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Biomedical subjects

K Fujitani

Publications and source records attributed to K Fujitani.

At least 91 records · Page 5Linked to original sources
PubMed1985

Effects of diltiazem and nitroglycerin on left ventricular diastolic properties in patients with coronary artery disease.

To determine the effects of diltiazem (DTZ) and nitroglycerin (NTG) on left ventricular (LV) diastolic relaxation and filling in patients with cornary artery disease (CADpts), LV graphy and time constant (Tc) of LV isovolumic pressure decay were studied before and 5 min after intravenous DTZ (10 mg) in 16 CADpts and sublingual NTG (0.3 mg) in 11 CADpts. Diastolic regional ventricular filling dynamics were quantitated by segmental area-time curves during early-, mid- and late-filling periods. After NTG, LV systolic pressure (LVSP), end-diastolic pressure (EDP) and end-diastolic volume (EDV) decreased. Early-filling rate (EFR) decreased (165 +/- 82 to 122 +/- 61 ml/sec/m2) due to a decrease in the regional early-filling rate in the normokinetic area and late-filling rate (LFR) increased (95 +/- 38 to 145 +/- 45 ml/sec/m2), while LV peak positive dp/dt, peak LVSP/end-systolic volume (ESV) ratio, Tc and mid-filling rate (MFR) were unchanged. After DTZ, LVSP decreased and EDV increased. EFR increased. EFR increased (127 +/- 54 to 166 +/- 60 ml/sec/m2) due to an enhanced regional early-filling rate in the mildly hypokinetic area, while EDP, LV peak positive dp/dt, peak LVSP/ESV ratio, Tc, MFR and LFR were unchanged. From these results, it was postulated that NTG caused a decrease in LV early filling and an increase in LV late filling, probably due to LV preload reduction. In contrast, DTZ caused significant improvement of LV early filling particularly in the mild hypokinetic area. Thus, DTZ but not NTG was able to relieve local myocardial dysfunction secondary to a stenosed coronary artery during the filling period, resulting in clinical improvement in CADpts.

Benzazepines↗
PubMed1985

[Hypertensive heart disease simulating dilated cardiomyopathy].

Echocardiography was performed for 246 patients with hypertension. Among the 246 patients, echocardiographic features simulating dilated cardiomyopathy (DCM) were observed in 12. These patients had past history of hypertension and prominent left ventricular dilatation with reduced left ventricular contractility, but no left ventricular wall thickening. To elucidate the mechanism producing DCM-like features in patients with hypertension, the clinical and echocardiographic findings of the 12 hypertensive patients (HT-DCM) were compared with those of 50 hypertensive patients without dilated left ventricles and of 31 patients with DCM. On admission, all patients with HT-DCM had congestive heart failure (CHF) without high blood pressure and their echocardiograms revealed the abnormal findings described above. There were no differences of the clinical and echocardiographic findings on admission between HT-DCM and DCM. Following medical treatment, relatively early improvement of CHF was noted in all patients with HT-DCM; the LV dimension decreased and diffuse wall motion abnormality improved steadily with gradual elevation of blood pressure during the follow-up periods. The LV function of most patients with HT-DCM improved markedly but never reached normal levels. There were no significant differences the right ventricular endomyocardial biopsy findings of between DCM and HT-DCM. It was suggested the DCM-like features in these cases are caused, not only by hypertension, but by other factors, as well.

Adult↗
PubMed1985

[Right ventricular dysplasia: clinical characteristics of five patients].

