[Congenital aortic stenosis].
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Biomedical subjects
Publications and source records attributed to T Ino.
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In a previous paper (Proc. Natl. Acad. Sci. USA 84, 4264, 1987) we reported that a DNA fragment containing a gene for the T-cell receptor beta chain, which had been excised from chromosome 7q35 during D beta-J beta joining, was inserted into chromosome 6p21.3 in a patient with acute T-cell leukemia. We have since screened for genes in the vicinity of the insertion point and have identified a gene that is equivalent to the murine TIS11d gene, a member of TIS11 early response gene family, that contains unique Cysteine-Histidine motifs. The human TIS11d gene consists of two exons and encodes a polypeptide of 492 amino acids. The insertion of the DNA fragment observed in this patient is located at the carboxy-terminal portion of the TIS11d protein.
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Fifteen patients were examined before and immediately after balloon angioplasty with a 4.3F, 30 MHz rotational tip intravascular ultrasound system. In 12 (80%) patients, 13 procedures could be analyzed because of sufficient image quality. The lesions for intravascular ultrasound (IVUS) study consisted of pulmonary arterial stenosis in 4 patients, Blalock-Taussig shunt stenosis in 3, coarctation of the aorta in 2, subclavian artery stenosis in 1, renal artery stenosis in 1, and ductus arteriosus in 1. Three distinctive morphologic types were identified: Group I had arterial stretching (3 patients); group IIa had superficial tearing (3); group IIb had deep intimal-medial tearing (5); group III had dissection (2). In the narrowest site, minimal and maximal luminal diameters, luminal area before and after balloon angioplasty were 3.5 +/- 1.8 mm vs 4.5 +/- 2.5 mm, 4.1 +/- 2.1 mm vs 5.4 +/- 3.5 mm, and 49.8 +/- 30.2 mm vs 88.3 +/- 45.2 mm2, respectively. The recoil value of group IIb with appropriate balloon angioplasty was approximately 0.3. IVUS may be an useful modality for evaluating the morphologic mechanism of dilatation after balloon angioplasty.
BACKGROUND: We investigated the usefulness of the preoperative left ventricular end-systolic volume index (LVESVI) as a predictor of postoperative ventricular function. METHODS: We retrospectively reviewed the records of 310 patients who underwent coronary artery bypass grafting and identified 20 patients with ischemic cardiomyopathy with a preoperative ejection fraction less than 0.30. We determined the preoperative and postoperative ejection fraction, LVESVI, and left ventricular enddiastolic volume index using biplane left cineventriculography. Patients were divided into groups depending on whether their preoperative LVESVI was less than 100 mL/m2 (group A, n = 10) or greater than 100 mL/m2 (group B, n = 10). RESULTS: The mean ejection fraction increased significantly after coronary artery bypass grafting in group A from 0.25 +/- 0.05 to 0.40 +/- 0.09 (p < 0.01), but did not change significantly in group B (0.26 +/- 0.05 versus 0.23 +/- 0.06). The mean LVESVI decreased significantly in group A from 83.2 +/- 13.7 to 61.7 +/- 20.4 mL/m2 after operation (p < 0.05), but did not change significantly in group B (124.7 +/- 21.0 versus 121.5 +/- 37.6 mL/m2). In group B, 4 patients had signs of congestive heart failure during the follow-up period and had to be rehospitalized. CONCLUSIONS: The mean ejection fraction improved significantly after coronary artery bypass grafting in patients with a preoperative LVESVI less than 100 mL/m2, despite the presence of a global left ventricular ejection fraction less than 0.30. Our results suggest that the preoperative LVESVI predicts the postoperative status and left ventricular function in patients with ischemic cardiomyopathy.
A 1-month-old boy with respiratory distress underwent pulmonary artery banding after diagnosis of d-loop transposition of the great arteries and ventricular septal defect. Respiratory distress recurred after surgery. Angiography, esophagography, and magnetic resonance imaging showed left aortic arch, retroesophageal aorta, and right descending aorta. Surgery at 9 months of age showed a right-sided ligamentum arteriosum. Division of the ligamentum relieved the constriction of the esophagus and trachea caused by this rare form of vascular ring.
