Akiko Sanada

Ventricular repolarization gradients in a patient with takotsubo cardiomyopathy

A 61-year-old woman had recurrent syncopal attacks caused by torsades de pointes associated with remarkable QT prolongation (QTc = 740 ms). Left ventriculography showed apical akinesis (ballooning) and basal hyperkinesis, but coronary angiography was normal. This was compatible with takotsubo cardiomyopathy. The wall motion of the left ventricle (LV) normalized within 2 months, and the remarkable QT prolongation and negative T-waves gradually normalized. However, polymorphic ventricular tachycardia recurred at 2.5 months after its initial onset, and we measured repolarization gradients using activation recovery intervals (ARIs) in an electrophysiological study. During atrial pacing at a cycle length of 1000 ms, the negative T-waves were observed in leads II, III, aVF, and V2-6 with QT prolongation, and the ARIs in both the epicardium and the endocardium increased from the basal site to the apical site. Moreover, the ARI tended to be longer in the epicardium than the endocardium at each level of the LV. In contrast, atrial extrastimulation changed the T-wave morphology (from negative to biphasic) in leads II, III, aVF, and V2-6 and changed the ARI gradients both from the LV basal site to the apical site and from the epicardium to the endocardium. These results suggest that the T-wave abnormalities seen in takotsubo cardiomyopathy during sinus rhythm are due to abnormal LV repolarization gradients.

Ventricular Tachyarrhythmia Associated with Hypertrophic Cardiomyopathy: Incidence, Prognosis, and Relation to Type of Hypertrophy

VT Associated with HCM. Objective: To assess the incidence, characteristics, and prognosis of ventricular tachyarrhythmia in hypertrophic cardiomyopathy (HCM).

A Case of Aortic Regurgitation Presenting with Recurrent Detachment of a Prosthetic Valve, as the First Presenting Symptom of Cardiovascular Behçet's Disease

A 33-year-old man with severe aortic regurgitation underwent initial aortic valve replacement (AVR). During the 2 years after AVR, 3 reoperations for prosthetic valve detachment were required. During hospitalization, he had no typical clinical findings, with the exception of a persistent inflammatory reaction; a pseudo-aneurysm around the Bentall graft developed 27 days after the 4th operation. This unique clinical course suggested the possibility of Behçets disease. In the 8 years of follow-up after the administration of prednisolone, the pseudo-aneurysm did not become enlarged and the detachment of the prosthetic valve was not observed. We herein present a case of cardiovascular Behçets disease, with a review of the literature.