Naotsugu Oyama

Successful Covering of a Hepatic Artery Aneurysm with a Coronary Stent Graft

In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in the size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient’s poor systemic status was a major obstruction to operative resection, transcatheter therapy was thought more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and a dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

Insulin resistance relates to acetylcholine-induced microvascular vasoconstriction in a patient with vasospastic angina: potential implication of causalities between hyperinsulinemia and coronary microcirculation failure

Coronary vasomotor response to acetylcholine infusion was studied in a 69-year-old currently smoking man with enhanced insulin response to oral glucose load. Coronary angiogram showed no significant stenoses. Immediately after 20 µg acetylcholine infusion in the right coronary artery, angiographic no-flow, ischemic electrocardiographic changes, and anginal pain developed in the absence of epicardial coronary obstruction. While intracoronary infusion of isosorbide dinitrate was only partially effective, intracoronary infusion of nicorandil, an agent known to improve coronary microcirculation, completely resolved these changes. This is the first case reported so far suggesting that enhanced insulin response may be associated with acetylcholine-induced microvascular vasoconstriction. Microvascular vasoconstriction must be considered when a patient with insulin resistance presents with chest pain.

Left Ventricular Asynchrony Caused by an Intramuscular Lipoma Computed Tomographic and Magnetic Resonance Detection

Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible with fat. In cardiac MR imaging, the signal intensity of the mass on several pulse sequences was consistent with that of fat (Figure 2A and 2B and Figure 3). For kinetic analysis of the left ventricular wall, cine MR imaging was done. This revealed asynchronic motion of the left ventricle due to the tumor (Movies I and II). The tumor contracted just after the systolic phase of the left ventricle. During contraction, the tumor was first pushed out and appeared constricted just after contraction. On the basis of CT and MR imaging, the lesion was thought to represent a lipoma arising within the myocardium with paracardiac extension. The inner myocardium of the mass was very thin, and surgical debulking was not considered an appropriate option because of the possibility of cardiac rupture.Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible …

Left Ventricular Asynchrony Caused by an Intramuscular Lipoma

Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible with fat. In cardiac MR imaging, the signal intensity of the mass on several pulse sequences was consistent with that of fat (Figure 2A and 2B and Figure 3). For kinetic analysis of the left ventricular wall, cine MR imaging was done. This revealed asynchronic motion of the left ventricle due to the tumor (Movies I and II). The tumor contracted just after the systolic phase of the left ventricle. During contraction, the tumor was first pushed out and appeared constricted just after contraction. On the basis of CT and MR imaging, the lesion was thought to represent a lipoma arising within the myocardium with paracardiac extension. The inner myocardium of the mass was very thin, and surgical debulking was not considered an appropriate option because of the possibility of cardiac rupture.Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible …