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Machida T, Izumo M, Suzuki K, Yoneyama K, Kamijima R, Mizukoshi K, Takai M, Kobayashi Y, Harada T, Miyake F, Ohtaki E, Nobuoka S, Matsumoto N, Akashi YJ. Value of anatomical aortic valve area using real-time three-dimensional transoesophageal echocardiography in patients with aortic stenosis: a comparison between tricuspid and bicuspid aortic valves. Eur Heart J Cardiovasc Imaging 2015; 16:1120-8. [DOI: 10.1093/ehjci/jev056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/18/2015] [Indexed: 11/12/2022] Open
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Mizukoshi K, Suzuki K, Yoneyama K, Kamijima R, Kou S, Takai M, Izumo M, Hayashi A, Ohtaki E, Akashi YJ, Osada N, Omiya K, Harada T, Nobuoka S, Miyake F. Early diastolic function during exertion influences exercise intolerance in patients with hypertrophic cardiomyopathy. J Echocardiogr 2012; 11:9-17. [PMID: 27278427 DOI: 10.1007/s12574-012-0150-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/23/2012] [Accepted: 10/04/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) patients with preserved left ventricular ejection fraction (LVEF) often develop dyspnea and exercise intolerance. Diastolic dysfunction may contribute to exercise intolerance in these patients. This study aimed to clarify our hypothesis as to whether diastolic function rather than systolic function would be associated with exercise intolerance in HCM using two-dimensional (2D) speckle tracking echocardiography during exercise. METHODS Thirty-three HCM patients (mean age 59.3 ± 15.7 years) underwent 2D speckle tracking echocardiography at rest and during submaximal semi-supine bicycle exercise. Global longitudinal strain (LS), LS rate during systole (LSRs), early diastole (LSRe), and late diastole (LSRa) were measured. The symptom-limited cardiopulmonary exercise testing was performed using a cycle ergometer for measuring the peak oxygen consumption (peak [Formula: see text]). RESULTS In the multivariate linear regression analysis, peak [Formula: see text] did not associate with strain or strain rate at rest. However, peak [Formula: see text] correlated with LS (β = -0.403, p = 0.007), LSRe (β = 6.041, p = 0.001), and LSRa (β = 5.117, p = 0.021) during exercise after adjustment for age, gender, and heart rate. The first quartile peak [Formula: see text] (14.2 mL/min/kg) was assessed to predict exercise intolerance. The C-statistic of delta LSRe was 0.74, which was relatively greater than that of delta LS (0.70) and delta LSRa (0.58), indicating that early diastolic function rather than systolic and late diastolic function affects exercise intolerance. CONCLUSIONS LSRe during exercise is closely associated with the peak [Formula: see text]. Early diastolic function during exercise is an important determinant of exercise capacity in patients with HCM.
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Affiliation(s)
- Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kihei Yoneyama
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Ryo Kamijima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Seisyou Kou
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Manabu Takai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akio Hayashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | | | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Naohiko Osada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kazuto Omiya
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tomoo Harada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sachihiko Nobuoka
- Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumihiko Miyake
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Suzuki K, Akashi YJ, Mizukoshi K, Kou S, Takai M, Izumo M, Hayashi A, Ohtaki E, Nobuoka S, Miyake F. Relationship between left ventricular ejection fraction and mitral annular displacement derived by speckle tracking echocardiography in patients with different heart diseases. J Cardiol 2012; 60:55-60. [DOI: 10.1016/j.jjcc.2012.01.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/23/2012] [Accepted: 01/30/2012] [Indexed: 12/01/2022]
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Kou S, Suzuki K, Akashi YJ, Mizukoshi K, Takai M, Izumo M, Shimozato T, Hayashi A, Ohtaki E, Osada N, Omiya K, Nobuoka S, Miyake F. Global longitudinal strain by two-dimensional speckle tracking imaging predicts exercise capacity in patients with chronic heart failure. J Echocardiogr 2011; 9:64-72. [PMID: 27276882 DOI: 10.1007/s12574-010-0076-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 11/04/2010] [Accepted: 11/05/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) predicts mortality in patients with chronic heart failure (CHF). However, a weak correlation was found between LVEF and peak oxygen uptake ([Formula: see text]) in CHF patients. Global longitudinal strain measured by two-dimensional (2D) strain is regarded as a more useful predictor of cardiac events than LVEF. We investigated whether 2D strain obtained at rest could predict peak [Formula: see text] in patients with CHF. METHODS Fifty-one patients (mean age of 54.0 ± 12.0 years, 14 females, LVEF 46.0 ± 15.0%) with stable CHF underwent resting echocardiography and cardiopulmonary exercise testing. Leg muscle strength was measured for the evaluation of peripheral factors. Global longitudinal strain (GLS) in the apical 4-, 3-, and 2-chamber views and global circumferential strain (GCS) in the parasternal mid short-axis view were measured. RESULTS In all patients, peak [Formula: see text] correlated with leg muscle strength (r = 0.55, p < 0.0001), LVEF (r = 0.46, p < 0.001), GLS (r = -0.45, p < 0.001), and GCS (r = -0.41, p = 0.005), respectively. No significant correlation was found between the ratio of early transmitral velocity to peak early diastolic mitral annulus velocity (E/E') and peak [Formula: see text]. In the patients with heart failure and reduced LVEF, a multiple stepwise linear regression analysis based on leg muscle strength, LVEF, E/E', GLS, and GCS was performed to identify independent predictors of peak [Formula: see text], resulting in leg muscle strength and GLS (R (2) = 0.888) as independent predictors of peak [Formula: see text]. CONCLUSION Global longitudinal strain at rest could possibly predict exercise capacity, which appeared to be more useful than LVEF, E/E', and GCS in CHF patients with reduced LVEF.
