Takuo Misawa

Percutaneous treatment of a free-floating thrombus in the right atrium of a patient with pulmonary embolism and acute myocarditis

Free-floating thrombi in the right atrium (RA) are extremely hazardous to patients with pulmonary thromboembolism, and optimal treatment methods remain unclear. We report a case of successful percutaneous intervention of a critical right atrial thrombus. The patient was a 50-year-old woman who had been under medication for acute myocarditis when she complained of sudden severe dyspnea. Echocardiography showed a mobile snake-like thrombus in the RA. The thrombus was pulled back to the distal inferior vena cava (IVC) using a catheter and an IVC filter was placed. Percutaneous treatment is useful for treating free-floating RA thrombi.

Comparison of patients with single, double and triple coronary arterial spasm

Abstract It is generally accepted that coronary arterial spasm plays an important role in ischemic heart disease. Some investigators described a case report showing spontaneous 3-vessel coronary vasospasm. 1 The other pointed out that multivessel coronary vasospasm is not rare. 2 The purpose of this report is to compare patients with 1-, 2- and 3-vessel coronary arterial spasm without significant organic stenosis and to elucidate the clinical characteristics and risk factors of them.

Development of High-Grade Ventricular Arrhythmias in Familial Amyloid Polyneuropathy

To determine which subsets of patients with amyloid heart disease are particularly susceptible to the development of clinically significant ventricular arrhythmias, 16 patients with familial amyloid polyneuropathy (FAP) were studied by serial 24-hour electrocardiographic monitorings and echocardiography. During a mean follow-up period of 26.6 months, seven patients (44%) developed repetitive premature ventricular complexes (PVCs), including ventricular couplets in four and ventricular tachycardia in three. One of them showed syncope at the time when the arrhythmia was identified. Although there were no significant differences in the mean age, duration of the illness before the beginning of the study, and the initial echocardiographic results, the mean follow-up periods were more prolonged and neurologic disabilities were more advanced in patients with repetitive PVCs compared with those without any significant arrhythmias. In addition, patients who developed repetitive PVCs showed significantly greater percent changes in ventricular wall thickness with resultant wall hypertrophy than those who did not. One of the three patients who died within one year of the final study experienced sudden cardiac death and had showed frequent episodes of ventricular tachycardia at the final study. We conclude that (1) high-grade ventricular arrhythmias develop frequently in patients with FAP in the far-advanced stage in whom progressive and marked myocardial amyloid infiltration occurs and (2) identification of subsets of patients with repetitive PVCs may be helpful for the treatment as well as management of amyloid heart disease.

Noninvasive Evaluation of Left Ventricular Systolic and Diastolic Time Intervals in Familial Amyloid Polyneuropathy

To determine left ventricular (LV) systolic and diastolic properties in patients with familial amyloid polyneuropathy (FAP), we analyzed simultaneous recordings of the electrocardiogram, phonocardiogram, carotid arterial pulse, and apex cardiogram (ACG) in 13 patients and 20 normal subjects. The following variables were measured: (1) LV systolic time intervals = iso-volumic contraction time (ICT), corrected preejection period (PEPi), corrected ejection time (ETi), corrected Q-I interval (Q-Ii), corrected Q-II interval (Q-IIi), PEP/ET, and ICT/ETi; (2) 1EA-O interval (IIA-O) = the time interval from the onset of the aortic component of the second heart sound to the 0 point on the ACG; (3) ΔT = the time interval from the onset of the aortic component of the second heart sound to the point on the ACG down-stroke where the curve falls to 50% of the total height of the diastolic deflection; and (4) ΔT/IIA-O. Patients with FAP had significantly greater Q-Ii, PEPi, Q-IIi, and PEP/ET than normal subjects, whereas there were no differences in the ETi, ICT, and ICT/ETi. Patients with FAP also showed slightly greater IIA-O than normal subjects but the difference was not significant. In addition, AT and AT/IIA-0 were significantly greater in patients with FAP than in normal subjects. We conclude that in patients with FAP, LV relaxation is impaired, especialy in early diastole, whereas systolic function is generally preserved, and that electromechanical delay is markedly increased.

Impaired Left Ventricular Diastolic Properties in Patients with Familial Amyloid Polyneuropathy : A Study by Computerized M-Mode Echocardiography

To determine left ventricular (LV) diastolic properties in patients with familial amyloid polyneuropathy (FAP), we examined 17 patients by means of computerized M-mode echocardiography and compared the results with 25 normal subjects. Patients with FAP showed a significantly lower peak rate of diastolic LV internal dimension (dD/dt) as well as a lower peak rate of diastolic thinning of the LV posterior wall (dW/dt) than normal subjects, whereas LV systolic parameters, including cardiac index, ejection fraction, and ejection time, were nearly identical. Furthermore, although eight of the 17 patients had normal LV posterior wall thickness, they had a significantly lower dD/dt, as well as a lower dW/dt, than normal subjects. We conclude that in patients with FAP LV diastolic properties are changed, whereas systolic function is almost preserved, and diastolic abnormalities can be seen even in the absence of LV hypertrophy.

Early Detection of Amyloid Heart Disease by Technetium-99M-Pyrophosphate Single-Photon Emission-Computed Tomography : A Study with Familial Amyloid Polyneuropathy

Eighteen patients with familial amyloid polyneuropathy (FAP) were studied to determine whether technetium-99m-pyrophosphate (Tc-99m-PYP) scintigraphy or two-dimensional echocardiography (2-DE) can detect myocardial involvement in an earlier stage. Thirteen of them were considered to be in the early stage of myocardial amyloid infiltrative process because they showed no clinical evidence of overt heart disease, as well as normal ventricular wall thickness and normal values for left ventricular systolic function. Although planner scintigraphy showed mild or moderate myocardial uptake in six (46 %) of the 13 patients, single-photon emission-computed tomography, performed in 12 of them, demonstrated an unevenly distributed biventricular uptake in ten (83 %), including four who were judged to be negative by the planner scanning. On the other hand, none had characteristic highly refractile myocardial echoes on the 2-DE images. In additional 95 control patients with nonischemic heart disease, planner scintigraphy showed diffuse positive pyrophosphate scans of the heart in five (4%) of them and 2-DE demonstrated granular sparkling echoes in 10 (10%). In conclusion, (1) planner Tc-99m-PYP scanning is a more sensitive and specific procedure to detect amyloid heart disease in the earlier stage of FAP than 2-DE and (2) single-photon emission-computed tomography may be more sensitive for diagnosing this condition.