Akihiko Sasaki

Body surface mapping criteria for diagnosis of left ventricular hypertrophy associated with complete right bundle branch block

The standard electrocardiographic (ECG) criteria for left ventricular hypertrophy are unreliable in patients with complete right bundle branch block. This study was undertaken to formulate criteria for diagnosing these patients by using body surface mapping. The echocardiographic left ventricular mass was calculated by the Penn method from M-mode measurements. Of 56 patients, 27 were defined as having left ventricular hypertrophy with a left ventricular mass of 215 g or more. Isopotential and isointegral maps of the QRS complex were observed. The QRS isointegral maps were separated into two parts at the end of the downstroke of the initial R wave of vector spatial magnitude. The body surface mapping criteria with the highest sensitivity were EPmax (maximum of early part of the QRS) 45 microV.s or greater (sensitivity 93%, specificity 90%), EPmax/d (EPmax averaged by EP duration) 0.8 mV or greater (sensitivity 93%, specificity 97%), and Max (initial maximum) 2.2 mV or greater (sensitivity 89%, specificity 90%). These results suggest that body surface mapping is a useful technique in diagnosing patients with left ventricular hypertrophy and right bundle branch block.

A Successful Case of Endovascular Stent Graft Treatment to Sealed Rupture of an Abdominal Aortic Aneurysm in an Elderly Patient.

High risk な89歳の腹部大動脈瘤被覆破裂の患者にステントグラフト内挿術を施行し良好な結果が得られた. 既往歴にASOがあり左I-Fバイパス, F-Fバイパス, 両側F-Pバイパスを受けている. 腹部大動脈瘤は腎動脈から2.5cm末梢に始まり径は4cm, 長さは3.5cmで分岐より中枢4cmで瘤は終わっている. 腹部大動脈の径は20mmで動脈瘤の頭側端より後腹膜腔へ造影剤の漏出がみられた. 30mm径, 長さ7.5cmの3連Zステントを中枢側は約1cmステントを裸にし, 24mm超薄型ウーブングラフトで被覆し中枢と末梢端を固定した. 左大腿動脈の人工血管よりデリバリーシースの先端を腎動脈の直下まで進めて内筒を固定しながら外筒を引き抜きステントグラフトを血管内に留置し, さらに大動脈閉塞バルーンにてステントを拡張固定した. 直後の造影ではリークもなく良好にステントグラフトが造影された.

Detection of silent myocardial ischemia patients by the spatial velocity electrocardiogram.

This study was designed to detect patients with type I silent myocardial ischemia (SMI) at rest by assessing the symmetry of the electrocardiographic (ECG) T wave using the spatial velocity electrocardiogram (SVECG). In this study, the ECG T waves in patients with SMI were symmetric compared with those in normal subjects, and the the c/a ratio in the SVECG-T wave as the index of degree of symmetry of the ECG T wave enabled us to diagnose 73% of these patients; the c/a ratio in the SVECG T wave was a useful index for detecting patients with type I SMI at rest.