Kozui Miyazawa

Norepinephrine levels in the coronary sinus in patients with cardiovascular diseases at rest and during isometric handgrip exercise

In order to evaluate cardiac sympathetic nerve activity, plasma norepinephrine levels in the coronary sinus (NECS) and in the artery (NEA) were determined in 24 subjects with cardiovascular diseases and in six with functional murmur. The resting NECS was greater than NEA in 14 subjects with normal left ventricular end-diastolic pressure (LVEDP) (p < 0.001) and/or in 22 with normal cardiac index (p < 0.04), whereas NECS was not significantly different from NEA in the remaining patients with elevated LVEDP and/or with reduced cardiac index. Isometric handgrip exercise increased both NECS and NEA (p < 0.001). When subjects were divided into two groups according to the slope of the ventricular function curve (delta stroke work index/delta LVEDP), NECS during exercise was greater then NEA in the group having slopes of 1.0 or more (p < 0.01), but neither values significantly differed in the group with slopes of less than 1.0. In the latter group, cardiac NE overflow rat calculated from the difference between NECS and NEA multiplied by coronary sinus plasma flow, was significantly less than that of the former group before and during handgrip (p < 0.05 and p < 0.01, respectively). These results suggest that cardiac norepinephrine release into the coronary sinus is reduced in patients with impaired cardiac function.

Measurement of Bronchial Blood Flow in Tetralogy of Fallot

Bronchial blood flow was measured in nine patients with tetralogy of Fallot and in two of these cases after radical operation also. The study was made of simultaneous recording of dye-dilution curves from the left atrium and the ear following dye injection into the aortic root. A method of calculating the bronchial blood flow was devised by combining the dye-dilution method with the Fick principle. The bronchial blood flow was increased in all cases. The mean value was 0.46±0.31 L/min, with a range from 0.14 to 1.27 L/min; this is equivalent to 15.3% of the pulmonary artery flow on the average. This study showed no definite relationships among pulmonary artery blood flow, pulmonary artery pressure, arterial oxygen saturation, severity of disease, and patients age. The postoperative measurement revealed no significant change in bronchial blood flow though its ratios to the pulmonary artery or aortic blood flows were considerably decreased.

Syphilitic Aneurysm of the ascending aorta producing pulmonic stenosis by compression

Abstract A case of a syphilitic aneurysm of the ascending aorta compressing the pulmonary artery and producing pulmonic stenosis is presented. The patient was accurately diagnosed by antemortem examination. Surgical correction was unsuccessful. Clinical complexities of this syndrome are discussed and criteria for the clinical diagnosis proposed.

ECHOCARDIOGRAPHIC FINDINGS OF PRIMARY PULMONARY HYPERTENSION

原発性肺高血圧症(PPH)における非侵襲的診断法を検討するため, 7例の本症患者(男2,女5,年令14～48才,平均30才)に心エコー図検査を施行,左-右短絡性疾患に続発した肺高血圧症(以下SPHと略す)と比較した. PPH群の肺動脈平均圧は42～90mmHg,平均60mmHg,肺血流量は1.85～3.48l/min/m2,平均2.64l/min/m2であつた.心エコー図所見として右室拡張期径の拡大が全例にみられたに反し,左房,左室径は正常,もしくは小であつた.僧帽弁後退速度は低下し,僧帽弁狭窄症と紛らわしい所見を呈したが,後尖の動きは正常であつた.心室中隔運動の振幅は左室後壁に比し大で, 7例中4例で奇異性運動がみられた.肺高血圧の所見とされる肺動脈弁エコーにおけるe-fslopeの水平化, ‘a’ dipの消失はPPH, SPH両群に共通にみられたが,もう一つの肺高血圧の所見,収縮期弁flutteringは後者で全例にみられたに反し,前者では明らかでない例が多かつた.又,弁エコーは援者で太いのに反し,前看で細く,対照的であつた. 4例のPPH剖検例(年令15～33才,平均25才)では肺動脈弁の肥厚を認めなかつたが, SPHの部検7例(年令1～25才,平均13才)では肺動脈弁の肥厚,膠原線維増殖が認められ,弁エコー厚さが異なる一因として,弁の器質的変化が関連を有すると考えられた.