Sachiyo Iwata

UNPREDICTABLE STENT EXPANSION AFTER FINAL KISSING BALLOON INFLATION FOR BIFURCATION LESIONS: AN INTRAVASCULAR ULTRASOUND ANALYSIS

Methods: We investigated 67 bifurcation lesions treated by single crossover sirolimus-eluting stent (SES) and additional KBT. After final KBT, stent cross sectional area (S-CSA) were measured in every 1 mm slice from distal end of proximal main vessel by intravascular ultrasound (IVUS). We also estimated S-CSA post KBT using Mitsudo’s formula (R2=MBB2 (Main branch balloon)+SBB2 (Side branch balloon)). Ratio of minimal/estimated S-CSA (Min/E ratio) was calculated, and Min/E ratio< 0.7 was defined as ‘suboptimal’ expansion after KBT.

ONLY TOTAL OCCLUSION TYPE IN-STENT RESTENOSIS IS ASSOCIATED WITH POOR FUNCTIONAL AND CLINICAL OUTCOMES AFTER SUCCESSFUL PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION

Methods: We investigated 339 STEMI patients who had undergone pPCI with BMS followed by rest (acute phase=within 2 weeks) /exercise stress (chronic phase) 99m-Tc-Tetrofosmin scintigraphy (TcTF) and follow-up coronary angiography (CAG). According to the result of follow-up CAG, they were divided into three groups (A: no ISR, n=228; B: ISR without occlusion, n=86; C: ISR with occlusion, n=25). Perfusion defect score (DS), left ventricular ejection fraction (LVEF) and myocardial ischemia were evaluated by TcTF. Re-hospitalization due to congestive heart failure and cardiac death were investigated as clinical events.

The advance in T2/T1-weighted cardiac magnetic resonance coronary plaque imaging

Methods Plaque imaging with 1.5-T CMR, OCT and IVUS were performed at corresponding sites in patients undergoing catheterization. CMR arterial wall imaging was divided into four categories according to the signal intensity ratio of vessel/lumen (low to diffuse high). OCT plaque characteristics for lipid content, fibrous cap thickness, and macrophage density were derived using previously validated criteria. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque with fibrous cap. Remodeling index (RI) was calculated as the ratio of the lesion to the reference external elastic membrane area with IVUS.

Reconstruction of the Right Ventricular Outflow Tract with a Transannular Patch for Ventricular Tachycardia Refractory to Radiofrequency Catheter Ablation in a Patient who Underwent Tetralogy of Fallot Surgery in Childhood

A 29‐year‐old male who underwent a complete tetralogy of Fallot repair at 2 years of age was referred to our hospital for treatment of sustained ventricular tachycardia (VT). The bipolar voltage map using an electroanatomical mapping system (CARTO, Biosense‐Webster. during sinus rhythm revealed a low voltage area identical to the site of the right ventricular outflow tract (RVOT. patch on the anterior wall of the RVOT. During the tachycardia, the activation wavefront was found to revolve in a counterclockwise manner around the patch in the RVOT. Two radiofrequency catheter ablation (RFCA. sessions creating a line between the patch in the RVOT and pulmonary artery achieved only transient success. He underwent a pulmonary valve replacement and reconstruction of the RVOT with a transannular patch to treat the VT refractory to RFCA and severe pressure gradient in the RVOT. In postoperative electrophysiological study, a low voltage area in the RVOT connected to the pulmonary artery with the patch was observed, and produced conduction block in the reentry circuit of the VT. The patient has been free from any VT recurrence during 6 months of follow up.