The purpose of this study was to elucidate the clinical features of right ventricular (RV) dysplasia, a recently described clinical entity characterized by RV myopathic changes and ventricular tachycardia of left bundle branch block morphology. Five cases were reported, in which the diagnosis was established according to the criteria of Marcus. Case 1, a 33-year-old man, was referred to us for evaluation of his paroxysmal ventricular tachycardia of five years duration. Case 2, a 38-year-old man, was admitted because of shock caused by ventricular tachycardia. In both cases, the QRS configurations during ventricular tachycardia were those of the left bundle branch block pattern, and electrocardiograms during sinus rhythm showed T wave inversions in the right precordial leads and late ventricular potentials. Two-dimensional echocardiography, radionuclide angiography and contrast angiography disclosed RV dilatation and dysfunction with normal left ventricular (LV) function. The biopsied myocardium from the right and left ventricles in Case 2 revealed myocytolysis, a paucity of myofibrils and proliferation of collagen fibers. Case 3, a 73-year-old woman began to experience exertional dyspnea since 16 years of age. Her treatment consisted of bed rest, diuretics and digitalis. In December 1983, her New York Heart Association functional class was III, and physical examinations disclosed a Levine III/VI systolic murmur suggestive of tricuspid regurgitation, jugular vein dilatation, hepatomegaly, and pretibial edema. Electrocardiogram showed atrial fibrillation, incomplete right bundle branch block and T wave inversions in the precordial leads. Chest radiograph revealed marked cardiomegaly (cardiothoracic ratio of 92%). Echocardiography, radionuclide angiography and contrast angiography revealed marked RV dilatation, depressed ejection fraction (RV end-diastolic volume index of 342 ml/m2, and RV ejection fraction of 28%). Case 4, a 20-year-old man, was admitted with a chief complaint of palpitation. Case 5, a 19-year-old man, was referred to us for the evaluation of asymptomatic cardiomegaly, and his cardiothoracic ratio was 54%. A 12-lead electrocardiogram showed right bundle branch block and T wave inversions in the right precordial leads. Ambulatory electrocardiography revealed frequent premature ventricular complexes of the left bundle branch block pattern. Echocardiography, radionuclide angiography, and contrast angiography disclosed RV dilatation and dysfunction in both cases, and mild LV dilatation and dysfunction (LV end-diastolic volume index of 149 ml/m2, LV ejection fraction of 48%) in Case 4.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

[Clinical significance of early redistribution of the exercise-induced thallium-201 defect in ischemic heart disease].

This study clarified thallium-201 (Tl) kinetics in the early stage after exercise in patients with ischemic heart disease (IHD). Tl was administered for 39 patients with IHD and eight normal subjects during maximal exercise. Immediately after exercise, dynamic data were obtained using a double slant-hole collimator at one frame/2 min for a 20 min period. The data of 10 frames (20 min) were spatially smoothed, and semiquantitative segmental analyses of the uptake and kinetics of Tl were performed by computer. In eight normal subjects, Tl uptake was uniform throughout the continuous 20 min, and Tl activity was unchanged throughout the 20 min period after exercise. Among 39 patients with IHD, 39 had Tl defects in the first frame (initial defect). Among 39 initial defects, 15 (38%) showed complete or partial early redistribution as early as 20 min and Tl activity in the defect increased (10.5 +/- 1.5%) over the 20 min period. Early redistribution occurred in 10 (43%) of 23 patients with effort angina and in five (83%) of six patients with variant forms of angina, but in no patients with myocardial infarction. Patients with early redistribution showed a greater frequency either of good collateral vessels or of mild stenosis of the coronary artery, compared with those who had no early redistribution. In conclusion, analysis of Tl kinetics in the early stages after exercise can provide important information about the coronary perfusion state during recovery from transient ischemia, and early redistribution may be a sign of preserved hyperemic flow in the ischemic region.

Angina Pectoris↗
PubMed1984

Clinical features, problems in medical management and therapeutic planning in severe valvular heart disease.

Clinical features and pathological findings were reviewed in 90 postmortem cases of valvular heart disease (VHD) to clarify the problems and limitations of medical management. The clinical features of severe mitral valve disease included congestive heart failure (CHF), with tricuspid regurgitation in many cases, atrial fibrillation, frequent ventricular premature beats, ventricular hypertrophy, cardiomegaly, increased pulmonary arterial pressure and abnormal hepatorenal function. The most common causes of aortic valve disease (AVD) were rheumatic fever and infective endocarditis, and the major causes of death were sudden death and intractable CHF. Autopsy in cases of AVD revealed marked left ventricular hypertrophy and dilatation, vegetations, thickening, adhesion and calcification in the aortic valve. Some patients died of cardiogenic shock due either to severely impaired cardiac function or to associated myocardial or pulmonary infarction. Abrupt onset of embolism was also related to death of the patients. The management of VHD must include the treatment of CHF and arrhythmias and the prevention of embolism. Appropriate timing for surgery and close follow-up by cardiologists is mandatory.

