Tsutomu Igarashi

New subtype of apical hypertrophic cardiomyopathy identified with nuclear magnetic resonance imaging as an underlying cause of markedly inverted T waves

OBJECTIVES The aim of this study was to elucidate the clinical importance of a new subtype of apical hypertrophic cardiomyopathy that could not be diagnosed with the classical diagnostic criteria. BACKGROUND Apical hypertrophic cardiomyopathy is recognized by a characteristic spade-shaped intraventricular cavity on the end-diastolic left ventriculogram in the right anterior oblique projection, often associated with giant negative T waves [negativity > or = 1.0 mV (10 mm)]. As an underlying cause of giant negative T waves, an additional new subtype of apical hypertrophic cardiomyopathy has been identified. METHODS In 40 patients with inverted T waves (negativity > or = 0.5 mV), including 26 patients with giant negative T waves, nuclear magnetic resonance (NMR) long-axis images corresponding to the left ventriculogram in the right anterior oblique projection and short-axis images at various levels, including the apical level, were obtained to define the site of hypertrophied myocardium. RESULTS Long-axis images indicated a spadelike configuration in 17 patients, whereas this diagnostic configuration was not present in the other 23 patients. Nine of these 23 patients had significantly hypertrophied myocardium at the basal level. In the 14 remaining patients, short-axis images indicated no hypertrophy at the basal level and proved that the area of hypertrophied myocardium was confined to a narrow region of the septum or the anterior or lateral wall at the apical level (nonspade apical hypertrophic cardiomyopathy). The hypertrophied myocardium of the nonspade type was so narrowly confined that the mass did not form a spadelike configuration or could not be detected on the long-axis image. CONCLUSIONS Nonspade apical hypertrophic cardiomyopathy was newly identified on NMR short-axis images, and this could be an additional, important underlying cause of moderately to severely inverted T waves.

Diagnosis of patent ductus arteriosus in adults by biplane transesophageal color Doppler flow mapping

Abstract In infants and children, direct visualization of patent ductus arteriosus and shunt flow is often successful using transthoracic 2-dimensional 1 and color Doppler echocardiography. 2 In adults, however, transthoracic echocardiography may fail to yield diagnostic information on patent ductus arteriosus because the ductus is located far from the transducer on the chest wall. 3 Since the recent development of a transesophageal transducer with the capabilities of color-coded Doppler flow imaging, both single- and biplane transesophageal echocardiography have been extensively used in the assessment of patients with cardiovascular diseases. 4–8 Transesophageal approach affords consistent high-quality 2-dimensional images of the arch and descending aorta without being restricted by lung tissue or ribs. This study evaluates the diagnostic usefulness of transthoracic and biplane transesophageal color Doppler echocardiography in adolescent and adult patients with patent ductus arteriosus.

Follow-Up in mitral valve prolapse by phonocardiography, M-mode and two-dimensional echocardiography and Doppler echocardiography

To assess the serial phonocardiographic and echocardiographic change in patients with mitral valve prolapse (MVP), phonocardiograms and echocardiograms were reviewed retrospectively in 116 patients (48 men and 68 women, mean age 27 years) who had been determined to have MVP and were reexamined 4.3 years (range 1 to 14) later by phonocardiography and echocardiography between 1971 and 1988. Follow-up phonocardiograms showed periods when 5 of 18 patients with silent MVP developed mid- or late systolic clicks. Of 57 patients with mid- or late systolic clicks, 15 had silent MVP, 6 developed a late systolic murmur with or without systolic clicks and 1 developed a pansystolic murmur. Two of 9 patients with an isolated late systolic murmur developed a pansystolic murmur. M-mode echocardiograms showed that left atrial and left ventricular dimensions at end-diastole and end-systole increased in patients with systolic murmur (33 +/- 10 vs 35 +/- 11, 46 +/- 6 vs 50 +/- 7 and 29 +/- 4 vs 31 +/- 5 mm, respectively, all p less than 0.001) and no statistically significant changes in any of these dimensions were found in patients without a systolic murmur. The degree of MVP evaluated by the anteroposterior mitral leaflet angle on the 2-dimensional echocardiogram was more severe in patients with a systolic murmur than in patients without systolic murmur (157 +/- 12 vs 131 +/- 16 degrees, p less than 0.001). The degree of prolapse did not change during the follow-up periods. The number of patients with mitral regurgitation detected by pulsed Doppler echocardiography increased from 21 of 72 (29%) to 31 of 72 (43%).(ABSTRACT TRUNCATED AT 250 WORDS)

Visualization of Sinus Venosus-type Atrial Septal Defect by Biplane Transesophageal Echocardiography

In this article we describe three patients in whom biplane transesophageal echocardiography was useful in diagnosing sinus venosus type atrial septal defects. In two patients, diagnosis of anomalous pulmonary venous drainage was made correctly by biplane transesophageal echocardiography.

Effect of amyl nitrite on mitral valve prolapse and mitral regurgitation : a transesophageal echocardiographic study

To test the hypothesis that amyl nitrite (AN) increases the degree of prolapse by reducing the left ventricular size and making the mitral apparatus relatively more redundant in patients with mitral valve prolapse (MVP), transesophageal echocardiography was performed in 23 patients with MPV before and after AN inhalation. The heart rate increased from 84±20 to 104±25 beats/min (p<0.001), and the left ventricular end-diastolic dimension decreased from 40±6 to 37±5 mm (p<0.001) after AN administration