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Biomedical subjects

T Degawa

Publications and source records attributed to T Degawa.

29 records · Page 2Linked to original sources
PubMed1990

[Significance of residual coronary artery stenosis after reperfusion therapy in acute myocardial infarction].

We evaluated the efficacy of reperfusion therapy in acute myocardial infarction in terms of postinfarction angina (PIA), reinfarction and coronary reocclusion. In 99 hospitalized patients with acute myocardial infarction within 6 hours after the onset of symptoms, 67 were treated using intracoronary thrombolysis (ICT) alone (Group T) and the remaining 32 using ICT followed by percutaneous transluminal coronary angioplasty (PTCA) (Group T + A). PTCA was performed for the arteries with high grade residual stenosis (TIMI grade 0, 1, 2) after ICT. Recatheterization was performed 28 +/- 12 days after hospitalization in 93% (62/67) of Group T and in all of Group T + A. There were no significant differences in age, sex, time interval from the onset to reperfusion, the extents of coronary artery disease and the Cohn grade of collaterals. However, anteroseptal infarction was more frequent in Group T than in Group T + A (p less than 0.05). Residual stenosis (diameter) at the end of intervention was 81 +/- 14% in Group T, and 48 +/- 15% in Group T + A, (p less than 0.01). Residual stenosis at recatheterization was 70 +/- 23% in Group T, and 55 +/- 22% in Group T + A (p less than NS). The incidence of PIA did not differ between the two groups (20.1% vs 6.2%). However, the incidence was higher in patients with residual stenosis of 70% or more than in those with residual stenosis of less than 70% (23.8% vs 2.9%, p less than 0.05). The incidence of reinfarction (re-elevation of CPK) did not differ between the two groups (7.4% in Group T, 6.2% in Group T + A); and neither did the incidence of coronary reocclusion at the time of recatheterization (14.5% vs 3.1%). We concluded that higher degree of residual stenosis at the end of intervention has a greater risk of PIA and reocclusion. Although differences were not statistically significant, the patients treated with ICT followed by PTCA seemed to have lower incidence of PIA and reocclusion compared with those treated with ICT alone, thus having better hospital prognosis.

Aged↗
PubMed1990

[The effect of percutaneous transluminal coronary recanalization (PTCR) on late potentials detected by signal-averaged electrocardiogram in patients with previous myocardial infarction].

The purpose of this study was to assess the effect of percutaneous transluminal coronary recanalization (PTCR) on late potentials (LP) in patients with previous myocardial infarction (MI). The signal-averaged ECG was recorded by Fukuda VCM-3000 in 54 patients with anterior MI (average of 32 months after onset of MI). Fifty four patients were divided into two groups: Group A was comprised of 29 patients who underwent PTCR, and Group B was comprised of 25 patients who didn't receive PTCR. Ventricular arrhythmias detected by 24 hour Holter monitoring, and left ventriculographic findings were also evaluated. The presence of LP was defined as low amplitude signals (less than 15 microV) in the last 40 msec of the filtered QRS complex. The incidence of LP was significantly higher in Group B than in Group A (32% vs 7%, p less than 0.01). The presence of PVCs and ejection fraction (EF), LV end-diastolic volume (EDV), LV end-systolic volume (ESV) and % abnormally contracting segment (% ACS) were not significantly different in each respective groups. However, ESV and % ACS were significantly larger (p less than 0.05), and EF was significantly smaller (p less than 0.01) in patients with LP (+) than in patients with LP (-). LP was present in two patients who had undergone PTCR (TIMI grade 2) unsuccessfully, whereas it was not present in the 27 patients with successful PTCR (TIMI grade 3). It was concluded that successful recanalization of the infarct-related arteries may reduce the incidence of LP.

Aged↗
PubMed1990

[Two cases of acute coronary occlusion after successful coronary angioplasty associated with a treadmill stress testing].

