Predictor of underlying myocardial damage in normally functioning left ventricle with narrow QRS complex: relationship between QRS duration at right ventricle pacing and iodine-123 metaiodobenzylguanidine myocardial scintigraphy.

Objective: Washout rate of iodine-123 metaiodobenzylguanidine (MIBG) myocardial scintigraphy is correlated with the degree of myocardial damage. The aim of this study is to ascertain whether there is any relationship between QRS complex duration at right ventricle (RV) pacing and the degree of myocardial damage assessed by I-123 MIBG myocardial scintigraphy in normally functioning left ventricle.

Methods: The study included 22 patients (10 men and 12 women, ranging in age from 48 to 89 years), with atrioventricular (AV) block (n = 15) and sick sinus syndrome (n = 7).

Aortic valve replacement for aortic regurgitation in a patient with left ventricular noncompaction.

We present a case of a 61-year-old man who underwent aortic valve replacement for aortic regurgitation complicated with left ventricular noncompaction. The pathogenesis of this condition remains unknown. In advanced form, left ventricular noncompaction produces marked disability and carries a poor prognosis.

Rupture of the left atrial 'basal' appendage due to blunt trauma in an elderly patient.

Blunt traumatic cardiac rupture is associated with a high mortality rate. Motor vehicle accidents account for most cardiac ruptures, but crush injury is relatively rare. We describe a case of a 77-year-old man who had the left atrial 'basal' appendage ruptured through blunt trauma due to a fall.

Progressive congestive heart failure due to common iliac arteriovenous fistula: a case report.

Arteriovenous shunt is one of the causes of heart failure, but heart failure caused by common iliac arteriovenous fistula is relatively rare. A 64-year-old man who developed acute heart failure due to venous perforation of a common iliac aneurysm and also had bilateral aneurysms (diameter 58 mm) was referred to our department. On admission, the patient complained of dyspnea and swollen left leg, so diuretic agent was administered to treat the heart failure.

Discrepancy between Doppler and catheter measurements of pressure gradients across small-size prosthetic valve.

Objectives: The exact role of pressure gradient across the prosthetic valve estimated from Doppler flow velocity remains controversial. This in-vivo study was designed to assess the actual discrepancy between Doppler and catheter measurements of the pressure gradients for small bileaflet prosthetic valves in the aortic position.

Methods: Bileaflet prosthetic valves (19 mm-ATS) were implanted into the aortic position in pigs, and pressure gradients across the valves were examined by volume loading under right heart bypass.

Recurrent pericardial tamponade from atrial hemangioma.

We encountered a 72-year-old woman with a left atrial hemangioma arising in the appendage and growing like an extracardiac mass. Life-threatening cardiac tamponade, recurrent over a 5-year clinical course, was the only sign of this rare tumor. The extraatrial growth pattern of the tumor made it difficult to distinguish the cardiac origin from a paracardiac mass.

C-reactive protein and atrial fibrillation. Is inflammation a consequence or a cause of atrial fibrillation?

To clarify whether inflammation is a cause or consequence of atrial fibrillation (AF), we measured high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) before and after pharmacological cardioversion in 15 patients with paroxysmal AF. Levels of hs-CRP, IL-6, and TNF-alpha after cardioversion were significantly higher than those in controls (P < 0.05).

Hemodynamic effects of intravenous administration of olprinone hydrochloride on experimental pulmonary hypertension.

To examine acute effects of olprinone hydrochloride (CAS 106730-54-0, Coretec) on pulmonary hypertension, hypoxic pulmonary hypertension was produced in 6 adult Beagle dogs. Using this pulmonary hypertension model, single intravenous bolus injections of olprinone at doses of 10, 30 and 100 micrograms/kg were administered at 5-min intervals and hemodynamic parameters were evaluated. Heart rate increased at doses of 30 and 100 micrograms/kg, but did not change at a dose of 10 micrograms/kg.

Fourteen-year survival in a case of ventricular septal perforation after myocardial infarction.

We treated a case of ventricular septal perforation (VSP) who survived for 14 years after myocardial infarction. Nine years after the onset of myocardial infarction, an apparent cardiac murmur was discovered by chance, and following further examination, the patient was diagnosed as having VSP. The patient is still in the NYHA functional class I, and requiring no surgical treatment.

Ultrasonic evaluation of congestive liver after tricuspid annuloplasty.