OBJECTIVES: This study sought to determine the types of trans-membrane action potentials associated with bipolar electrograms that show double and fractionated potentials. BACKGROUND: The cellular correlates of ventricular bipolar electrograms showing double potentials and fractionated low amplitude potentials remain poorly defined. METHODS: A bipolar electrogram (1-cm interelectrode distance [6F, USCI]) and two transmembrane action potentials (within 1 mm of each pole) were recorded simultaneously in 12 isolated canine right ventricular endocardial preparations (2 x 1 cm, 2 mm thick). The long axis of the bipolar electrode was parallel to the long axis of the superficial endocardial fibers, and the recordings were made at 40 to 500 Hz. RESULTS: The following phenomena were associated with double potentials: 1) an increase in conduction time between the two poles of the bipole during a) the propagation of premature action potentials (7 of 12 tissues in 4 mmol/liter extracellular potassium ion concentration [K+]o); b) rapid pacing and premature stimuli (3 of 6 in 9 mmol/liter [K+]o); and c) the propagation of slow responses induced by barium chloride (4 mmol/liter). There was a positive correlation between conduction time (CT) and interspike interval (IPI) of the double potential (IPI [ms] = 0.5 x CT [ms] + 35) during early afterdepolarizations induced by barium chloride (4 mmol/liter) superfusion (three of six tissues). The following events were associated with fractionated electrograms: 1) propagation of induced graded responses (six tissues) in 4 mmol/liter [K+]o; 2) induced reentry at cycle lengths of 140 to 170 ms in 9 mmol/liter [K+]o (four of six tissues); and 3) asynchronous afterdepolarizations induced by 4 mmol/liter barium chloride (four of six tissues). CONCLUSIONS: Endocardial double potentials and fractionated electrograms seen on clinically used bipolar electrodes occur under conditions of slowed or discontinuous conduction and induced reentry and during asynchronous automatic firing initiated by afterdepolarizations. Caution must be exercised in interpreting such bipolar electrograms because more than one type of cellular action potential may cause these abnormal electrographic results.
OBJECTIVE: The objective of our study was to describe the efficacy of corticosteroids for ventricular tachycardia in four children with structurally normal hearts in whom endomyocardial biopsy revealed histologic changes of lymphocytic myocarditis. PATIENTS: The four patients had unexplained ventricular tachycardia. Three dysrhythmias were sustained, and one was inducible by exercise. Patient ages ranged from 4 months to 12 years. Three of the four patients had no symptoms. In two of them, ventricular tachycardia was identified by mass screening for heart disease. Two patients received oral steroids and two received pulse steroid therapy. RESULTS: In all four patients, significant underlying diseases were not found by noninvasive evaluation. Right ventricular endomyocardial biopsy revealed abnormal histologic findings of chronic lymphocytic myocarditis in all patients. Steroid therapy was effective in all four patients, two of whom received methylprednisolone pulse therapy. CONCLUSIONS: We conclude that unexplained ventricular tachycardia may be the only manifestation of clinically silent myocarditis. Steroid therapy should therefore be considered if conventional antiarrhythmic medication is not effective and histologic findings confirm the presence of lymphocytic myocarditis.
Cardiac operations with cardiopulmonary bypass cause a systemic inflammatory response. Neutrophils and monocytes-macrophages play an important role in triggering the initiation of the inflammatory response. Recently, some kinds of cytokines that are powerful leukocyte chemotactic factors have been characterized concerning an inflammatory response: interleukin-8 has a potent chemoattractant activity for neutrophils, and monocyte chemoattractant factor has monocyte-macrophage chemotactic activity. To investigate the possible roles of the cytokines in the inflammatory response in cardiopulmonary bypass, 12 adult patients undergoing cardiopulmonary bypass were studied for measurement of interleukin-8 and monocyte chemoattractant factor. Systemic blood was collected before cardiopulmonary bypass, at the end of cardiopulmonary bypass, and at 3, 12, 24, and 48 hours after cardiopulmonary bypass from the patients' radial arteries. Significant increases in levels of interleukin-8 and monocyte chemoattractant factor were detected with a peak level at 3 hours after bypass compared with levels before cardiopulmonary bypass (p < 0.05). This study demonstrated that interleukin-8 and monocyte chemoattractant factor are released into the circulation after adult hypothermic cardiopulmonary bypass and reach a maximum level 3 hours after bypass.
Effects of 12 months of simvastatin treatment were examined in 48 NIDDM patients with total serum cholesterol levels exceeding 220 mg/dl and were compared with those in 35 nondiabetic patients with hypercholesterolemia. In the diabetic group, 5-10 mg of simvastatin given once daily at bedtime significantly lowered total cholesterol (21%). LDL cholesterol (28%), apoB (15%) and triglycerides (8%) levels. These changes were identical to those in the nondiabetic group, except for triglycerides which did not change significantly. HDL cholesterol increased significantly in the nondiabetic group but not in the diabetic group. The reductions in LDL cholesterol and apoB in hypercholesterolemic patients with NIDDM were not influenced by gender, age, glycemic control, the presence or absence of systemic hypertension, obesity and overt proteinuria. In addition, the decrease in LDL cholesterol was not affected by the number of risk factors per patient. Simvastatin did not significantly alter hemoglobin A1c or fasting plasma glucose and was well tolerated in both groups. Simvastatin produced beneficial effects on serum lipids and apolipoproteins and neutral effects on glycemic control in hypercholesterolemic patients with NIDDM, whether or not they had an additional atherosclerotic risk factor.