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Affiliation(s)
- Seisyou Kou
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Manabu Takai
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takashi Shimozato
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Akio Hayashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | | | - Naohiko Osada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kazuto Omiya
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sachihiko Nobuoka
- Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumihiko Miyake
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Miyauchi M, Izumo M, Akashi YJ, Suzuki K, Ryu S, Hashimoto N, Miyake F, Nobuoka S, Ohtaki E. Acute myocardial infarction in a young adult patient with simultaneous total occlusion of double coronary arteries. J Echocardiogr 2010; 8:126-8. [PMID: 27278944 DOI: 10.1007/s12574-010-0045-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 04/20/2010] [Accepted: 04/24/2010] [Indexed: 10/19/2022]
Abstract
We report an otherwise healthy 16-year-old male patient with simultaneous double vessel acute myocardial infarction. Coronary angiography (CAG) showed simultaneous total occlusion of the left anterior descending artery (LAD) and the left circumflex artery (LCX). Emergent percutaneous coronary intervention (PCI) was performed on the diseased lesions. After PCI, coronary artery aneurysms were found in both the LAD and LCX. The patient was discharged after a 56-day hospitalization. The New York Heart Association (NYHA) Functional Classification at discharge was II. Medical therapy became ineffective over time because of exacerbated ischemic mitral regurgitation; successful mitral annuloplasty was performed. The post-operative course was uneventful.
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Affiliation(s)
- Motoki Miyauchi
- Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shonosuke Ryu
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Nobuyuki Hashimoto
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Fumihiko Miyake
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sachihiko Nobuoka
- Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiji Ohtaki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Suzuki K, Akashi YJ, Mizukoshi K, Kou S, Takai M, Izumo M, Shimozato T, Hayashi A, Ohtaki E, Nobuoka S, Miyake F. Hyperventilation and cold-pressor stress echocardiography combined with automated functional imaging non-invasively detected vasospastic angina. BMJ Case Rep 2010; 2010:bcr0620103060. [PMID: 22798093 PMCID: PMC3029994 DOI: 10.1136/bcr.06.2010.3060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 47-year-old male presented with chest discomfort while sleeping. The patient was suspected of having vasospastic angina (VSA) and underwent hyperventilation and cold-pressor stress echocardiography. No chest pain, ECG changes or decreased wall motion was found. However, automated function imaging (AFI) showed decreased peak systolic strain at the apex and postsystolic shortening at both the apex and inferior wall, which was not found before the test. The provocation test revealed 99% stenosis in the right coronary artery #2 at a dose of 50 μg acetylcholine and 90% stenosis in the left coronary artery #8 at a dose of 100 μg. The patient was thus diagnosed as having VSA. The present case demonstrates the usefulness of AFI combined with hyperventilation and cold-pressor stress echocardiography as a screening examination for VSA.
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Affiliation(s)
- Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
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Izumo M, Suzuki K, Moonen M, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Miyake F, Ohtaki E, Lancellotti P. Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure. European Journal of Echocardiography 2010; 12:54-60. [DOI: 10.1093/ejechocard/jeq105] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Io H, Ro Y, Sekiguchi Y, Shimaoka T, Inuma J, Hotta Y, Aruga S, Inami Y, Sato M, Kobayashi T, Masuda A, Kaneko K, Hamada C, Ohtaki E, Horikoshi S, Tomino Y. Cardiac Function and Structure in Longitudinal Analysis of Echocardiography in Peritoneal Dialysis Patients. Perit Dial Int 2010; 30:353-61. [DOI: 10.3747/pdi.2009.00007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
♦ Background Echocardiography is widely used for the evaluation of cardiac structures and function. The prognostic value of assessment of left cardiac atrium (LA) size in peritoneal dialysis (PD) patients is still unclear. The objective of the present study is to investigate prospectively a longitudinal monitoring of echocardiography parameters after start of PD. We also investigated a correlation study among plasma atrial natriuretic peptide (ANP) level, LA size, and cardiac function undergoing aggressive treatment. ♦ Methods Correlation among plasma ANP, LA size, and cardiac function was prospectively analyzed by Doppler echocardiography in 32 PD patients in Juntendo University Hospital, Tokyo. Measurement of these parameters was performed at 0, 6, 12, 18, and 24 months after start of PD. All patients were treated with an angiotensin type 1 receptor blocker to control blood pressure to less than 140/90 mmHg. Other antihypertensive drugs such as diuretics and/or calcium channel blockers were added if blood pressure rose to over 140/90 mmHg. Hemoglobin and hematocrit levels were targeted at 10.0 g/dL and 30.0% respectively with recombinant human erythropoietin treatment. A diuretic was added or patients decreased their water intake if ANP was more than 43.0 pg/mL or LA diameter (LAD) more than 39 mm, and for other basic markers of volume status. Cardiac function was measured before and after drainage of PD fluid to evaluate the influence of cardiac function. ♦ Results LAD at start of dialysis (36 ± 4.6 mm) decreased significantly to 33 ± 3.3 mm ( p < 0.05), 33 ± 3.2 mm ( p < 0.05), and 33 ± 3.6 mm ( p < 0.05) after 6, 12, and 24 months, respectively. Ejection fraction after 6 months was significantly increased compared with that at start of dialysis ( p < 0.05). Left ventricular mass index (LVMI) after 6, 12, and 24 months was significantly decreased compared with that at start of dialysis ( p < 0.05). ANP was 56 ± 39 pg/mL at start of dialysis and decreased significantly to 33 ± 19 pg/mL after 24 months ( p < 0.05). ANP was significantly correlated with LAD ( r = 0.412, p < 0.01), transmitral A wave flow velocity ( r = 0.429, p < 0.01), and LVMI ( r = 0.426, p < 0.01). Instillation of the dialysis fluid did not affect any parameters except inferior vena cava dimension. ♦ Conclusions This study demonstrates a reduction in LA size and LVMI in PD patients followed over 24 months. Left ventricular structure, contraction, and compliance were well preserved in PD patients undergoing aggressive treatment based on measurements of plasma ANP and LAD.
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Affiliation(s)
- Hiroaki Io
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Yuuki Ro
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Yoshimi Sekiguchi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Tetsutaro Shimaoka
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Jiro Inuma
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Yoko Hotta
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Seiki Aruga
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Yuko Inami
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Michiko Sato
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Takashi Kobayashi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Atsumi Masuda
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Kayo Kaneko
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Chieko Hamada
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | | | - Satoshi Horikoshi
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine
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Izumo M, Akashi YJ, Suzuki K, Omiya K, Miyake F, Ohtaki E. Recurrent takotsubo cardiomyopathy with variant forms of left ventricular dysfunction. J Cardiol Cases 2010; 2:e37-e40. [PMID: 30524588 DOI: 10.1016/j.jccase.2010.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/11/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022] Open
Abstract
A 78-year-old man presented to our emergency department with dyspnea. The patient was diagnosed as having pneumonia from the chest X-ray which depicted mass-like opacity in the left lower lobe. On the 5th hospital day, electrocardiography showed giant negative T waves in pericardial leads and echocardiography demonstrated left ventricular apical akinesis and basal hyperkinesis. Accordingly, the patient was retrospectively diagnosed as having typical takotsubo cardiomyopathy. Two years later, the patient was admitted again to our hospital with pneumonia. On the 2nd hospital day, echocardiography showed left ventricular basal and mid-ventricular akinesis combined with normal apical wall motion. Ventricular wall motion was normalized within two months. The patient was finally diagnosed as having inverted takotsubo cardiomyopathy. Here, we report the patient who had recurrent takotsubo cardiomyopathy with variant forms of left ventricular dysfunction caused by repeated physical stress in two years.
