemodynamics were evaluated just before the initiation of OLV (T1), 15 min after OLV (T2), and 15 min (T3) and 30 min (T4) after the application of HFJV or CPAP to the nondependent lung.

Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction.

Aims: Early statin treatment has beneficial effects on prognosis after acute coronary syndrome. The no-reflow phenomenon determines the prognosis after acute myocardial infarction. We investigated the effects of statin treatment before admission on the development of the no-reflow after infarction.