A new antithrombogenic material was studied, fluorine-acryl-styrene-urethane-silicone (FASUS) copolymer, the theoretical basis of which attributed to its hydrophilic and hydrophobic microdomain structure. In this series of experiments, the blood compatibility of this copolymer was evaluated in vitro and ex vivo. For the in vitro evaluation, a whole blood clotting test and the microsphere column test were performed. For the ex vivo evaluation, two series of shunt tests in rabbits were performed, one was the arterioartery (A-A) shunt model, and the other was the arteriovenous (A-V) shunt model. The antithrombogenicity was assessed by measuring the shunt obstructive time in the A-A shunt experiment. The A-V shunt experiment was assessed by measuring the circulating platelet counts, platelet aggregability, activated partial thromboplastin time (APTT), and prothrombin time (PT). In the whole blood clotting test, FASUS revealed the significantly longer blood clotting time than that of the control glass tubings (19.7 +/- 1.0 versus 6.5 +/- 0.7 min, p < 0.001). In the microsphere column test, the coated group had a 30% reduction of the platelet number in the eluted blood in contrast with a marked decrease of 70% in the control group (p < 0.05). In the ex vivo A-A shunt experiment, the occlusion time for the FASUS-coated group was significantly longer than that of the control (109.7 +/- 17.3 versus 3.0 +/- 0.4 min, p < 0.05). The A-V shunt experiment showed that the FASUS copolymer suppressed the decrease in platelet counts and tended to improve prolonged APTT compared with that of the control. Clinically, in 25 patients, we placed coated FASUS copolymer into the cannulas for use in percutaneous cardiopulmonary support (PCPS) procedures. There was no evidence of thrombus on the blood contacting surface and no thromboembolism in major organs clinically or upon postmortem examination. In summary, this new copolymer may be effective in preventing thrombus formation in vitro, ex vivo, and in clinical situations.
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Directional coronary atherectomy (DCA) was performed on a 51-year-old man with unstable angina due to a 90% stenosis of the proximal side of the left anterior descending artery (LAD). A coronary angiography after the DCA showed the coronary artery perforation communicating with the pericardial space. He suffered cardiac tamponade and cardiogenic shock, and was taken to the emergent surgical intervention. The both side of the perforation was ligated to control active bleeding and coronary artery bypass grafting to the distal portion of the LAD was performed. It is stated that the incidence of tamponade resulting from vessel perforation after DCA is extremely rare.
In 42 patients with thoracic aortic disease, a selective cerebral perfusion with 16 degrees C cold blood was applied for the brain protection during the repair of the thoracic aorta. The surgical repair consisted of the replacement of the ascending aorta (9 cases), the ascending aorta and aortic arch (12 cases), the aortic arch (18 cases), and the aortic arch and descending aorta (3 cases). Twenty-two patients of them (52%) required emergency surgery and four patients died due to postoperative complications including visceral organ ischemia (2 cases) and multiple organ failure (2 cases). The mortality rate of this group was 18.2% (4/22 cases). In elective surgical classes, one patient died due to intraoperative coronary embolism. The mortality rate of this group was 5.0% (1/20 cases). No postoperative obvious brain defect was observed except one old patient (85-year-old female) with ruptured aortic arch who already had the brain infarction preoperatively. She died due to multiple organ failure with unconsciousness. Other patients including the patients with long cerebral perfusion (> 180 min) recovered well and returned to normal daily life. The selective cerebral perfusion with cold blood was easy to prepare and demonstrated the superb efficacy of brain protection in the patient.
From January, 1990 through July 1994, 615 adult patients were undergone cardiovascular operation under the cardiopulmonary bypass. Sixteen patients were suffered perioperative cerebral infarction. The etiology of the cerebral infarction was evaluated on the pre and postoperative brain CT findings by the neurologists. In the 283 coronary artery bypass operations, 4 patients suffered watershed infarction (WS) and 4 cerebral embolism. In the 252 valve operations, one WS and one embolism. In the 80 thoracic aortic operations, 5 WS and one embolism, respectively. The risk factors of WS were the elderly, emergency, the longer operative period, and the longer cardiopulmonary bypass period. The risk factor of the embolism were male, preoperative cerebral infarction, the calcified finding of the ascending aorta by the chest CT. It is important to take preventive strategies against the watershed infarction.
A 44 year-old woman with acute myeloid leukemia (AML, FAB, M4E) developed heart failure during treatment with anthracyclines for AML. She had not experienced heart disease and her left ventricular ejection fraction (LVEF) was 59% at the end of a successful remission induction therapy. Because her LVEF decreased to 33% after early consolidation therapy, the chemotherapy for AML was discontinued. The cumulative dose of daunorubicin, aclarubicin and mitoxantrone was 486 mg/m2, 135 mg/m2 and 55 mg/m2, respectively. In October 1990, four months after the end of the chemotherapy, heart failure (class III, NYHA) developed and did not improve by treatment consisting of dobutamin, digoxin and diuretics. Anthracycline cardiomyopathy was histologically confirmed by endomyocardial biopsy. Then we administered selective beta 1-antagonist, metoprolol (Seloken), with an initial dose of 5 mg/day which was doubled 3 times every 4 or 8 weeks to 40 mg/day, according to the treatment schedule of dilated cardiomyopathy. She recuperated satisfactorily (Class I, NYHA), and was discharged on February '91. Her LVEF gradually improved and it has been maintained at above 50% on an outpatient basis. The patient has been in complete hematological remission during this period. It seems that low dose selective beta 1-antagonist therapy has a potential to improve myocardial function in some patients with anthracycline cardiomyopathy.