Junji Kusama

A giant left circumflex coronary artery – right atrium arteriovenous fistula detected by multislice spiral computed tomography

A 70-year-old man was referred to our hospital because of symptoms of congestive heart failure. The initial echocardiographic study revealed a dilated and poorly contractile left ventricle, a markedly dilated left circumflex coronary artery (LCx), and an enormously dilated anomalous vessel inferior to the right atrium (RA). Color Doppler flow mapping documented a turbulent flow in the LCx, draining into the RA through the anomalous vessel. An LCx-RA arteriovenous fistula was suspected. Multislice spiral computed tomography (MSCT) imaging was performed using a Somatom Volume Zoom (4-detector-row, Siemens, Stuttgart, Germany) with collimation 1.0 mm, table feed 1.5 mm/rotation, 140 kV, 320 mA, and gantry rotation time 500 ms. Our scan protocol and image reconstruction method have been reported previously. 1 Metoprolol (40 mg) was

Takotsubo-shaped cardiomyopathy with type I CD36 deficiency

A transient left ventricular apical ballooning (so-called “ampulla” or “Takotsubo-shaped” cardiomyopathy) with type I CD36 deficiency is described in a 71-year-old woman. The patient was referred because of chest pain and worsening of dyspnea. Electrocardiogram showed T-wave inversions on the precordal leads, and acute coronary syndrome was suspected. Left ventricular apical ballooning was observed by echocardiogram and left ventriculography, and coronary arteriography did not reveal any significant stenosis. Left ventricular motion normalized at the follow-up period and there were no increases in specific markers for myocardial damage, such as myocardial band fraction of creatine kinase and troponin T, through out the admission. 123I-metaiodobengylguanidine myocardial single photon emission computed tomography (SPECT) revealed decreased accumulation areas at the apex, while 201Tl SPECT showed normal accumulation. An abnormal metabolism of cardiac free fatty acid was suggested by lack of accumulation of 123I beta-methyliodophenyl pentadecanoic acid (BMIPP) SPECT. No CD36 expression in either platelets or monocytes/macrophages was shown using flow cytometer analysis and type I CD36 deficiency was diagnosed. DNA sequencing showed that the patient had compound heterozygosity of the CD36 gene (a nucleotide change in C478T and an adenine insertion at nucleotide 1159 in exon 10). Although CD36 deficiency is thought to be involved with many cardiovascular disease and metabolic abnormalities, Takotsubo-shaped cardiomyopathy with CD36 deficiency had not been reported. Further studies of Takotsubo-shaped cardiomyopathy and CD36 deficiency may reveal an association between this cardiomyopathy and specific genetic profiles.

Assessment of coronary artery abnormalities in a patient with Kawasaki disease by multislice computed tomography

The high spatial resolution of multislice computed tomography (MSCT) permits direct visualization of the coronary artery system. In this report, we describe coronary artery abnormalities in a young adult with Kawasaki disease. MSCT detected a giant coronary artery aneurysm, coronary artery stenosis in the first diagonal artery, and a multi-layered structure in the right coronary artery and the left circumflex artery. These findings corresponded well to those obtained by coronary angiography. MSCT has the potential to be the standard diagnostic tool for the follow-up evaluation of coronary artery disease in adolescents and young adults with Kawasaki disease.

Visualization of a coronary collateral channel by multislice spiral computed tomography

motion artifacts which occur during the rapid filling and atrial contraction periods, and allows for a better image quality as compared to the conventional technique which utilizes the R-R interval as a reference. The data were transferred to a computer workstation for post-processing (3D Virtuoso, Siemens, Germany). The scan was completed within 15min and post-processing, including manual reconstruction of volume rendering and curved multiplanar images, required 20min with the use of our image reconstruction method. Figure 1A demonstrates complete occlusion at the proximal portion of the RCA with retrograde contrast enhancement of the distal segments and the right ventricular branch. Figure 1B shows a volume-rendering image of the distal portions of the RCA and the LCx. A well-developed collateral channel connecting the distal portion of the LCx and the atrioventricular node branch of the RCA was visualized. A curved multiplanar reconstruction image also depicted a collateral channel (Fig. 1C). With its excellent spatial resolution, MSCT not only permits visualization of the major coronary artery segments, but also has the potential to detect well-developed collateral channels in patients with complete coronary artery occlusion when artifact-free images are obtained.