Shigemoto Nakanishi

Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients.

Abstract In 30 of 1,002 consecutive patients who had left heart catheterization and cineangiography for evaluation of either ischemic heart disease or cardiomyopathy the electrocardiogram showed giant negative T waves (greater than 10 mm) associated with high QRS voltage (R wave greater than 26 mm in lead V 5 or the sum of the S wave in lead V 1 and the R wave in lead V 5 35 mm or more) in the precordial leads despite absence of hypertension or significant coronary artery disease. In all 30 patients a characteristic spade-like configuration (concentric apical hypertrophy) was observed in the right anterior oblique ventriculogram at end-diastole as well as in the long axis two dimensional echocardiogram. The average apical thickness in these patients (24.8 ± 6.6 mm) was significantly greater than that in normal subjects (9.4 ± 3.1 mm) ( P P P P P It is concluded that these 30 patients have nonobstructive hypertrophic cardiomyopathy with marked concentric hypertrophy in the apex (apical hypertrophic type) and with a different septal shape and contraction pattern from those seen in the obstructive type. This type of hypertrophy appears to be a fairly common type of hypertrophic cardiomyopathy in Japan.

Primary coronary artery dissection observed at coronary angiography.

Abstract Primary coronary artery dissection has rarely been reported since Prettys first description in 1931.l Earlier cases, which were diagnosed incidentally at autopsy, yielded a clinical picture of catastrophic acute coronary artery disease, revealed either by sudden death (62%) or acute myocardial ischemia (38%). 2 Recently, however, the diagnosis has been made on clinical grounds. Among the 15 previous case reports of primary coronary artery dissection documented by coronary arteriogram (Table I), the diagnosis was made during coronary angiogram conducted for initial examination of acute myocardial infarction in 13 and during coronary angiogram performed under a diagnosis of angina pectoris in 2 patients.

Intravascular imaging of serial changes of disease in saphenous vein grafts after coronary artery bypass grafting

To clarify the structural changes of saphenous vein grafts after coronary artery bypass grafting, intravascular ultrasound and angioscopic images were obtained from 23 grafts in vivo and 5 grafts and 3 new veins in vitro; the images were compared with histologic findings. Intravascular ultrasound demonstrated a single-layered appearance at new veins and all of the angiographically normal grafts within 6 months after surgery. A triple-layered appearance that might be related to the remarkably proliferative and degenerated intima was revealed histologically at 73.3% of the normal sites of grafts between 5 and 10 years after operation. In 83.3% of the stenoses at several years after operation, angioscopy showed yellow atheromatous plaques, often with a friable surface; a heterogeneous, lucent echo pattern was revealed on intravascular ultrasound. Thus intravascular ultrasound and angioscopy may be used to identify the morphologic changes of graft at different points after implantation more precisely than conventional angiography.

Prediction of the severity of coronary artery disease by measurement of lipoprotein (a)

BackgroundA number of clinical studies have shown that high serum lipoprotein (a) [Lp(a)] levels are associated with coronary artery disease (CAD). It is, however, unclear whether increased serum concentration of Lp(a) alone is a significant risk factor for CAD. MethodsWe studied 120 consecutive patients who underwent selective coronary angiography: 34 with old myocardial infarction, 47 with angina pectoris, and 39 without ischemic heart disease. ResultsSerum Lp(a) concentrations measured by an enzyme immunoassay method were significantly higher in both the myocardial infarction (mean 23.5 mg/dL, P<0.01) and angina pectoris (22.6 mg/dL, P<0.05) groups than in the no ischemic heart disease group (14.1 mg/dL). On multiple regression analysis with Friesingers severity score (F score) as the criterion variable, the factors that were independently related to F score were Lp(a) (standard regression coefficient [p] = 0.326, P< 0.01), high-density lipoprotein cholesterol (-0.251, P<0.01), and low-density lipoprotein cholesterol (0.225, P<0.01); other coronary risk factors were not related to the score. Serum Lp(a) levels rose as the number of affected arteries (≥75% stenosis) increased (13.3, 21.7, 21.8, and 30.1 mg/dL for zero, one, two, and three affected vessels, respectively). Very similar results were obtained in 78 selected subjects with normal serum cholesterol (<220 mg/dL). ConclusionsWe conclude that Lp(a) is an independent risk factor for CAD and further predicts its severity.

Efficacy of nifekalant hydrochloride on the treatment of life-threatening ventricular tachyarrhythmias during reperfusion for acute myocardial infarction.

Nifekalant hydrochloride, which is formally known as MS-551, is a new class III antiarrhythmic drug. This drug inhibits several cardiac potassium channels and is effective for various experimental arrhythmias. In this case report, we demonstrated the clinical effect of nifekalant hydrochloride on the sustained ventricular tachycardia (VT) due to reperfusion therapy for acute myocardial infarction with severe left ventricular dysfunction.

Coronary Revascularization in a Patient with Calcified Aorta Using Ventricular Fibrillation without Aortic Cross-clamping.

上行大動脈に高度の石灰化病変がある54歳の女性症例に対して, 上行大動脈にまったく操作を加えずに冠動脈バイパス術を行った. 大腿動脈より送血カニューレを挿入して体外循環を行い, cardioplegia 液を使用せず大動脈非遮断低体温心室細動下に, 両側内胸動脈と右胃大網動脈の3本の動脈グラフトを使用して3枝バイパス術を施行した. 術後は脳合併症など起こすことなく順調に経過した. 上行大動脈の高度石灰化症例に対してはこの aortic no touch technique が安全かつ確実な手術方法と考えられた.