Yutaka Watanabe

Reduction of infracardiac intestinal activity by a small amount of soda water in technetium-99m tetrofosmin myocardial perfusion scintigraphy with adenosine stress

BackgroundIn technetium (Tc)-99m myocardial perfusion imaging (MPI), intestinal activity often interferes with the assessment of myocardial perfusion of the inferior wall. We examined whether a small amount of soda water prevents intestinal activity and improves image quality of the inferior wall in Tc-99m tetrofosmin MPI.Methods and ResultsNinety-five patients referred for 1-day rest/stress Tc-99m tetrofosmin MPI were assigned to one of two groups automatically, according to the data when they underwent MPI: the soda water group (n=63) ingested 100 mL soda water just before image acquisition after adenosine stress, and the control group (n=32) underwent no intervention. The frequency of intestinal activity was assessed visually on planar images. The inferior myocardial wall and the abdominal activity adjacent to the myocardium were assessed quantitatively on three different planar images during stress, and the mean inferior wall-to-abdomen (1/A) count ratio was calculated. The frequency of intestinal activity was 69.8% in the soda water group, and 90.6% in the control group (P=.038). The I/A count ratio was significantly higher in the soda water group than in the control group (1.98±0.51 vs 1.50±0.35, respectively, P<.0001, ±SD).ConclusionsThe intake of 100 mL of soda water improves intestinal activity and improves the image quality of the inferior wall.

Management of Multiple Cholesterol Embolization Syndrome-A Case Report

A sixty-two-year-old man who underwent coronary angiography and received acute thrombolytic and anticoagulant therapy for acute myocardial infarction developed multisystemic injury, including renal insufficiency and cutaneous manifestations. Fundoscopic examination and skin biopsy specimen led to the diagnosis of multiple cholesterol embolization syndrome (MCES). Discontinuation of anticoagulants and administration of hemostatic (carbazochrome, tranexamic acid, reptilase, and vitamin K) and antihyperlipidemic (cholestyramine and probucol) drugs resulted in temporary improvement of cutaneous and renal disorders and extended survival for about one year. Besides severe aortic atherosclerosis, postmortem examination revealed numerous cholesterol emboli to multiple organs. MCES is a rare but serious complication of left heart catheterization and anticoagulant therapy, and the optimal treatment remains to be established. The authors suggest here that the above-mentioned therapy might be effective for management of MCES.

Kawasaki disease complicated by acute myocardial infarction 9 years after onset

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