We presented two cases of acute coronary occlusion after successful percutaneous transluminal coronary angioplasty (PTCA) associated with a treadmill stress testing. Case 1: A 54-year-old man with effort angina was referred to our hospital for cardiac catheterization. At the time of cardiac catheterization, the proximal RCA had a 99% diameter narrowing, and the proximal LCX had a 90% diameter narrowing. PTCA was performed and both lesions were successfully dilated. Eight days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 173/min (103% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 140 mmHg. A few minutes after the end of exercise, he developed a severe chest pain and ECG changes, which showed ST elevation in leads II, III, aVF and ST depression in leads V4-V6. Emergency coronary angiography disclosed an acute coronary occlusion of RCA at the site of PTCA. Emergency PTCA was performed and the lesion was successfully re-dilated. Case 2: A 68-year-old man was referred to our hospital for cardiac catheterization a month after subendocardial anterior myocardial infarction. At the time of cardiac catheterization, the proximal LAD have a 99% diameter narrowing. PTCA was performed and the lesion was successfully dilated. 18 days after PTCA, he had a symptom-limited treadmill stress testing, using the Bruce protocol. The exercise was terminated at a peak heart rate of 158/min (102% of aged-predicted maximal heart rate), and at a maximal systolic blood pressure of 218 mmHg. Ten minutes after the one of 218 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[A case of intrapleural rupture of pulmonary arteriovenous malformation with shock].

We report a case of a 59-year-old male who suddenly developed massive right hemothorax and shock due to pulmonary arteriovenous malformation (AVM). He was admitted as an emergency case because of severe back pain, cyanosis and cold sweat. Although shock with massive right hemothorax was found, echocardiographic and X-ray computed tomographic examination showed no dilatation of the aorta, no intimal flap in the aorta and no pericardial effusion which suggested aneurysm. Pulmonary arteriography, performed subsequently, disclosed intrapleural rupture of the right pulmonary AVM. The patient recovered successfully from the state of shock. The pulmonary AVM was removed by segmentectomy of the right lung (S4). He was discharged following an uneventful postoperative course. Intrapleural rupture with shock is a very rare complication of pulmonary AVM. Pulmonary AVM should be considered as one possible cause in patients with massive hemothorax and shock.

Arteriovenous Malformations↗
PubMed1989

[Indications for PTCA for the infarcted myocardium without redistribution by T1-201 myocardial scintigraphy: the role of two-dimensional echocardiography].

Persistent myocardial hypoperfusion in delayed images demonstrated by preoperative exercise T1-201 myocardial scintigraphy may improve after PTCA. The purpose of this study was to test whether PTCA-induced improvement could be anticipated by means of preoperative two-dimensional echocardiography and exercise T1-201 myocardial scintigraphy. The subjects consisted of 24 patients with prior myocardial infarction, in whom serial exercise T1-201 myocardial scintigraphy had been performed during treadmill exercise testing. The patients were divided into three groups according to the results of two-dimensional echocardiography (Group I: eight patients with hypokinesis in the infarct zone; Group II: eight patients with akinesis without a thin wall in the infarct zone; Group III: eight patients with akinesis with a thin wall in the infarct zone). Results were as follows: 1. There was no significant difference in initial T1-uptake in all the 24 patients before and after PTCA, though significantly increased uptakes were observed in Groups I and II after PTCA. 2. There were significant differences in preoperative initial T1-uptakes among the three groups. 3. In Group II, the patients with postoperative scintigraphic improvement had significantly higher preoperative initial T1-uptakes. 4. The postoperative improvement of myocardial perfusion was accompanied by improvement in wall motion. Therefore, an infarct zone without delayed redistribution in T1-201 myocardial scintigraphy does not necessarily indicate scar tissue. However, it may represent hypokinetic or akinetic areas without thin walls on two-dimensional echocardiograms, suggesting a hibernating myocardial state due to chronic intermittent episodes of myocardial ischemia. In such cases, improvement of myocardial perfusion after PTCA can be expected.

