Norikatsu Morioka

Coronary Vasospasm at the Site of Myocardial Bridge Report of Two Cases

Two patients with angina pectoris and postmyocardial infarction angina due to coronary vasospasm at the site of myocardial bridge are described. Intracoronary injection of isosorbide dinitrate led to resolution of coronary vasospasm on acetylcholine provocation test, and vasospastic angina pectoris has been well controlled after treatment with calcium channel blockers.

Serum markers of angiogenesis and myocardial ultrasonic tissue characterization in patients with dilated cardiomyopathy

It has been proven that a disturbance in angiogenesis contributes to the progression of myocardial interstitial fibrosis in idiopathic dilated cardiomyopathy (DCM). This study was designed to evaluate the relationship between serum activity of angiogenic factors and myocardial ultrasonic tissue characterization in patients with DCM.

Assessment of intermediate stenosis in the left anterior descending coronary artery with contrast-enhanced transthoracic Doppler echocardiography.

Background Visual or quantitative assessment of coronary angiography may not exactly predict the physiological significance of intermediate (40‐70%) coronary stenosis. Coronary flow reserve is a well‐established marker of the functional significance of coronary stenosis. Objectives The aim of this study was to compare the coronary flow velocity reserve (CFVR) using contrastenhanced transthoracic Doppler echocardiography (CETTDE) with thallium‐201 imaging in assessment of intermediate lesions in the left anterior descending coronary artery (LAD). Methods A consecutive series of 50 patients with intermediate stenosis in the LAD underwent pharmacological stress thallium‐201 imaging and CFVR measured by CETTDE. Results CFVR could be measured in 49 of 50 patients by the present method. A CFVR <2.0 predicted the presence of a stress thallium defect in 12 of 14 patients (agreement =90%, κ =0.76, P < 0.001). The sensitivity and specificity of CFVR for stress thallium‐201 results were 86 and 91%, respectively. In contrast, significant stenosis (> 50% by diameter) showed fair agreement for stress thallium defects (agreement = 59%, κ = 0.28, P < 0.05). Conclusions In the evaluation of intermediate lesions in the LAD, CFVR as assessed by CE‐TTDE could accurately predict the presence of ischemia on stress thallium imaging, whereas angiographic stenosis did not yield reliable results. Coron Artery Dis 14:247‐254

A case of pulmonary stenosis after a repair for tetralogy of Fallot treated with percutaneous pulmonary valvuloplasty using a triple-balloon technique

The patient was a 37-year-old female who had undergone a repair for tetralogy of Fallot (TOF) at the age of 4 years. Postoperative pulmonary stenosis remained, but she continued to be managed medically. Approximately 3 years ago, at the age of 34, she exhibited a worsening of fatigue and dyspnea during exertion (New York Heart Association III), and was therefore hospitalized for a detailed examination. In cardiac catheterization, a right ventricle to pulmonary artery peak-to-peak gradient of about 90 mmHg was observed. Since it appeared that medical treatment alone would not sufficiently control her heart failure, pulmonary valvuloplasty using a triple-balloon technique was performed for the pulmonary stenosis. The peak-to-peak gradient immediately after the procedure decreased to 13 mmHg. There were no indications of restenosis approximately 6 months after the procedure, and the symptoms of heart failure in her daily life improved thereafter.

Influence of meal intake on pulse wave indices in type 2 diabetes

Augmentation index (AI), brachial–ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI) are available for the assessment of arterial stiffness in clinical practices. However, influences of meal intake on these indices are still poorly understood. The aim of this study is to elucidate the effects of daily meal intake on pulse wave indices in patients with type 2 diabetes. We studied 17 patients with type 2 diabetes. AI was measured at fasting, 60 and 120 min after a commercial mixed meal (500 kcal) intake. The baPWV and CAVI were measured at fasting and 80–100 min after meal intake. All pulse indices decreased significantly after meal intake (AI, 89.3±9.7% to 77.9±9.4%, 82.0±8.4%, P<0.001; baPWV, 1652±286–1586±240 cm s–1, P=0.002; CAVI, 9.52±0.92–9.20±0.89, P=0.037). Δ120 (value 120 min after meal intake−fasting value) AI correlated significantly with age, body weight, Δ120 systolic blood pressure (SBP), Δ120 diastolic blood pressure, Δ120 pulse pressure, Δ120 heart rate and fasting AI. Δ (postprandial value−fasting value) baPWV correlated significantly with fasting baPWV, Δ SBP, Δ pulse pressure and HbA1c. In contrast, Δ CAVI did not correlate with any clinical variables. In conclusion, postprandial decreases in AI, baPWV and CAVI can lead to underestimate arterial stiffness in patients with type 2 diabetes. Postprandial changes in AI and baPWV, but not CAVI, are associated with changes in hemodynamic variables after daily meal intake.

The lurking potential of tangential forces: A case of an arteriovenous shunt developed by percutaneous coronary intervention for the septal branch

We describe the case of a 59-year-old male. His first percutaneous coronary intervention (PCI) using a bare metal stent was performed for a 90% stenosis in the mid portion of the left anterior descending artery (LAD). However, we performed re-PCI because in-stent restenosis developed during a chronic stage. After the first dilatation of the restenotic lesion, using a cutting balloon, the stenosis at the ostium of the septal branch, which takes off from the stent strut, became exacerbated. Therefore, after selective guidewire insertion to the septal branch, we performed balloon inflation. Unfortunately, a coronary dissection and perforation developed in the septal branch and a coronary arteriovenous shunt was also formed. Additional inflation for in-stent restenosis with a perfusion balloon provided successful occlusion of the ostium of the septal branch and the shunt flow disappeared. After careful re-selection of a guide wire into the septal branch, the perforated portion was then dilated using a small-sized conventional balloon. Finally, reperfusion of the septal branch was accomplished without any angiographic sign of coronary dissection, perforation or shunt. We herein report a rare case of coronary arteriovenous shunt formation due to the dissection and perforation of a coronary artery.

Assessment of flow velocity in a bypass graft of the gastroepiploic artery by contrast-enhanced transabdominal Doppler echocardiography: a case report.

An 81-year-old man with effort angina pectoris underwent coronary artery bypass grafting operation using the bilateral internal thoracic arteries and the right gastroepiploic artery (GEA). Angiography after operation showed that the bilateral internal thoracic arteries were patent. Abdominal angiography showed severe ostial stenosis in the celiac trunk. The GEA was not opacified by the celiac trunk but by the superior mesenteric artery, by collaterals. GEA flow could be detected from the epigastric lesion by contrast-enhanced Doppler echocardiography, and moreover, the flow velocity reserve of the graft was 2.4. This case suggests that the GEA graft can provide sufficient blood flow to the coronary artery despite ostial stenosis of the celiac trunk.