Koshichiro Hirosawa

Prinzmetal's Variant Angina: Coronary Arteriogram and Left Ventriculogram during Angina Attack Induced by Methacholine

Recently, in Prinzmetals variant angina, many cases with normal coronary arteries have been reported. The anginal attacks frequently relapse after aortocoronary bypass grafting. It is frequently possible to induce an anginal attack by parasympathomimetic agents such as methacholine and pilocarpine. In this study, methacholine (0.13 mg per kilogram) was injected subcutaneously in three cases of this disease to induce an angina attack, and coronary arteriograms and left ventriculograms were recorded. In all cases a coronary arterial spasm corresponding to the site of the ST-segment elevation in the electrocardiogram was observed. Complete occlusion due to the spasm was observed even in the normal coronary artery. Asynergy was seen in the left ventricular wall corresponding to the site of the ST-segment elevation in the electrocardiogram.

Prinzmetal's variant form of angina pectoris. Re-evaluation of mechanisms.

Thirty-five patients with typical Prinzmetals variant angina were studied by coronary cineangiography. There was no demonstrable stenosis of the major coronary arteries in 19 patients. Nine patients with single coronary stenosis underwent aortocoronary bypass and had recurrence of the symptoms postoperatively. Administration of nifedipine effected complete cessation of the symptoms among patients formerly treated medically. Although surgical treatment did not effect permanent relief of pain, all patients initially treated surgically experienced relief of pain when nifedipine was administered. The pathophysiology of variant angina remains obscure. Our results suggest that neurohumoral factors exert more of an effect on the myocardial cell than on the coronary vessels.

Natural history of subarterial infundibular ventricular septal defect

Development of aortic valvular deformities was studied retrospectively in 395 inpatients with subarterial infundibular ventricular septal defect (siVSD). Aortic valvular deformities included prolapse into siVSD without aortic regurgitation (77 patients), prolapse and aortic regurgitation (95 patients), and aneurysm of the sinus of Valsalva (36 patients). No aortic valvular deformity was found in 187 patients, and 111 of these 187 patients had associated pulmonary hypertension. Prolapse and regurgitation of the aortic valve developed most frequently at the age 5 to 8 years. Aneurysm of the sinus of Valsalva was not found before the age of 10 years but began to develop during the teens and was diagnosed most frequently in the twenties. Patients with pulmonary hypertension did not develop aortic valvular deformities except in one instance. All inpatients with siVSD and without pulmonary hypertension over the age of 30 years had developed some aortic valvular deformities.

Evaluation of tricuspid regurgitation by blood flow pattern in the hepatic vein using pulsed Doppler technique

Evaluation of tricuspid regurgitation (TR) was attempted by observing the blood flow pattern in the hepatic vein (HV), inferior vena cava dimension (IVCD), and hepatic vein dimension (HVD), with the use of a combined system of pulsed Doppler technique and two-dimensional echocardiography in 60 patients with valvular heart disease. For comparison, all patients underwent right ventriculography, by which TR was classified as mild, moderate, or severe. IVCD and HVD of the group with severe TR were significantly larger than those of the other groups (p less than 0.005). Several types of abnormal blood flow patterns in the HV were demonstrated in patients with atrial fibrillation. By these flow patterns, the severe or moderate TR groups could be differentiated from the mild TR group, because 21 of the 26 patients (81%) in the former group showed reverse hepatic flow during systole. Also, the Doppler shifts from baseline in the sound spectrogram correlated well with right atrial pressure (RAP) and right ventricular end-diastolic pressure (RVEDP) (r = -0.72, -0.64, p less than 0.001, respectively). This method is useful for rapidly evaluating considerable TR and for estimating RAP and RVEDP noninvasively.

Clinical and echocardiographic features of pulmonary valve endocarditis.

We studied the clinical and echocardiographic features of eight patients with infective pulmonary valve endocarditis. In two patients, the vegetation was limited to the pulmonary valve; in the six other patients, infective lesions were also present on the mitral or aortic valves. None of the patients were addicted to narcotics. Seven of the eight patients had underlying congenital heart disease. In six patients the organism responsible for the infective endocarditis was Streptococcus viridans.Tlwo-dimensional echocardiography performed using a wide-angle sector scanner was more useful than M-mode echocardiography for evaluating patients with pulmonary valve endocarditis.

Endomyocardial Biopsy Approach to the Patients with Ventricular Tachycardia with Special Reference to Arrhythmogenic Right Ventricular Dysplasia : SYMPOSIUM ON VENTRICULAR ARRHYTHMIA : BASIC AND CLINICAL STUDIES : 50th Annual Scientific Session of the Japanese Circulation Society

Right ventricular endomyocardial biopsies were performed in patients with repetitive ventricular tachycardia (VT; 8 patients) or ventricular premature beats (1 patient) which showed left bundle branch block morphology in electrocardiograms. These 9 male patients ranging in age from 21-55 years (mean 37.7 years) revealed enlargement and/or asynergy of the right ventricle in the ventriculogram. Randomly selected biopsied patients with dilated cardiomyopathy (DCM; 18 patients) and chronic right ventricular overloading (14 patients) who did not show the above-described arrhythmias served as controls. A histopathological analysis revealed advanced myocardial interstitial fibrosis associated with an increase in fatty tissue in 8 of the 9 patients (89%). Moreover, advanced hypertrophy of myocytes (grade 2 or more of our criteria), disarrangement of muscle bundles and endocardial thickening were prominent with incidences of 75%, 75% and 78%, respectively. Incidence of all findings was more pronounced in the ARVD group. Suggestiveness of post-myocarditic change in the biopsied specimen was high in 1 patient, showing a lower incidence (12%) than the DCM group (17%). From these results, we can conclude that different etiological factors may be the bases of these pathological changes. We believe that the presence of a large amount of fatty tissue within the myocardial tissue is an important element in the etiology of ventricular arrhythmias as it has also been recognized in patients with non-ARVD idiopathic ventricular tachycardia in our biopsy series.

Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease

SummaryFourteen cases of heart disease with hypereosinophilia were analyzed employing conventional cardiologic methods, including echocardiography, cardiac catheterization, and endomycoardial biopsy. The cases were divided into four types: (1) Acute carditic (endocarditis, myocarditis, pericarditis; five cases); (2) ventricular dilation (three cases); (3) restrictive (three cases); (4) electric disturbance (three cases). Biopsy revealed significant changes in all cases. In one case of the ventricular dilation type, endomyocardial fibrosis with myocardial degeneration was seen, and in another case mural thrombus formation was shown to be present. In three cases of the restrictive type, endomyocardial fibrosis (EMF) was observed. In two cases of the electric disturbance type, minor right ventricular myocardial degeneration was observed. In two of the three cases of the carditic type and in three of eight cases in other categories, postmyocarditic changes were observed. The course of the disease compared with the type of disorder revealed a short course in the carditic type and a longer course, ranging from 2 to 24 years, with one exception, in the other types. It is also confirmed that the various histopathologic changes can be related to particular clinical presentations. We have shown that the basic changes in eosinophilic heart disease are not restricted to the endomyocardium and that they occur in various parts of the heart causing more widespread manifestations. The more comprehensive term “eosinophilic heart diease” is a preferable description.

Detection of mitral ring abscess by two-dimensional echocardiography.

M-mode and two-dimensional echocardiographic features of mitral ring abscess are described. A round, dense echo mass between the posterior mitral leaflet and left ventricular posterior wall was demonstrated in long- and short-axis views of the left ventricle. The diagnosis of mitral ring abscess was confirmed at surgery. The superiority of two-dimensional echocardiography over M-mode echocardiography for evaluating patients with mitral ring abscess is also discussed.

Microanalysis of free fatty acids in plasma of experimental animals and humans by high-performance liquid chromatography

A high-performance liquid chromatographic (HPLC) method was developed for microanalysis of thirteen free fatty acids using 200 microliter of plasma. Fatty acids were derivatized with 9-anthryldiazomethane for HPLC analysis. Use of an ODS minicolumn for pretreatment of plasma gave a more accurate determination of free fatty acids in plasma than by chloroform extraction. Using this method, thirteen free fatty acids in the plasma of normal human, dog, rabbit, guinea pig and rat were determined.

Relationship between myocardial infarction and preinfarction angina: a histopathological study of coronary arteries in two sudden death cases employing serial section.

Two patients who had previously experienced old myocardial infarction and who died suddenly after an attack of chest pain were examined and discussed. In both cases two of the three main coronary arteries showed severe stenosis with canalization. Ruptured atheromatous plaque was found in the unblocked coronary artery. Fibrin was already formed and surrounded the fractured intimal collagen fiber, foam cells, and cholesterin clefts, but a luminal thrombi had not yet been formed. Fresh occluding thrombi were formed at the site of the ruptured atheromatous plaque. Coronary thrombi containing abscess components such as foam cells, cholesterin clefts, and the fractured intimal collagen fiber were found in our preliminary study. These views support the supposition that this fracture between the lumen and the plaque might precede and be responsible for the formation of the thrombus and the onset of acute myocardial infarction. It was confirmed that the attack of preinfarction angina occurred at the time of the rupture of the atheromatous plaque. The rupture of the atheromatous plaque plays an important part as an initiating factor of peinfarction angina and myocardial infarction. Thus, it is necessary to examine coronary arteries by serial histopathological section method.