Shiro Hata

The Left Ventriculographic Pattern and Serial Electrocardiographic Changes in Hypertrophic Cardiomyopathy Patients with Giant Negative T Waves

The configuration of the left ventriculogram (LVG) was classified in 64 patients with hypertrophic cardiomyopathy (HCM) observed in ECG, and characteristics of the configuration and serial changes in SV1+RV5 and giant negative T (GNT) waves were studied. The LVG configuration was classified into the spade (15 patients), papillary-muscle hypertrophy (PMH; n = 23), oval (n = 24) and banana types (n = 2). The spade, PMH and oval types were observed for mean periods of 66, 90 and 91 months, respectively. Serial changes in ECG were as follows: GNT decreased from 16.7 +/- 3.3 to 13.3 +/- 5.1 mm in the spade type and decreased significantly from 16.9 +/- 5.9 to 9.8 +/- 6.9 mm in PMH but showed no changes in the oval type. SV1+RV5 decreased significantly from 69.0 +/- 14.9 to 58.2 +/- 14.7 mm in PMH but showed no significant changes in the spade or oval types. Thus GNT decreased progressively in many patients with the exception of a few with the oval type. From these findings, we consider that apical hypertrophy had been established at the time of the initial LVG and changed over time thereafter in the spade and PMH types but that hypertrophy was still in progress in some patients with the oval type.

Comparison of Neointimal Tissue Characteristics Between Bare-metal and Second-generation Drug-eluting Stents Nine Months after Implantation in Patients with ST-segment Elevation Myocardial Infarction

Background: Neointimal tissue characteristics after implantation of stents are related to late/ very late stent thrombosis and/ or restenosis of target lesion. However, the difference of them has not been fully elucidated among bare-metal stents (BMS) and second-generation drug-eluting stents (DES). Methods: The present study uses optical coherence tomography (OCT) to compare neointimal tissue characteristics among BMS (n = 22), Endeavor zotarolimus - (E-ZES; n = 21), everolimus - (EES; n = 22) and biolimus A9 - (BES; n = 23) eluting stents in the patients with STEMI who underwent follow-up coronary angiography at nine months after stent implantation. Results: Quantitative coronary angiography revealed significantly higher restenosis rates for BMS and E-ZES than EES and BES. OCT showed significantly lower and higher rates for covered and uncovered EES, respectively, than for BMS and E-ZES. The malapposition rate for E-ZES was significantly lower than those of other two types of DES. The neointima of EES and BES was significantly thinner than that of BMS and E-ZES. Evagination was more prevalent in BES among the four stents, and the rate of evagination/strut significantly correlated with positive remodeling (r = 0.312, p = 0.006). Conclusion: Neointimal tissue characteristics were different among BMS and second-generation DES at nine months after implantation into patients with STEMI. This might be related to the differences of future cardiac events.

Formation of Two Aneurysms from a Coronary Artery-Pulmonary Artery Fistula

Accessible online at: www.karger.com/crd Aneurysm formation from a coronary artery-pulmonary artery fistula is very rare. A few reported cases were detected after acute cardiac tamponade and were complicated by rupture of the aneurysm [1]. Other cases were detected coincidentally at coronary angiography [2–4]. Here, we present a rare case of two aneurysms from a coronary arterypulmonary artery fistula detected coincidentally by chest computed tomography (CT). A 58-year-old woman with a history of left mastectomy for breast cancer was referred to our hospital for the examination of abnormal shadows on chest CT scans. She had been periodically checked for recurrence and metastasis of breast cancer by chest CT until July 6, 2000, when shadows of a mass in the vicinity of the base of the aorta were first identified (fig. 1a). Coronary aneurysms were suspected. The size of the aneurysms was not so large so that the patient was followed up conservatively. On February 6, 2002, a repeat chest CT showed an enlargement of the shadows of the mass (fig. 1b). The patient had no history of Kawasaki disease, Takayasu’s arteritis, chest trauma or radiation therapy. No symptoms, such as chest pain, suggestive of coronary heart disease, were reported. Physical examination showed no audible heart murmurs. Selective

The Pulmonary Vascular Response to Acute Hypoxia in Chronic Pulmonary Disease: Morphological Assessment with Magnified Pulmonary Wedge Angiography

To detect hypoxic pulmonary vasoconstriction (HPV) morphologically, we investigated the pulmonary vascular response to acute hypoxia in 27 patients with chronic pulmonary disease (CPD) and 8 healthy subjects. Pulmonary hemodynamic measurements and magnified pulmonary wedge angiography (MPWA) were carried out before and after inhalation of 13% oxygen in nitrogen for 15 min. The diameters of central arteries (A) and muscular arteries (B) were measured using a densitometric method. Vasoconstriction was detected in the muscular arteries than in the central arteries by MPWA. There was a significant correlation between delta P (changes of mean PA pressure) and delta B/A (changes in diameters of B/A) in the CPD group. A significant correlation was found between delta SvO2 and delta B/A in the control group. We conclude that MPWA was a very useful method for the simple detection of HPV in patients with CPDs and we detected one site of HPV on the ninth generation of the pulmonary arterial tree by MPWA.