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Affiliation(s)
- Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511 Kawasaki, Kanagawa, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511 Kawasaki, Kanagawa, Japan
| | - Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511 Kawasaki, Kanagawa, Japan
| | - Kazuto Omiya
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511 Kawasaki, Kanagawa, Japan
| | - Fumihiko Miyake
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, 216-8511 Kawasaki, Kanagawa, Japan
| | - Eiji Ohtaki
- Ohtaki Hearts Clinic, Bunkyo-ku, Tokyo, Japan
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Izumo M, Lancellotti P, Suzuki K, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Nobuoka S, Ohtaki E, Miyake F. Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. European Journal of Echocardiography 2009; 10:961-7. [DOI: 10.1093/ejechocard/jep114] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nagasaki M, Nishimura S, Ohtaki E, Kasegawa H, Matsumura T, Nagayama M, Koyanagi T, Tohbaru T, Misu K, Asano R, Sumiyoshi T, Hosoda S. The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy. Int J Cardiol 2006; 108:171-6. [PMID: 15916824 DOI: 10.1016/j.ijcard.2005.04.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Revised: 03/08/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Functional mitral regurgitation (MR) is one of the common and severe complications in patients with dilated cardiomyopathy. The detailed mechanisms that cause functional MR remain to be elucidated. Using two-dimensional transthoracic echocardiography, we investigated the differences in major determinants of MR severity between ischemic cardiomyopathy (ICM) and non-ICM patients. METHODS We enrolled 103 patients (91 males; age 64+/-12 years) with significant left ventricular (LV) dilatation. They were divided into ICM group (n=69) with significant coronary disease, and non-ICM (n=34) group without coronary disease. We devised a novel and simple parameter; the short-axis sphericity index (SI), to evaluate global LV remodeling, and used coaptation depth (CD) and tenting area (TA) to evaluate mitral deformity. RESULTS In all cases, CD, TA and left atrium diameter (LAD) correlated positively with maximum regurgitation area (MRA) (r=0.54, 0.57, 0.57; P<0.0001). A negative correlation was observed between MRA and SI (r=-0.33, P=0.0008). There was no significant relationship between MRA and LV ejection fraction (EF). In non-ICM cases, SI tended to be lower with reduced EF. Multivariate stepwise linear regression analysis showed the following equations; ICM: MRA=-9.4+0.81CD+0.21LAD (r2=0.47, P<0.0001), non-ICM: MRA=-7.2+0.17LVDs (LV end systolic diameter) -8.7SI+0.27LAD (r2=0.63, P<0.0001). CONCLUSIONS The strongest determinants of functional MR severity differ in ICM and non-ICM. While LV diameter and SI (global LV remodeling index) mainly determine the severity in non-ICM, CD that reflects mitral deformity is the major determinant in ICM.
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Affiliation(s)
- Mika Nagasaki
- Sakakibara Heart Institute, Cardiology, 3-16-1 Asahi-Cho, Fuchu City Tokyo 183-0003, Japan
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Eguchi K, Ohtaki E, Matsumura T, Tanaka K, Tohbaru T, Iguchi N, Misu K, Asano R, Nagayama M, Sumiyoshi T, Kasegawa H, Hosoda S. Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitation. Eur Heart J 2005; 26:1866-72. [PMID: 15845559 DOI: 10.1093/eurheartj/ehi272] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To examine the impact of pre-operative atrial fibrillation (AF) on the outcome of mitral valve repair (MVR) for degenerative mitral regurgitation (MR). METHODS AND RESULTS Among 392 patients with moderate to severe MR who underwent MVR between 1991 and 2002, 283 patients with isolated degenerative MR were followed for 4.7+/-3.3 years. Of 27 deaths, nine were due to cardioembolic events and four were due to left ventricular (LV) dysfunction. When compared with patients with pre-operative AF, those with sinus rhythm (SR) had better survival (96+/-2.1 vs. 87+/-3.2% at 5 years, P=0.002) and higher cardiac event-free rates (96+/-2.0 vs. 75+/-4.4% at 5 years, P<0.001). In patients with pre-operative SR, observed and expected survival were similar (P=0.811). Cox multivariable regression analysis confirmed AF [P=0.027, adjusted hazard ratio (AHR) 2.9] and age as independently predictive of survival, and AF (P=0.002, AHR 3.1), New York Heart Association Class, and LV fractional shortening as independently predictive of cardiac event. CONCLUSION Death due to LV dysfunction was not frequent and cardioembolic events due to AF were the leading cause for cardiac death. Pre-operative AF became a strong independent predictor of survival and morbidity. Patients with pre-operative SR had excellent prognosis. The benefits of preventing cardioembolic events due to AF validate the indication of MVR for patients with high risk for AF.
