Masahiko Noguchi

SIGNIFICANCE OF 6-MINUTE WALK STRESS ECHOCARDIOGRAPHY FOR PATIENTS WITH AORTIC STENOSIS

There is a paucity of an investigation of 6-minite walk stress echocardiography (6WSE) for patients with aortic stenosis (AS). The aim of this study is to investigate the significance and safety of 6WSE for AS patients. We prospectively evaluate consecutive 102 ambulant patients with moderate or

Significance of intravascular ultrasound and exercise stress echocardiography in diagnosis of exercise-induced vasospastic angina at the site of moderate stenosis

Recently, exercise-induced spastic coronary artery occlusion at the site of moderate stenosis, which Prinzmetal’s angina or cardiac syndrome X does not cover, was reported. Multi-modality imaging is important for the diagnosis of coronary artery disease with a complex ischemic mechanism. However, the previous report did not include findings from intracoronary imaging at the site of moderate coronary stenosis. We report a case of exercise-induced vasospastic angina at the site of moderate stenosis, where multi-modality imaging, including exercise stress echocardiography and intravascular ultrasound, was utilized to make a definitive diagnosis and investigate underlying causes.

Superiority of novel automated assessment of aortic annulus by intraoperative three-dimensional transesophageal echocardiography in patients with severe aortic stenosis: Comparison with conventional cross-sectional assessment

BACKGROUND Previous studies have demonstrated that three-dimensional (3D) transesophageal echocardiography (TEE) is an alternative to multi-detector computed tomography (MDCT) for aortic valve sizing in transcatheter aortic valve replacement (TAVR). However, conventional cross-sectional analysis of aortic annulus by 3D TEE has some limitations such as lengthy analytical time. A novel software for automated valve measurement has been developed for 3D TEE. We evaluated the accuracy and analytical time of aortic annular measurements using this novel automated software in the clinical setting. METHODS We retrospectively studied 43 patients with symptomatic severe aortic stenosis (AS) who underwent TAVR. All patients underwent intraoperative TEE and MDCT. We measured aortic annular area by automated, semi-automated, and cross-sectional methods using 3D TEE datasets. These measurements were compared to the corresponding MDCT reference values. We also compared the analytical time of the three methods. RESULTS Automated and semi-automated analyses required significantly shorter analytical time compared to cross-sectional analysis (automated: 30.1±5.79s, semi-automated: 74.1±15.0s, manual: 81.8±18.5s, p<0.05). Compared to MDCT measurement (393.7±81.0mm2), annular areas measured by automated and cross-sectional methods were significantly smaller (automated: 380.6±77.1mm2, cross-sectional: 374.7±76.8mm2, p<0.05), while that obtained by semi-automated method was not significantly different (387.7±75.8mm2). Annular areas determined by semi-automated and cross-sectional analyses had narrower limits of agreement (LOA) with MDCT measurements, compared to automated analysis (automated: -68.6 to 94.7mm2, semi-automated: -48.3 to 60.2mm2, cross-sectional: -40.0 to 77.9mm2). Measurements by all three methods using 3D TEE showed high correlation with MDCT measurement (automated: r=0.86, semi-automated: r=0.94, cross-sectional: r=0.93). CONCLUSIONS For aortic annular measurements using 3D TEE in AS patients, semi-automated analysis using the novel automated software reduced analytical time while maintaining similar accuracy compared to the conventional cross-sectional analysis. This automated software may have acceptable feasibility in the clinical setting.

Usefulness of Cutting Balloon Angioplasty Prior to Stenting with Intravascular Ultrasound Imaging Guidance for Spontaneous Multi-vessel Coronary Dissection Including the Left Main Coronary Artery

We report a case of percutaneous coronary intervention for spontaneous multi-vessel coronary artery dissection including the left main coronary artery. This case suggests that intracoronary imaging is useful for understanding the complex anatomy and for choosing the appropriate management for effective revascularization. Furthermore, cutting balloon angioplasty prior to stenting is useful for preventing the longitudinal extension of the intramural hematoma and avoiding unnecessary stent implantation.

Successfully Treated Nonocclusive Mesenteric Ischemia After Transcatheter Aortic Valve Replacement

An 80-year-old man with symptomatic severe aortic stenosis underwent transcatheter aortic valve replacement. Postoperatively, the patient was hemodynamically stable without inotropic or mechanical support. Approximately 30 hours after the procedure, he developed severe abdominal pain, and a blood test result showed elevated serum lactate level. We suspected nonocclusive mesenteric ischemia and performed emergency selective angiography of the superior mesenteric artery, which showed vasospasm. We confirmed the diagnosis of nonocclusive mesenteric ischemia, and it was treated successfully with intraarterial infusion of vasodilators into the superior mesenteric artery.

Accuracy and usefulness of aortic annular measurement using real-time three-dimensional transesophageal echocardiography: Comparison with direct surgical sizing

BACKGROUND There is a paucity of data that demonstrates a clinical impact of anatomical measurements of the aortic annulus by three-dimensional (3D) transesophageal echocardiography (TEE) on surgical aortic valve replacement (AVR). The aim of this study is to validate the accuracy of 3D TEE measurements compared with the direct intraoperative annular diameter and to investigate an impact of 3D TEE on a prediction of AVR with aortic annular enlargement (AAE). METHODS AND RESULTS We retrospectively enrolled 61 patients who underwent both two-dimension (2D) and 3D TEE and transthoracic echocardiography (TTE) before AVR. The annular diameters were measured noninvasively with 2D TEE (D2D) and TTE (DTTE) in a classical manner and the area- and perimeter-derived annular diameters (Darea, Dperim) were measured from using 3D TEE analysis. Intraoperative annular diameter was measured with the manufactures sizer (Dintraope). Darea showed the best agreement with Dintraope in the Bland-Altman analysis. Darea, Dperim, D2D, and DTTE correlated well with Dintraope (r=0.821, 0.820, 0.532, and 0.610, respectively; all p<0.001). Three patients underwent AVR with AAE and the specificity of Dperim for prediction of AAE was significantly higher than D2D (p=0.008). CONCLUSIONS 3D TEE measurement of aortic annular diameter showed better agreement with the direct intraoperative measurement than 2D TEE and TTE measurements. 3D TEE measurement could predict AVR with AAE more accurately than 2D TEE and TTE measurements.

Variant Angina Leading to Cardiac Arrest in a Patient With Moyamoya Disease

A 22-year-old woman was referred to our hospital with syncope following chest pain. Initial work-up with blood test, electrocardiography, and echocardiography were unremarkable. Diffusion-weighted magnetic resonance imaging showed acute-stage cerebral infarction in the right temporal to occipital

Delayed right ventricular defibrillation lead perforation presenting as cardiac tamponade and treated surgically

Right ventricular perforation leading to cardiac tamponade can occur during the chronic phase after cardiac device implantation. Physicians who manage the pacemaker clinic must be alert to the wide range of symptoms and signs that can accompany delayed right ventricular perforation. Surgical rather than percutaneous lead extraction may be prudent.