Adult↗
PubMed1984

The effect of isosorbide dinitrate on exertional hypotension in old myocardial infarction.

Four patients with old myocardial infarction (OMI) revealed exertional hypotension in the treadmill exercise test. All had a multivessel disease, severe left ventricular dysfunction and exercise-induced ST depression or angina to indicate additional myocardial ischemia. After 5 mg of oral isosorbide dinitrate (ISDN), the response of blood pressure was improved with a delayed onset of ST depression or angina. To confirm the effect of ISDN on the pressure response to exercise, 26 patients with OMI were further studied. In patients without ST depression and angina (Group I), the systolic blood pressure (SBP) at the matched work load was significantly decreased after ISDN. However, in patients with ST depression or angina (Group II), SBP at the matched work load was not altered after ISDN. The increment of change in SBP due to ISDN, namely from the resting level to the matched work load, was significantly larger in Group II than in Group I. In addition, the patients with marked left ventricular dysfunction in Group I revealed a more change in SBP due to ISDN than the others in Group I. It was concluded that exertional hypotension or suppressed pressure response of OMI could be corrected by 5 mg of oral ISDN due to its favorable effects on the exercise-induced myocardial ischemia and preexisting left ventricular dysfunction.

Aged↗
PubMed1984

Assessment of left ventricular function in ischemic heart disease. The relation between pressure decay during the isovolumic relaxation phase and regional wall motion abnormality.

We examine whether regional wall motion abnormality (RWMA) could contribute to the slowed relaxation rate of the left ventricle (LV) in patients with coronary artery disease (CADpts). Simultaneous observations were made on the time constant (Tc) of the isovolumic pressure decay and left ventriculography at the control period and after right atrial pacing. Subsequently, the subjects investigated were divided into 3 groups, i.e. normal subjects (Group I, n = 8), CADpts with normal wall motion during the control period (Group II, n = 21), and CADpts with RWMA during the control period (Group III, n = 28). The latter two groups were further divided into two subgroups according to the presence (Group IIa and IIIa) or absence (Group IIb and IIIb) of pacing-induced RWMA. We measured Tc by a method of exponential analysis that could estimate the asymptote. During the control period, Tc was significantly prolonged in Group III (82 +/- 26 msec) than that in Group I (60 +/- 6 msec) and Group II (63 +/- 12 msec). Tc was prolonged in proportion to the extent of RWMA during the control period. Immediately after right atrial pacing, Tc was markedly prolonged in Group IIa (from 61 +/- 12 to 90 +/- 20 msec, p less than 0.001) and in Group IIIa (from 73 +/- 26 to 95 +/- 34 msec, p less than 0.001). The post-pacing prolongation of Tc was closely correlated with the extent of post-pacing RWMA. From these results, it is postulated that RWMA may play an important role as a causes of the altered LV relaxation in CADpts.

Adult↗
PubMed1984

[Regional myocardial contraction in ischemic heart disease: evaluation of regional myocardial thickening by two-dimensional echocardiography].

There were many studies concerning the evaluation of regional wall motion in ischemic heart disease by left ventriculography (LVG) and two-dimensional echocardiography (2DE), but only a few observations on the regional myocardial thickening have been reported. In a survey of 48 cases of old myocardial infarction, we selected 21 cases with adequate 2DE images for the evaluation of regional wall motion and thickening. In all cases the 2DE examinations were performed within seven days before or after LVG examinations. The left ventricular wall on 2DE was divided into 11 segments and wall motion and thickening in each segment were graded to three classes, i.e. none, reduced and normal. The results on 2DE were then compared with the grade of wall motion of the corresponding segment on LVG. The sensitivity and specificity of 2DE wall motion were 50% and 89% in none, 59% and 48% in reduced, and 89% and 84% in normal, respectively. The sensitivity and specificity of 2DE myocardial thickening were 81% and 93% in none, 82% and 70% in reduced, and 92% in normal, respectively. These results indicated that the regional myocardial thickening by 2DE has a higher sensitivity and specificity. Therefore, observation of both myocardial thickening and wall motion will be necessary for the proper evaluation of regional myocardial contraction in ischemic heart disease.