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Affiliation(s)
- Kosei Eguchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Uchikawa SI, Ohtaki E, Sumiyoshi T, Hosoda S, Kasegawa H. Impact of mitral regurgitation on long-term survival in patients with ischemic cardiomyopathy: efficacy of combined mitral valve repair and revascularization. Heart Vessels 2004; 19:172-8. [PMID: 15278390 DOI: 10.1007/s00380-004-0763-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2003] [Accepted: 01/09/2004] [Indexed: 10/26/2022]
Abstract
Ischemic cardiomyopathy complicated by severe mitral regurgitation (MR) has a poor prognosis. In such cases, whether mitral valve repair for MR improves the prognosis of survival remains unclear. In this study, 50 patients diagnosed with ischemic cardiomyopathy at our hospital between August 1991 and August 1996 were studied to examine the long-term prognosis and factors determining the prognosis. Among 17 patients with the complication of severe MR, 11 underwent mitral valve repair (repair group) and 6 did not (nonrepair group). Among the 33 patients without MR, 15 underwent revascularization (revascularization group) and 18 received medical treatment alone (medical group). Patients with MR showed significantly poorer baseline activities of daily living (ADL) [New York Heart Association (NYHA) class III or above: MR(+) vs MR(-) = 14 vs 8; P = 0.0001] and survival rate [MR(+) vs MR(-); log rank = 3.8, P = 0.05]. In contrast, patients in whom mitral valve repair was actively performed to resolve MR had favorable outcomes for both ADL (NYHA class improved from 3.9 +/- 0.3 to 2.7 +/- 1.0; P = 0.0004) and survival rate (MV repair vs nonrepair: long rank = 10.1, P = 0.0015). In addition, among patients without MR, the revascularization group showed more favorable results in terms of ADL (NYHA class improved from 3.5 +/- 0.7 to 2.5 +/- 0.8; P = 0.0059) and survival rate (revascularization vs medical: log rank = 3.7, P = 0.05), irrespective of improvement of left ventricular function. When the factors determining the prognosis for ischemic cardiomyopathy were examined by multivariate analysis, whether or not revascularization was conducted, the presence or absence of mitral regurgitation, and if present, whether or not mitral valve repair was performed were identified as independent factors determining the prognosis (revascularization: hazard ratio = 0.121, P = 0.012; absence of MR: hazard ratio = 0.104, P = 0.050; mitral valve repair: hazard ratio = 0.018, P = 0.005). These results showed that revascularization should be conducted as actively as possible in patients with ischemic cardiomyopathy; in addition, for those patients with mitral regurgitation, mitral valve repair should be conducted actively to relieve it.
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Affiliation(s)
- Shin-Ichiro Uchikawa
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan.
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Matsumura T, Ohtaki E, Tanaka K, Misu K, Tohbaru T, Asano R, Nagayama M, Kitahara K, Umemura J, Sumiyoshi T, Kasegawa H, Hosoda S. Predictors of left ventricular dysfunction following mitral valve repair for mitral regurgitation: Reply. J Am Coll Cardiol 2004. [DOI: 10.1016/j.jacc.2004.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Eguchi K, Ohtaki E, Misu K, Aikawa M, Sumiyoshi T, Hosoda S, Koyanagi T. Acute myocardial infarction caused by embolism of thrombus in the right coronary sinus of valsalva: a case report and review of the literature. J Am Soc Echocardiogr 2004; 17:173-7. [PMID: 14752493 DOI: 10.1016/j.echo.2003.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 56-year-old man presented with sustained chest pain. Coronary angiography revealed total occlusion of the distal right coronary artery and left anterior descending branch. Left ventriculography depicted a mobile mass in the right sinus of Valsalva originating from the ostium of the right coronary artery. Transesophageal echocardiography (TEE) showed a mobile mass in the sinus of Valsalva and another mobile mass in the aortic arch. The mass at the right sinus of Valsalva was surgically resected, and histologic examination revealed an organized thrombus. Coagulation study showed protein S deficiency. This is the first case of acute myocardial infarction as a result of multiple coronary embolism caused by thrombosis in the right sinus of Valsalva with a second aortic arch thrombosis, contributed by protein S deficiency.
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Affiliation(s)
- Kosei Eguchi
- Department of Cardiology, Sakakibara Heart Institute, 2-5-4 Yoyogi, Shibuyra-ku, Tokyo 515-0053, Japan
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Takeda N, Ohtaki E, Kitahara K, Nagayama M, Nagasaki M. Pulmonary Thromboembolism in a Patient With an Anomalous Right Coronary Artery as a Cause of Unusual Biventricular Myocardial Infarction. Circ J 2004; 68:883-6. [PMID: 15329514 DOI: 10.1253/circj.68.883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This report presents the first case of an unusual biventricular myocardial infarction caused by pulmonary thromboembolism in a 55-year-old woman who had an anomalous origin of the right coronary artery (RCA) from the left coronary sinus. The RCA consequently courses between the aorta and pulmonary trunk, and dilatation of the pulmonary artery because of elevated pulmonary artery pressure compressed the proximal portion of the RCA. The consequent reduced right coronary oxygen supply and sudden increase in right ventricular afterload contributed to the characteristic right ventricular infarction, in addition to a left ventricular infero-posterior infarction. Her anginal symptoms disappeared following successful anticoagulation therapy and insertion of an inferior vena caval filter, without coronary bypass. This pathophysiologic phenomenon is rare, but can be fatal.
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Affiliation(s)
- Norifumi Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan.
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Tanaka K, Ohtaki E, Matsumura T, Misu K, Tohbaru T, Asano R, Kitahara K, Umemura J, Sumiyoshi T, Kasegawa H, Hosoda S. Impact of a preoperative mitral regurgitation scoring system on outcome of surgical repair for mitral valve prolapse. Am J Cardiol 2003; 92:1306-9. [PMID: 14636908 DOI: 10.1016/j.amjcard.2003.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The optimal timing of surgical correction of severe mitral regurgitation (MR) is important for improved morbidity and mortality. We utilized a scoring system to decide the timing of procedures. Based on clinical features and echocardiographic data, we hypothesized that preoperative semi-quantitation of MR using this scoring system may be useful for predicting prognosis after repair. The MR score was composed of 6 parameters associated with disease severity (i.e., history of heart failure, atrial fibrillation, pulmonary hypertension, left ventricular end-systolic dimension, fractional shortening, and left atrial dimension). The maximum score was 6. Of 267 patients who underwent mitral valve repair in the last 10 years, 191 patients with mitral valve prolapse were studied. Patients were categorized into 2 groups according to MR score (group low [L] : 0 to 2.5 and group high [H]: >/=3.0) irrespective of New York Heart Association functional class. A significant difference in postoperative event-free survival was observed between both groups (p = 0.0014); the adjusted risk ratio was 3.4 (95% confidence interval 1.6 to 7.2). Postoperative echocardiography showed larger left ventricular systolic dimensions (p <0.0001), lower fractional shortening (p = 0.0016), and larger left atrial dimensions (p <0.0001) in group H than group L. Thus, an MR score is a simple way to predict the prognosis of severe MR independently of subjective symptoms in patients undergoing mitral valve repair.