Adult↗
PubMed1989

[The relationship between mitral regurgitation and asynergy of the left ventricle in old myocardial infarction].

To elucidate the mechanism of mitral regurgitation (MR) in patients with old myocardial infarction, two-dimensional (2D) and 2D Doppler echocardiographic examinations were performed in 92 patients. According to the sites of asynergy in the short-axis view of the left ventricle at the papillary muscle level, the patients were classified in three groups; i.e., anteroseptal (AS) group (49 cases), inferoposterior (IP) group (29 cases), and the AS + IP group (14 cases). The existence and severity of MR were evaluated by 2D Doppler echocardiography and the presence of mitral valve prolapse (MPV), by 2D echocardiography. The mitral valve ring diameter was also measured. The incidence of MR was significantly higher in the IP group (41%) and AS + IP group (43%) than in the AS group (20%) (p less than 0.05, respectively). In the IP group, 21 patients had left ventricular asynergy at the base of the posterior papillary muscle; eight did not. In the former 21 patients with asynergy, MR was detected in 12 (57%) and MVP in nine (43%), whereas neither MR nor MVP was detected in the eight patients without asynergy. The grade of MR assessed by 2-D Doppler echocardiography was significantly more severe in patients with MVP than in those without MVP (MR distance: 23 +/- 6 mm with MVP vs 11 +/- 1 mm without MVP; p less than 0.05, MR area; 312 +/- 217 mm2 with MVP vs 64 +/- 29 mm2 without MVP; p less than 0.05). MR appeared at the mitral orifice between its middle portion and the posteromedial commissure, which coincided with the site of MVP in the majority of cases. In the AS and AS + IP groups, however, such close relationships between MR and MVP were absent. In these groups, mitral valve ring diameters were significantly larger in patients with MR than in those without MR (AS group: 32 +/- 3 mm with MR vs 24 +/- 2 mm without MR; p less than 0.01, IP group: 26 +/- 2 mm with MR vs 25 +/- 2 mm without MR; NS, AS + IP group: 30 +/- 3 mm with MR vs 24 +/- 1 mm without MR; p less than 0.05). Mitral valve ring diameters in the IP group with MR (26 +/- 2 mm) were smaller than in those in the AS and AS + IP groups with MR, and did not differ from those in the IP group without MR (25 +/- 2 mm). In conclusion, posterior papillary muscle dysfunction was mainly responsible for MR in the inferoposterior infarction and the dilatation of the mitral valve ring in the infarction involving the anteroseptal wall.

Aged↗
PubMedDate not supplied

Elastic recoil following percutaneous transluminal coronary angioplasty and Palmaz-Schatz stent implantation.

The post-procedural elastic recoil in 133 lesions treated with the Palmaz-Schatz stent was compared to 133 matched lesions treated with balloon angioplasty to determine the role of prevention of elastic recoil in the creation of a larger initial luminal diameter. Elastic recoil was defined as the difference between the maximal diameter of the inflated balloon and the minimal luminal diameter of the dilated segment immediately after the procedure and was evaluated by quantitative coronary angiography. Overdilatation was defined as a dilatation induced by a balloon with a maximal diameter larger than the pre-procedure reference diameter. The percent diameter stenosis was reduced from 73% to 31% in the balloon angioplasty group and from 72% to -4% in the stent group (31% vs. -4%, p < 0.01). Elastic recoil was significantly larger in the balloon angioplasty group than in the stent group (0.94 +/- 0.29 mm vs. 0.09 +/- 0.09 mm, p < 0.01). Overdilatation and lesion morphology had no significant effects on elastic recoil in the stent group. In the balloon angioplasty group, overdilatation, noncalcified lesions and eccentric lesions were associated with increased elastic recoil. These results indicated that the larger post-procedural luminal diameter associated with the Palmaz-Schatz stent was primarily the result of prevention of elastic recoil, which was not influenced by the degree of overdilatation or lesion morphology.

Angioplasty, Balloon, Coronary↗