Masatake Sato

Association between Takayasu arteritis and ulcerative colitis – case report and review of serological HLA analysis

Summary Background Takayasu arteritis and ulcerative colitis are immune-mediated inflammatory diseases; genetic factors are assumed to play an important role in the pathogenesis of these 2 diseases. However, the coexistence of these 2 diseases has rarely been reported. Case Report In this report, we present a rare case of a 29-year-old man with a 4 years history of ulcerative colitis who developed Takayasu arteritis. He was found to carry the following human leukocyte antigens (HLA): A11, A24, B52, B62, DR4, and DR9. Conclusions We present a case report and review of the pertinent literature on serological analysis of HLA haplotype of the patients who exhibit both these diseases. In patients with both Takayasu arteritis and ulcerative colitis, high frequency of HLA-A24, B52, and DR 2 is observed. The pathological relevance of HLA-A24, B52, and DR2 to concomitant Takayasu arteritis and ulcerative colitis requires further investigation.

Factors influencing left atrial volume in treated hypertension

BACKGROUND Left atrial (LA) enlargement has been documented to occur in hypertension (HT), and has been an index for evaluating the diastolic function of the left ventricle. Enlargement of the LA is one of the vital factors that induce heart failure and atrial fibrillation (AF) in patients with HT. METHODS AND SUBJECTS 130 treated hypertensive patients were enrolled. All recruits participated in an echocardiogram, electrocardiogram, a routine blood examination including brain natriuretic peptide (BNP), and physical examinations. RESULTS Left ventricular mass (LVM) indexed to height(2.7) had a significant positive correlation with left atrial volume index (LAVI) (p<0.0001), as well as natural logarithm BNP (p<0.001). Blood pressure levels were not associated with LAVI, neither body mass index nor age. LAVI had a positive correlation with factors involving the left ventricle volume, LVM, and right ventricle systolic pressure (RVSP) (r=0.687, p<0.0001). The parameters of LV diastolic function were positively but weakly associated with LA size. In the subgroup of LAVI, the evidence of paroxysmal atrial fibrillation (PAF): LAVI<32 ml/m(2) had no PAF, whereas the incidence of PAF was 7.5%, 11.4%, and 15.2%, respectively in the LAVI>32 ml/m(2) group. Of anti-hypertension drugs, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers had a tendency to reduce LAVI; however, there was no statistical significance within the groups. CONCLUSIONS Left ventricular volume and mass are independent factors affecting LAVI in treated HT. The incidence of PAF is associated with LA size. In patients with treated HT, LA size may be a useful surrogate marker for monitoring the effectiveness of medical therapy and occurrence of AF.

Percutaneous coronary intervention of a single coronary artery arising from the right sinus of Valsalva

We describe a 67-year-old woman who presented with acute lateral myocardial infarction. Coronary angiography demonstrated a single coronary artery along with the left anterior descending and left circumflex arteries that originated from proximal branches of the right coronary artery, which arose from a normal ostium in the right sinus of Valsalva. Percutaneous coronary intervention (PCI) was performed to treat 99% stenosis with a filling defect in the midportion of the left circumflex artery. This extremely rare coronary anomaly was successfully treated by PCI.

A case of coagula tamponade 4 years after Bentall procedure

A 76-year-old man was admitted to hospital because of shortness of breath, and a pericardial clot with left ventricular diastolic collapse was detected by echocardiography. Approximately 4 years earlier, the patient had undertaken the Bentall procedure with a bioprosthesis (Freestyle ) because of aortic regurgitation and dilatation of the aortic root. A transthoracic echocardiogram (TTE) obtained 1 year after the operation showed a mild pericardial effusion and no evidence of tamponade. Six months before admission, the patient noticed increased fatigue and shortness of breath. On physical examination, the patient’s blood pressure was 102/68 mmHg, heart rate 80 beats per min, respiratory rate 14 breaths per min, and his temperature was 36.7 C. The breath sounds were clear. An examination of the heart showed no significant murmurs. The arms and legs were warm, with symmetric pulses and no edema. Because the patient had a bioprosthetic valve, anticoagulant therapy was not performed, and activated partial thromboplastin time and prothrombin time were normal. The transthoracic echocardiographic study on admission showed a large localized pericardial clot mass in the postero-lateral region and the inward motion of the left ventricular posterior wall was noted during diastole (i.e., left ventricular diastolic collapse) (Figs. 1 and 2), which are findings consistent with coagula tamponade [1–3]. There were no classical echocardiographic signs of tamponade (i.e., right ventricular diastolic collapse and right atrial collapse) [4, 5]. The patient underwent elective surgery, and the pericardial clot and bloody fluid were removed. Biopsy specimens were taken from the pericardium, and the pericardial biopsy section showed a lymphocyte-rich inflammatory infiltrate. Idiopathic pericarditis was thought to be the cause of slight but continuous oozing into the pericardium, which may produce a localized clot. An echocardiogram obtained after the re-operation showed no re-accumulation of the pericardial effusion. The patient was discharged 21 days after the operation, and has remained stable at home.

1037-144 Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy

Paroxysmal atrial fibrillation (PAF) is a common complication of patients with hypertrophic cardiomyopathy (HCM), often leading to acute or progressive heart failure and cerebral infarction. Therefore, the early detection of patients with HCM at risk for atrial fibrillation (AF) development has important implications for patient treatment. M-mode left atrial (LA) dimension, a unidimensional measure of LA size, was shown to be incremental to clinical risk factors for predicting AF in both the Framingham Heart Study and the Cardiovascular Health Study. However, the inaccuracy of the M-mode method is expected when the LA enlarges, and LA volume (LAV) has been shown to provide a more accurate assessment of LA size than M-mode LA dimensions. The aim of this study was to evaluate the ability of LAV to assess the risk of PAF development for patients with HCM and preserved left ventricular (LV) systolic function.