To assess the effect of tricuspid annuloplasty (TAP), the authors measured the size of the liver by using echography in the patients undergoing tricuspid annuloplasty. From April 1989 to August 1996, 18 patients underwent TAP. The authors measured preoperatively and postoperatively the hepatic index (HI) by echography, defined as follows: HI=L x D/BSA (L: the top-to-bottom length of the left hepatic lobe; D: the front-to-back length of the left hepatic lobe; BSA: body surface area).

Experimental His-bundle pacing: histopathological and electrophysiological examination.

His-bundle pacing gives a more physiological ventricular contraction in comparison to right ventricular apical pacing. However the problems of lead fixation and stability of long-term His-bundle pacing are yet unsolved. We used six adult beagles, in which a screw-in lead was anchored in the His-bundle region for observation of the pacing conditions and histopathologic changes of the conduction system over the course of 2 months.

[Two cases of mitral restenosis occurring eight years after percutaneous balloon mitral commissurotomy (PTMC)].

A 63-year-old man and a 49-year-old man who underwent PTMC eight years before were admitted in our hospital because of regurgitation and restenosis of the mitral valve. Both of them had ulcer like lesion on the anterior leaflet near the commissure of the mitral valve. These changes were made by PTMC and likely caused thrombosis.

Isolated levocardia associated with absence of inferior vena cava, lobulated spleen and sick sinus syndrome. A case report.

We evaluated a 68-year-old male patient with isolated levocardia without intracardiac anomaly. The patient's condition was complicated by the absence of the inferior vena cava, a lobulated spleen and sick sinus syndrome. Isolated levocardia without intracardiac anomaly is very rare and only 25 cases of this disease have been reported, to our knowledge.

Pitfalls of intervention therapy in a patient with anomalous origin of the right coronary artery from the left sinus of Valsalva associated with organic stenosis.

A 64-year-old man visited our hospital with a complaint of exertional chest discomfort. Exercise electrocardiography revealed ST segment depression in the V4-V6 leads, and exercise thallium myocardial scintigraphy demonstrated myocardial ischemia in the area of the right coronary artery, suggesting effort angina. Diagnostic coronary angiography revealed an anomalous origin of the right coronary artery from the left sinus of Valsalva and 90% organic stenosis at the proximal portion.

Atrial fibrillation activates platelets and coagulation in a time-dependent manner: a study in patients with paroxysmal atrial fibrillation.

Objectives: To determine whether atrial fibrillation (AF) alone affects the fibrinocoagulation system, we examined the relation between fibrinocoagulation activity and duration of AF in patients with paroxysmal AF (PAF).

Background: Patients with chronic AF are at higher risk for stroke and a hypercoagulative state. It is not clear whether this hypercoagulative state is attributable to AF alone or to the underlying disease.

Sudden death during Holter electrocardiogram monitoring in a patient with variant angina.

We report a case of sudden death due to variant angina during Holter electrocardiogram (ECG) monitoring. The patient, a 60-year-old man, had been aware of chest discomfort lasting less than one minute at midnight 2 days earlier. Because variant angina or arrhythmia was suspected, Holter ECG monitoring was performed.

Chaotic musical murmur in aortic regurgitation.

We report an interesting case of aortic regurgitation. Phonocardiographically, the shape of the diastolic musical murmur in this case changed in each cardiac cycle despite being in sinus rhythm, in the same posture and in the same breathing phase. Experimentally, we were able to obtain a similar noise pattern using an artificial respirator and a hemispherical silicone membrane.

Tensile force of pacing lead extraction. A comparison between tined type and screw-in type.

Three months after implantation of endocardial pacing leads in 10 mongrel dogs, the tensile forces needed to remove 5 tined type and 5 screw-in type leads were compared experimentally. Mean maximum tensile force was 291 +/- 174 g with the screw-in type and 1174 +/- 369 g with the tined type (p < 0.01).

Effect of atrial fibrillation on the fibrino-coagulation system--study in patients with paroxysmal atrial fibrillation.

To clarify the effect of atrial fibrillation (AF) on the fibrino-coagulation system, fibrino-coagulation parameters in the paroxysmal period of AF were determined in 13 patients with paroxysmal atrial fibrillation (PAF) and compared with those in the non-paroxysmal period of AF, and with those in normal subjects. Estimated titers of hemoglobin and hematocrit in the paroxysmal period of AF were significantly higher than those in the non-paroxysmal period and also higher than those in normal subjects. The activated partial thromboplastin time in the paroxysmal period was also longer than that in the non-paroxysmal period of AF or in normal subjects.