Adult↗
PubMed1984

[Three-dimensional evaluation of mitral regurgitation by pulsed Doppler echocardiography: analysis of the amount and direction of regurgitant flow].

Pulsed doppler echocardiography (PDE) was used to evaluate mitral regurgitation (MR) non-invasively and quantitatively in 156 patients including 51 of rheumatic valvular disease, 57 of mitral valve prolapse (MVP) or chordal rupture of the mitral valve (RCT), and 48 of ischemic heart disease (IHD) or dilated cardiomyopathy (DCM). The severity of MR was estimated three-dimensionally by a MR scoring system as follows: As an index of direction and extent of regurgitation, nine sampling sites were selected in the left atrium at the level of the mitral annulus. These include the anterior, mid, and posterior parts of each portion of the postero-medial, middle, and antero-lateral sides. The depth of regurgitation was graded by three degrees in the long-axis projection of the left ventricle; grade 1; MR signals localized within the level of the mitral annulus, grade 2; MR detected beyond the mitral annulus but not reaching the aortic valve level; and grade 3; MR detected beyond the aortic valve level in the left atrium. The MR score was comprised of the products of numbers of points at which MR signals were detected and the grades of the maximum depth. The MR scores correlated well with the severity of MR as determined by the left ventriculogram (LVG); the MR score was 4.0 +/- 1.6 (mean +/- S.D.) points in grade 1; 9.6 +/- 2.6 points in grade 2; 18.0 +/- 3.2 points in grade 3; and 23.0 +/- 1.7 points in grade 4 by LVG. Doppler mapping of the left atrium at the level of the mitral annulus suggested that the directions of MR varied with each disease and valvular lesion. Thus, these observations were helpful in the investigation of MR by PDE. We concluded that the above-mentioned MR scoring system proves a very useful method for quantitatively evaluating MR non-invasively.

Adolescent↗
PubMed1983

Occult cranium bifidum. Radiological and surgical findings.

Six cases of congenital subscalp nodule associated with underlying cranium bifidum are reported. A plain skull roentgenogram showed a midline bone defect in the parieto-occipital region near the lambda. CT scan demonstrated neither brain malformation nor ventricular deformity except for the high position of the straight sinus. Cerebral angiography revealed an elongation of the vein of Galen and anomalous upward course of the straight sinus. At surgery, the tumor was solid and connected to a cord which extended intracranially via the cranium bifidum and blended with thickened arachnoid membrane either on the dorsal aspect of the midbrain or at the surface of the anterior vermis. Histologically, the tumor consisted in all cases of arachnoid cells and fibrous tissue with immature glial cells in one case. Possible pathogenesis of these tumors could be a result of the fetal nuchal bleb.

Cerebral Angiography↗
PubMed1983

Two cases of myocardial infarction with coronary arteriovenous fistula.

Myocardial infarction in the presence of coronary arteriovenous fistula (CAVF) has rarely been reported. Two young male patients with dual abnormalities, an organic stenosis and a CAVF in the left anterior descending artery, were reported. Each fistula originated closely proximal to the stenotic lesion and drained into the main pulmonary artery. It was thought that the coronary steal phenomenon through the fistula further reduced the coronary blood flow distal to the stenosis. Thus, both the stenotic lesion and the fistula possibly contributed to the occurrence of the myocardial infarction. Since angiographic details of myocardial infarction with CAVF have rarely been reported these findings may be important in clarifying the mechanism of myocardial infarction with CAVF.

Adult↗
PubMed1983

Studies on the effects of hyperkalemia on serum and myocardial digoxin concentration in dogs.

The effects of hyperkalemia on serum and myocardial digoxin (DX) concentration was studied in conjunction with hemodynamic changes in 31 normal dogs. The myocardial DX concentration in the hyperkalemic (HK) group was significantly lower than that in normokalemic (NK) group, despite a significantly higher serum DX concentration in the HK group. In the HK group, the myocardial sodium concentration was significantly lower than in the NK group. Coincident with these biochemical changes, no increase of LV max dP/dt after DX administration was observed in the HK group. These results suggest that there might be competitive antagonism between myocardial uptake of potassium and DX.

Animals↗