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Affiliation(s)
- Kaoru Tanaka
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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18
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Matsumura T, Ohtaki E, Tanaka K, Misu K, Tobaru T, Asano R, Nagayama M, Kitahara K, Umemura J, Sumiyoshi T, Kasegawa H, Hosoda S. Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol 2003; 42:458-63. [PMID: 12906972 DOI: 10.1016/s0735-1097(03)00649-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to determine whether echocardiography before mitral valve repair (MVR) for mitral regurgitation (MR) was predictive of postoperative left ventricular (LV) dysfunction and useful for deciding the optimal timing of repair. BACKGROUND Some reports have shown that the preoperative echocardiographic data of left ventricular ejection fraction (LVEF) and left ventricular end-systolic diameter (LVDs) were good predictors of postoperative LV dysfunction. However, few reports were based on long-term follow-up data of large numbers of patients who underwent MVR in the last decade. METHODS A total of 274 patients with moderate or severe MR underwent MVR between October 1, 1991, and September 30, 2000. Among them, 171 patients who had both an operation for isolated MR due to degenerative pathology and a postoperative echocardiogram were studied. Postoperative echocardiograms were performed 3.9 +/- 2.4 years after the operation. The LVEF decreased from 66 +/- 10% before surgery to 63 +/- 11% after surgery (p < 0.0001). On univariate analysis, preoperative LVEF and LVDs correlated with postoperative LVEF (r = 0.41 and r = -0.39, respectively). Overall, postoperative LV dysfunction (defined as LVEF <50%) was not frequent (12%). However, the incidence of postoperative LV dysfunction was high in patients with preoperative LVEF <55% (38%) or LVDs > or =40 mm (23%). CONCLUSIONS In patients with MR, the echocardiographic data of LVEF and LVDs were good predictors of postoperative LV dysfunction. When a decrease in LVEF or an increase in LVDs is detected, MVR should be considered to preserve postoperative LV function.
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Harada T, Ohtaki E, Misu K, Sumiyoshi T, Hosoda S. Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing chinese herbal laxative. Cardiology 2003; 98:218. [PMID: 12566654 DOI: 10.1159/000067316] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2002] [Accepted: 05/06/2002] [Indexed: 11/19/2022]
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Abstract
A 26-year old Japanese woman experienced new aortic valve regurgitation associated with a preceding high fever of unknown cause. During the fever episode, although bacteremia or fungemia was not evident despite frequent blood cultures, intravenous panipenem/betamipron (PAPM/BP) gradually resulted in decline of the fever. Echocardiography and operative procedures revealed a quadricuspid aortic valve (QAV), which was composed of two equal larger cusps and two unequal smaller cusps (type f). A smaller accessory cusp was damaged but showed no active vegetation. A Medtronic Freestyle bioprosthesis was implanted using a subcoronary technique. Although the risk of endocarditis for this rare valve abnormality is not well documented, the present case may support the conventional assumption that patients with unequal small cusps are prone to endocarditis.
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Affiliation(s)
- Norifumi Takeda
- Department of Cardiology, Sakakibara Heart Institute, Shibuya-ku, Tokyo 151-0053, Japan
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21
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Matsumura T, Ohtaki E, Misu K, Tohbaru T, Asano R, Nagayama M, Kitahara K, Umemura J, Sumiyoshi T, Kawase M, Ida T, Kasegawa H, Hosoda S. Etiology of aortic valve disease and recent changes in Japan:a study of 600 valve replacement cases. Int J Cardiol 2002; 86:217-23. [PMID: 12419559 DOI: 10.1016/s0167-5273(02)00199-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies on the etiology of aortic valve disease in the US showed a decrease in rheumatic valve disease and an increase in age-related degenerative disease. The purpose of this study was to describe the etiology of aortic valve disease and its temporal changes in Japan, based on a large number of cases. METHODS The medical charts of all patients who underwent aortic valve replacement at our institute between 1977 and 1999 were reviewed. Among the 600 patients analyzed, 213 (36%) had pure aortic stenosis, 265 (44%) had pure aortic regurgitation, and 122 (20%) had combined stenosis and regurgitation. RESULTS The causes were rheumatic change (49%), degenerative change (19%), bicuspid valves (18%), infective endocarditis (5%) and others (9%). Rheumatic disease continued to be the most common cause of aortic stenosis, but its frequency decreased from 100% in 1977-1979 to 37% in 1995-1999. In contrast, the frequency of degenerative change among stenotic valves increased recently from 11% in 1990-1994 to 30% in 1995-1999. Similarly, rheumatic disease remained to be the leading cause of aortic regurgitation, with a decline in frequency from 46% in 1985-1989 to 27% in 1995-1999. The percentage of degenerative change among regurgitant valves did not change appreciably. CONCLUSIONS There was a shift in the causes of aortic valve disease, with a decrease in rheumatic disease and an increase in degenerative disease. This trend was similar to that observed in the US. These findings suggest the increasing importance of aortic valve disease due to degenerative change.
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Affiliation(s)
- Takayoshi Matsumura
- Department of Cardiology, Sakakibara Heart Institute, 2-5-4, Yoyogi, Shibuya-ku, Tokyo 151-0053, Japan
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Takeda N, Ohtaki E, Misu K, Asano R, Tobaru T, Nagayama M, Kitahara K, Umemura J, Sumiyoshi T, Hosoda S. Normalization of left ventricular parameters following combined pimobendan and carvedilol treatment in a case of unclassified cardiomyopathy with longstanding refractory status. Intern Med 2002; 41:1147-52. [PMID: 12521204 DOI: 10.2169/internalmedicine.41.1147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 58-year-old man with a 64-month history of unclassified cardiomyopathy developed congestive heart failure (CHF) and had been dependent on long-term intravenous positive inotropes. Combined pimobendan and carvedilol administration resulted in marked symptomatic improvement from New York Heart Association functional class IV to I. Echocardiograms showed improvement of left ventricular (LV) ejection fraction from 15 to 48%, and LV end-diastolic diameter from 6.7 to 4.9 cm. This mode of therapy not only improved LV contractile function but also normalized LV volume, which was an unusual clinical course compared with the general course of advanced CHF.
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Abstract
Perimyocarditis represents an inflammation of both the myocardium and pericardium. Although several causative agents have been recognized, pericarditis or myocarditis associated with rubella is an unusual complication. In a 29-year-old woman, left ventricular function transiently deteriorated accompanied by ongoing cardiac inflammation a few days after illness. The titer of rubella virus increased from seronegative to more than 32-fold during the admission, and a rise in specific antirubella virus antibody was present. The patient was suspected of having perimyocarditis associated with the rubella infection. The authors also present clinical features of rubella-associated perimyocarditis and myocarditis in the literature.
