Yuko Wakisaka

Prognostic Significance of Frequent Premature Ventricular Contractions Originating from the Ventricular Outflow Tract in Patients with Normal Left Ventricular Function.

Background: Recently, it has been reported that frequent premature ventricular contractions (PVCs) may be associated with causing heart failure in patients with left ventricular (LV) dysfunction. However, the prognostic significance of frequent PVCs in asymptomatic patients with a normal LV function is unclear. Methods: Two hundred and thirty-nine consecutive patients presenting with frequent PVCs (>1000 beats/day) originating from the right or left ventricular outflow tract without any detectable heart disease were enrolled in the study. Structural heart disease was ruled out by echocardiography and cardiac magnetic resonance imaging, and Holter-ECG monitoring was repeated two or three times to evaluate the PVC prevalence at the initial evaluation. All patients were followed up for at least 4 years, and further observation was continued if possible. Results: During an observation period of 5.6 (1.7) years, no patients exhibited any serious cardiac events. Although there was no significant change in the mean LV ejection fraction (LVEF) and mean LV diastolic dimension (LVDd), there was a significant negative correlation between the PVC prevalence and ΔLVEF (p<0.001) and positive correlation between the PVC prevalence and ΔLVDd (p<0.001). When the development of LV dysfunction was defined as ΔLVEF>−6%, 13 patients exhibited LV dysfunction. For the prediction of the development of LV dysfunction, PVC prevalence and LVEF at the initial evaluation were independent predicting factors (p<0.01). Conclusion: Although the prognosis in patients with frequent PVCs was considered relatively benign, attention should be paid to the progression of the LV dysfunction during a long-term observation, especially in patients with a high PVC prevalence.

Prevalence of adult patients with congenital heart disease in Japan

BACKGROUND Today most patients with congenital heart disease (CHD) can be expected to survive into adulthood. Reports regarding the number of adults with CHD in Japan are scarce. Our study aims to define the number of these adults. MATERIAL AND METHODS The estimated number of infants born in Japan with major CHDs since 1947 was calculated together with mortality rates. We estimated the number of CHD survivors from data on survival rates of unoperated and postoperative patients. The number of deaths from 1968 to 1997 was analyzed using individual death certificates held by the Japanese Government. RESULTS In 1967, 163,058 patients with CHD including 53,846 adults were assumed to be alive. From 1968 to 1997, 548,360 patients with CHD were born and 82,919 died. A total of 622,800 patients, including 304,474 children (49%) and 318,326 adults (51%) were estimated to be alive in 1997. From 1997 to 2007, there has been an estimated increase of 9000 adults every year, and in 2007, 409,101 adults are estimated to be alive. CONCLUSIONS The prevalence in adults with CHD in Japan has explosively increased from 1967 to 2007. There were 409,101 adults with CHD in 2007 with an annual increase of 9000. These data are crucial for planning the establishment in Japan of special facilities and resources necessary for the care of these patients.

Systemic ventricular morphology-associated increased QRS duration compromises the ventricular mechano-electrical and energetic properties long-term after the Fontan operation

OBJECTIVES To evaluate the impact of systemic ventricular (SV) morphology on mechano-electrical interaction (MEI) and compare the results with clinical profiles in Fontan patients. BACKGROUND Abnormal ventricular MEI causes systolic dysfunction of the right and left ventricles (RV, LV). METHODS We evaluated serial changes (up to 15 years post-Fontan operation) in QRS duration (QRS-d, ms), catheterization-based hemodynamics and SV performance in 77 patients and compared them with 36 referents. RESULTS Preoperative QRS-d was wider in the Fontan patients (86+/-14 vs. 64+/-9, p<0.001) and steadily increased for the next 15 years (107+/-25 vs. 85+/-9, p<0.001). QRS-d was wider in non-LV type SV patients than those with LV morphology (p<0.05) with a positive association with age at repair (p<0.001). SV contractility (Ees) improved in the RV and LV groups (p<0.05), during the next 10-year Ees, ventriculoarterial coupling (Ea/Ees) and ventricular efficiency (SW/PVA) were superior in the LV group. QRS-d and its long-term change correlated with the corresponding SV volume and change (p<0.01), respectively, while the immediate postoperative volume reduction did not result in the QRS-d shortening. QRS-d correlated with Ees, Ea/Ees, SW/PVA, and peak oxygen uptake (VO(2)) (p<0.001) and QRS-d was one of the main determinants of peak VO(2) (r=-0.48, p<0.001). CONCLUSIONS SV morphology-associated wide QRS-d compromises the MEI as well as energetic properties long-term after the Fontan operation, especially in non-LV type patients.

A young adult who had undergone coronary artery bypass grafting and abdominal aortic replacement with prosthetic vessel later after incomplete Kawasaki disease

A 33-year-old male with a history of undiagnosed fever at the age of 14 years underwent coronary artery bypass grafting (CABG) and abdominal aortic replacement with a prosthetic vessel. Syncope and chest pain on exertion at the age of 19 years led to the diagnosis of complete occlusion of three major coronary branches and emergency CABG was performed. Fourteen years later, a pulsating abdominal mass was an incidental finding during an outpatient clinic visit and an abdominal aortic aneurysm was confirmed by computed tomography. Based on the recorded symptoms and examination findings, the past history of unexplained fever was suspected to be due to incomplete Kawasaki disease. Co-existing systemic arterial lesions should be sought in patients with multi-vessel coronary disease due to Kawasaki disease, although their prevalence is low.