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Affiliation(s)
- Tomohiro Harada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Harada T, Ohtaki E, Sumiyoshi T, Hosoda S. Paralytic ileus induced by the combined use of nifedipine and diltiazem in the treatment of vasospastic angina. Cardiology 2002; 97:113-4. [PMID: 11978960 DOI: 10.1159/000057683] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Harada T, Ohtaki E, Kasegawa H, Sumiyoshi T, Hosoda S. 4-Dimensional color Doppler echocardiography during mitral valve surgery. J Cardiovasc Surg (Torino) 2002; 43:567-9. [PMID: 12124576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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26
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Harada T, Ohtaki E, Kitahara K, Sumiyoshi T, Hosoda S. Carvedilol-induced changes in cardiac diastolic performance in a patient with isolated noncompaction of the myocardium. Intern Med 2002; 41:642-7. [PMID: 12211534 DOI: 10.2169/internalmedicine.41.642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Isolated ventricular noncompaction (IVNC) is an unusual congenital heart disease. The morphological features are trabeculations and intertrabecular recesses within the left ventricle. Important clinical considerations include the high mortality due to depressed cardiac function, and the instance of ventricular arrhythmia and systemic embolism. One of reasons for the high mortality is that there is still no effective therapy with the exception of the recommendation for anticoagulation therapy to prevent embolisms. Hence, we describe a 29-year-old man with IVNC presenting with chronic heart failure. Careful up-titration of carvedilol in this patient changed the parameters of cardiac diastolic performance
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Harada T, Ohtaki E, Asano R, Imai Y, Sumiyoshi T. A 70-year-old woman with cardiogenic shock and change in acute electrocardiogram patterns. Left main shock syndrome/acute LMT occlusion. J Cardiol 2002; 40:37-40. [PMID: 12166248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Tomohiro Harada
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Tokyo
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28
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Matsumura T, Tsushima K, Ohtaki E, Misu K, Tohbaru T, Asano R, Nagayama M, Kitahara K, Umemura J, Sumiyoshi T, Hosoda S. Effects of carvedilol on plasma levels of interleukin-6 and tumor necrosis factor-alpha in nine patients with dilated cardiomyopathy. J Cardiol 2002; 39:253-7. [PMID: 12048901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Whether beta-blocker therapy changes the circulating levels of cytokines as congestive heart failure improves remains uncertain. METHODS Nine patients with idiopathic dilated cardiomyopathy, who had previously received conventional treatment and were classified as New York Heart Association (NYHA) functional class II, received carvedilol by stepwise dose increase up to 20 mg daily, and the plasma interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels were measured. RESULTS IL-6 was significantly reduced from 0.80 +/- 0.49 pg/ml before therapy to 0.21 +/- 0.08 pg/ml after carvedilol was increased to 20 mg daily (p < 0.05). Moreover, IL-6 level had already decreased significantly compared to the baseline when the dose of carvedilol had reached 10 mg daily (0.28 +/- 0.12 pg/ml, p < 0.05). TNF-alpha levels did not change significantly. CONCLUSIONS These results demonstrate that IL-6 concentration is significantly decreased by beta-blocker therapy. The efficacy for heart failure may be related to the change of IL-6 concentration.
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Affiliation(s)
- Takayoshi Matsumura
- Department of Cardiology, Sakakibara Heart Institute, Yoyogi 2-5-4, Shibuya-ku, Tokyo 151-0053
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Harada T, Ohtaki E, Watanabe T, Kasegawa H, Sumiyoshi T, Hosoda S. Detection of muftiple regurgitation during mitral valvuloplasty by multiangle four-dimensional color Doppler echocardiography. Heart Vessels 2002; 16:167-9. [PMID: 12224790 DOI: 10.1007/s003800200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tomohiro Harada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Harada T, Ohtaki E, Sumiyoshi T, Hosoda S. A 68-year-old female with repetitive palpitation. Adrenal pheochromocytoma. J Cardiol 2002; 39:233-6. [PMID: 11977772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Tomohiro Harada
- Department of Cardiology, Sakakibara Heart Institute, Yoyogi 2-5-4, Shibuya-ku, Tokyo 151-0053
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Tanaka K, Ohtaki E, Kasegawa H, Sumiyoshi T, Hosoda S. Practical scoring system of mitral regurgitation assessing the optimal timing of operations: its predictive value of postoperative cardiac events and functional reversibility. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)81908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Harada T, Ohtaki E, Sumiyoshi T. Papillary muscles identified by myocardial contrast echocardiography in preparation for percutaneous transluminal septal myocardial ablation. Acta Cardiol 2002; 57:25-7. [PMID: 11918131 DOI: 10.2143/ac.57.1.2005377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In patients with hypertrophic obstructive cardiomyopathy (HOCM), percutaneous transluminal septal myocardial ablation (PTSMA) supplemented by myocardial contrast echocardiography (MCE) can provide a therapeutic benefit. We report a 33-year-old woman with HOCM in which MCE revealed a septal branch artery supplying the postero-medial papillary muscles. Thus, PTSMA was aborted because of the risk of acute mitral regurgitation secondary to papillary muscle dysfunction.
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Affiliation(s)
- Tomohiro Harada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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Harada T, Ohtaki E, Sumiyoshi T, Hosoda S. Successful three-dimensional reconstruction using transesophageal echocardiography in a patient with a left atrial myxoma. Jpn Heart J 2001; 42:789-92. [PMID: 11933928 DOI: 10.1536/jhj.42.789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Two-dimensional echocardiography can provide intracardiac images. However, the cross-sectional images require mental reconstruction to understand a three-dimensional intracardiac structure. It is sometimes hard for inexperienced echocardiographers to engage in reconstruction. Thus, three-dimensional echocardiography is potentially beneficial because these images can provide extra information without mental reconstruction. Herein we demonstrate three-dimensional reconstruction using transesophageal echocardiography in a patient with a left atrial myxoma. It contributed to clarifying the surgical considerations, including whether the tumor was adhering to the left atrium or the mitral valve.
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Affiliation(s)
- T Harada
- Department of Cardiovascular Medicine, University of Tokyo, Graduate School of Medicine, Japan
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Harada T, Ohtaki E, Kitamura J, Asano R, Kasegawa H, Koyanagi T, Sumiyoshi T, Hosoda S. Saccular aneurysm of pulmonary autograft after the Ross procedure. J Heart Valve Dis 2001; 10:750-3. [PMID: 11767181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The Ross procedure, which includes removal of the malformed aortic valve and replacement of a pulmonary autograft in the aortic position, has increased the number of available treatment options. Recently, dilatation of the autograft pulmonary root after the Ross procedure has been reported as a complication. We report a patient with bicuspid aortic valve malformations and aortic annulus dilatation, who had a saccular-form, true-type, aneurysm in the pulmonary autograft seven months after the Ross procedure. These changes have not been described so far as complication. Pathologically, marked mucoid degeneration was noted in the tunica media of the aneurysm, as well as in the original aortic root. These findings may suggest similar pathological characteristics between the aorta and pulmonary arteries. Hence, the surgical risks accompanying vascular characteristics in patients with congenital aortic valve malformations should be considered.
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Affiliation(s)
- T Harada
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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35
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Satoi M, Matsuishi T, Yamada S, Yamashita Y, Ohtaki E, Mori K, Riikonen R, Kato H, Percy AK. Decreased cerebrospinal fluid levels of beta-phenylethylamine in patients with Rett syndrome. Ann Neurol 2000; 47:801-3. [PMID: 10852546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
To clarify the mechanism of brain impairment in Rett syndrome, we measured the cerebrospinal fluid levels of beta-phenylethylamine (PEA) in 17 patients with Rett syndrome. Findings were compared with those obtained in age-matched controls and diseased controls. The cerebrospinal fluid level of PEA was significantly lower in patients with Rett syndrome than in the controls (31% of control values). The alteration in the cerebrospinal fluid level of PEA may reflect dopamine system impairment in Rett syndrome.
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Affiliation(s)
- M Satoi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
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36
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Harada T, Ohtaki E, Kitahara K, Umemura J, Sumiyoshi T, Hosoda S. Comparison of carvedilol effect to left ventricular function between low and high dose in chronic heart failure. J Card Fail 1999. [DOI: 10.1016/s1071-9164(99)91242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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Sakakibara Heart Institute, Uchikawa S, Ohtaki E, Tohbaru T, Misu K, Asano R, Kitahara K, Umemura J, Sumiyoshi T, Hosoda S. Clinical evaluation of patients with dilated cardiomyopathy surviving ten years or longer. J Card Fail 1998. [DOI: 10.1016/s1071-9164(98)90423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Ohtaki E, Kasegawa H, Asano R, Tobaru T, Misu K, Kitahara K, Umemura J, Sumiyoshi T, Kawase M, Saito K. [Pitfalls in echocardiographic diagnosis of mitral bileaflet prolapse]. J Cardiol 1998; 31 Suppl 1:61-5; discussion 66. [PMID: 9666399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preoperative echocardiography provides good planning information for successful repair of mitral valve regurgitation, but identifying the prolapse of both the anterior and posterior leaflets is sometimes difficult. To clarify the cause of this problem, preoperative echocardiographic findings and intraoperative observations of the prolapse were analyzed in 124 patients with non-rheumatic pure mitral regurgitation. In 48 patients with final diagnoses of bileaflet prolapse, 16 (33%) were considered to have only single leaflet prolapse before the operation. Anterior leaflet prolapse was overlooked in 14, and prolapse of either of its commissural segments was the least detectable by echocardiography. Chordal rupture was seen more in the posterior leaflet than in the anterior leaflet. Movement of the anterior leaflet may be influenced by a prolapsed and hypermobile posterior leaflet and/or regurgitant jet flow caused by the posterior leaflet prolapse.
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Affiliation(s)
- E Ohtaki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo
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39
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Shimizu T, Matsuishi T, Yamashita Y, Koga Y, Ohtaki E, Kato H, Goto Y, Nonaka I. Marinesco-Sjogren syndrome: can the diagnosis be made prior to cataract formation? Muscle Nerve 1997; 20:909-10. [PMID: 9179171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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40
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Nagamitsu S, Matsuishi T, Kisa T, Komori H, Miyazaki M, Hashimoto T, Yamashita Y, Ohtaki E, Kato H. CSF beta-endorphin levels in patients with infantile autism. J Autism Dev Disord 1997; 27:155-63. [PMID: 9105966 DOI: 10.1023/a:1025839807431] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We measured CSF levels of beta-endorphin, an opioid hormone, in 19 patients with infantile autism and in 3 patients with Rett syndrome, and compared them with control values. In infantile autism, CSF levels of beta-endorphin did not differ significantly from those of age-matched controls. There was no significant correlation between CSF levels and clinical symptoms, including self-injurious behavior, pain insensitivity, and stereotyped movement. However, CSF levels of beta-endorphin were significantly higher in the patients with Rett syndrome than in the control (p < .05). Data suggest that neurons containing beta-endorphin may not be involved in patients with infantile autism. Thus, there is no relationship between dysfunction of brain opioid and autism.
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Affiliation(s)
- S Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
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41
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Suzuki T, Ohtaki E, Murai T, Imai M, Kawai S, Kitaoka M, Kitahara K, Okada R, Suzuki S. Idiopathic restrictive cardiomyopathy with diffuse perimyocytic fibrosis--a rare observation. Jpn Circ J 1997; 61:272-4. [PMID: 9152778 DOI: 10.1253/jcj.61.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Idiopathic restrictive cardiomyopathy (RCM) is rare. Even today little is understood of its etiology or underlying mechanisms, and definitive diagnostic criteria are lacking. In this report, we describe a case of idiopathic RCM in a young Japanese woman who died while awaiting cardiac transplantation during the 5-year course of the disease. Rare pathologic findings of diffuse perimyocytic fibrosis were revealed at autopsy.
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Affiliation(s)
- T Suzuki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
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42
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Affiliation(s)
- M Horikawa
- Department of Pediatrics, National Higashi-Saga Hospital
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43
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Iwanaga R, Matsuishi T, Ohnishi A, Nakashima M, Abe T, Ohtaki E, Kojima K, Nagamitsu S, Ohbu K, Kato H. Serial magnetic resonance images in a patient with congenital sensory neuropathy with anhidrosis and complications resembling heat stroke. J Neurol Sci 1996; 142:79-84. [PMID: 8902724 DOI: 10.1016/0022-510x(96)00152-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the results of serial computerized tomography (CT) and magnetic resonance imaging (MRI) in a 9-month-old Japanese girl with the rare disorder, congenital sensory neuropathy with anhidrosis (CSNA). She developed a prolonged high fever, anorexia, and weight loss with laboratory findings of hemoconcentration and elevated levels of GOT, LDH and creatine phosphokinase (CK) in May 1995, and was hospitalized. The cerebrospinal fluid (CSF) was normal on admission. Elevation of CSF myelin basic protein on the 16th hospital day suggested a destruction of the myelin sheath. The first MRI performed on the 16th hospital day revealed no marked abnormalities when the patient exhibited a high fever, generalized tonic-clonic convulsions, and impaired consciousness. The patient had a persistent high fever, and developed a second generalized tonic clonic convulsion and became comatose. A second MRI on the 20th hospital day showed a bilateral symmetrical paracentral hypo-intensity of the white matter with occipital hypo-intensity on T2-weighted images. MRI findings were considered to represent the complications of the high fever with a loss of water from the cerebral cortices and deep white matter. MRI and CSF findings indicated the presence of brain damage due to the high fever.
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Affiliation(s)
- R Iwanaga
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume City 830, Japan
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Kitaoka M, Ohtaki E. [Cardiac rupture]. Ryoikibetsu Shokogun Shirizu 1996:574-7. [PMID: 9048099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M Kitaoka
- Division of Cardiology, Sakakibara Heart Institute
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45
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Ohtaki E. [Idiopathic left ventricular aneurysm]. Ryoikibetsu Shokogun Shirizu 1996:588-90. [PMID: 9048102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E Ohtaki
- Division of Cardiology, Sakakibara Heart Institute
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46
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Ohtaki E. [Cardiac aneurysm]. Ryoikibetsu Shokogun Shirizu 1996:567-70. [PMID: 9048097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E Ohtaki
- Division of Cardiology, Sakakibara Heart Institute
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47
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Katoh H, Suzuki T, Yokomori K, Suzuki S, Ohtaki E, Watanabe M, Yazaki Y, Nagai R. A novel immunoassay of smooth muscle myosin heavy chain in serum. J Immunol Methods 1995; 185:57-63. [PMID: 7665900 DOI: 10.1016/0022-1759(95)00104-i] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We have developed a double monoclonal sandwich enzyme immunoassay to measure smooth muscle myosin heavy chain (MHC). Analytical performance of the assay showed reliable detection of smooth muscle MHC in human sera. The mean of the smooth muscle MHC level in normal human sera was 0.9 +/- 0.9 ng/ml. In sera of patients with aortic dissection, the smooth muscle MHC level sharply elevated at the onset and rapidly decreased to normal levels. Immunoassay of smooth muscle MHC in serum is a promising method for biochemical diagnosis of smooth muscle disorders.
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Affiliation(s)
- H Katoh
- Immunology Laboratory, Yamasa Corporation, Chiba, Japan
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Ohtaki E, Matsuishi T, Hirano Y, Maekawa K. Acute disseminated encephalomyelitis after treatment with Japanese B encephalitis vaccine (Nakayama-Yoken and Beijing strains). J Neurol Neurosurg Psychiatry 1995; 59:316-7. [PMID: 7673966 PMCID: PMC486040 DOI: 10.1136/jnnp.59.3.316] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Seven children with acute disseminated encephalomyelitis (ADEM) after treatment with Japanese B encephalitis vaccine (JBEV) (Nakayama-Yoken strain 1968-88 and Beijing strain 1989-93) were identified by mailed questionnaires and by compilation of previously published case reports. It was considered that encephalomyelitis might have been related to vaccine treatment as the vaccine is derived from mouse brain tissue infected with Japanese B encephalitis virus, a potentially cross reactive antigen. The incidence of severe neurological complications associated with the newer Japanese B encephalitis Beijing strain vaccine seemed to be less than one case per 1,000,000, which is similar to the incidence of neurological complications associated with the older Nakayama-Yoken strain vaccine.
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Affiliation(s)
- E Ohtaki
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
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49
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Suzuki T, Ohtaki E, Kitaoka M, Saito K, Osada K, Kitahara K, Suzuki S, Kawase M. Serial transesophageal echocardiography imaging of a postoperative aortic ring abscess: a case report. J Cardiol 1995; 26:107-10. [PMID: 7674142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Transesophageal echocardiography (TEE) was used for the serial observation of a postoperative perivalvular abscess of a prosthetic aortic valve in a 65-year-old man who underwent aortic valve replacement for aortic regurgitation. Five months later, TEE revealed an aortic ring abscess. Ascending aortic grafting (Bentall method) and translocation of the aortic prosthetic valve were conducted for progressive mechanical valve dysfunction. Postoperative TEE showed flow between the left ventricular outflow tract and the abscess, which was unrestricted 1 month later. Associated clinical improvement suggested that washout of the abscess was a critical factor. This case illustrates the usefulness of TEE for examining postoperative aortic ring abscess.
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Affiliation(s)
- T Suzuki
- Division of Cardiology, Sakakibara Heart Institute, Tokyo
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Komori H, Matsuishi T, Yamada S, Yamashita Y, Ohtaki E, Kato H. Cerebrospinal fluid biopterin and biogenic amine metabolites during oral R-THBP therapy for infantile autism. J Autism Dev Disord 1995; 25:183-93. [PMID: 7559284 DOI: 10.1007/bf02178503] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Treatment with 6R-L-erythro-5,6,7,8-tetrahydrobiopterin (R-THBP) has been suggested to improve autistic behavior. Cerebrospinal fluid (CSF) levels of total biopterin, oxidized and reduced forms of biopterin, homovanillic acid, and 5-hydroxyindoleacetic acid were measured in 14 autistic children and 18 controls to clarify the mechanism of action of R-THBP. The 14 autistic children received R-THBP orally at 1 mg/kg per day; 7 children showed clinical improvement (responders) and the other 7 patients did not (nonresponders). There were no significant differences between responders, nonresponders, and controls in the CSF levels of the metabolites before R-THBP administration. When lumbar puncture was repeated in 6 autistic children in the 24th week of R-THBP therapy, there was no significant change in the CSF levels of any metabolites.
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Affiliation(s)
- H Komori
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan
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