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ABSTRACT: To evaluate changes in coronary artery spasticity in patients with vasospastic angina who had been stable for years under continuous drug treatment.
Follow up coronary angiography was performed under intracoronary ergonovine provocation in 27 well controlled patients with vasospastic angina and no organic stenosis; the tests were done > 24 months after the initial coronary angiography, in which occlusive spasm had been induced by the same regimen of ergonovine provocation.
The mean (SD) follow up period was 47.2 (21.6) months. All patients had been free from angina attack for more than 24 months under treatment with antianginal drugs. During this follow up period, organic stenosis developed in only one case. Occlusive spasm was observed during follow up coronary angiography in 23 patients. Spasm with 90% narrowing was observed in three other patients, and diffuse significant narrowing was seen in the final patient. No significant difference was found in spasticity (p = 0.75) between the initial and the follow up tests.
Repeated ergonovine provocation during coronary angiography after a controlled period of several years showed that coronary spasm remains inducible in most patients. Discontinuance of drug treatment during the remission from anginal attacks achieved by medication may put the patient at high risk.
Heart (British Cardiac Society) 05/1999; 81(5):528-32. · 4.22 Impact Factor
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ABSTRACT: A case of osteogenesis imperfecta with aortic regurgitation is described. The patient had a dilated aortic valve ring and an aneurysm of the Sinus of Valsalva. The patient manifested severe hemodynamic abnormalities and underwent aortic root reconstruction using a valved conduit. The operative problems and the pathological findings are discussed.
The Thoracic and Cardiovascular Surgeon 11/1991; 39(5):294-5. · 0.88 Impact Factor
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ABSTRACT: Coronary spasm is an important etiologic mechanism in the pathogenesis of myocardial ischemia. Provocative test of coronary spasm during coronary arteriography is clinically useful. The ergonovine test has gained widespread use, and we have examined the efficacy and safety of intracoronary ergonovine application with a fixed dose of 16 micrograms. We studied 119 patients undergoing coronary arteriography. Coronary spasm was induced in 34 cases by intracoronary administration of 16 micrograms of ergonovine maleate. Coronary spasm was readily resolved by intracoronary administration of isosorbide dinitrate. None of the cases negative to the intracoronary ergonovine applications could be induced by additional systemic administration of 0.4 mg of ergonovine. Side effects of ergonovine such as elevation of blood pressure, headache and chest symptoms were infrequent in the intracoronary ergonovine test. We conclude that our method of intracoronary ergonovine application is sensitive and safe for the diagnosis of coronary spasm.
Kokyu to junkan. Respiration & circulation 08/1991; 39(7):673-7.
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ABSTRACT: Percutaneous transluminal coronary angioplasty (PTCA) assisted by cardiopulmonary femorofemoral bypass was performed in 4 patients who were considered to be candidates for this technique because of their severe coronary artery diseases, including 2 with left main trunk disease, one with cardiogenic shock, and one with severe 3-vessel disease. Here we report the efficacy of cardiopulmonary support in PTCA. Case 1: An 85-year-old man with persistent unstable angina despite maximal doses of medications. Stenosis of the left anterior descending coronary artery (90%) was resolved by PTCA with cardiopulmonary bypass and intraaortic balloon pumping (IABP). Case 2: An 83-year-old man with unstable angina had high grade stenoses in the distal left main, left anterior descending and right coronary arteries. Although IABP was instituted for sustained chest discomfort and ST depression, the patient developed congestive heart failure. PTCA of the left main coronary artery with cardiopulmonary bypass was successfully performed. Case 3: A 64-year-old man with acute myocardial infarction. PTCA of the occluded left anterior descending coronary artery resulted in shock despite IABP, which was resolved by cardiopulmonary bypass with percutaneous insertion of cannulae, the technique we developed. Case 4: A 74-year-old man with unstable angina. He had a severe 3-vessel disease and a thrombus in the right coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Cardiology 02/1991; 21(2):273-81. · 1.28 Impact Factor
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ABSTRACT: We have evaluated the effects of LDL-aphereses performed over 15 to 62 months, involving both Double Filtration Plasmapheresis (DFPP) and LDL Adsorbent Plasmapheresis (LAPP), for 5 patients with familial hypercholesterolemia (FH) (1; homozygous, and 4; heterozygous) using computer image analysis by coronary angiography, (CAG). Results by CAG showed that in homozygous FH, 9 (75%) of 12 segments demonstrated no progression, 2 (16.7%) segments showed regression, and only 1 (8.3%) segment showed progression. In heterozygous FH, 27 (81.8%) of 33 segments showed progression, and 6 (18.2%) segments showed regression. Aorto coronary bypass was beneficial with obtained patency in 13 (93%) of the 14 grafts. We also performed an autopsy on one patient, with heterozygous FH who died suddenly probably due to fibrillation. The patient had received long-term LDL apheresis for 6 years and 7 months and had shown angiographic regression. The pathological findings showed no typical or new atheroma, significant cicatrization in the thickened intima and an eccentric thickened wall lesion. The serial angiographic findings together with the pathological findings very clearly support the use of LDL-apheresis for producing "true" regression in coronary atherosclerosis in FH.
Biomaterials, artificial cells, and immobilization biotechnology: official journal of the International Society for Artificial Cells and Immobilization Biotechnology 02/1991; 19(1):37-52.
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ABSTRACT: An 85 year old man with unstable angina pectoris was treated successfully with percutaneous transluminal coronary angioplasty supported by cardiopulmonary bypass and intra-aortic balloon pumping. Coronary angiography had shown stenoses in both the left main stem and left anterior descending coronary arteries. Drug treatment had been ineffective and he was too old for coronary arterial bypass grafting.
Heart 04/1990; 63(3):178-9.
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Progress in clinical and biological research 02/1990; 337:189-92.
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ABSTRACT: Seventeen patients with stenosis of bypass grafts or native coronary arteries (NCA) following coronary artery bypass underwent percutaneous transluminal angioplasty (PTCA). Stenoses were located in the saphenous vein graft (SVG) in 11 cases (involving 16 lesions), in the internal mammary artery graft (IMAG) in 2 cases (2 lesions), and in the NCA in 9 cases (13 lesions). All patients had disabling angina pectoris or a post-operative stenosis of more than 50%. PTCA was successful in 75% of all the SVG stenotic lesions, 50% of the IMAG lesions and in 67% of the NCA lesions. There were no complications associated with PTCA. After successful PTCA, restenosis developed in 23% of the SVG cases, 0% of the IMAG cases and in 38% of the NCA cases. Though relief of chest pain was found in 10 patients (59%), PTCA of the NCA was not so effective as PTCA of the bypass grafts.
Kyobu geka. The Japanese journal of thoracic surgery 10/1989; 42(10):814-7.
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ABSTRACT: Two patients who developed coronary aneurysm at the site of Percutaneous Transluminal Coronary Angioplasty (PTCA) in proximal LAD accompanied by severe re-stenosis just proximal to the aneurysm are described. Both patients underwent Coronary Arterial Bypass Grafting (CABG) to distal LAD to stop anginal attacks refractory to any anti-anginal drugs and to prevent a rupture of a coronary aneurysm. After the operation the anginal attacks disappeared and no trace of coronary aneurysm was visible in the coronary angiogram.
The Thoracic and Cardiovascular Surgeon 03/1988; 36(1):46-8. · 0.88 Impact Factor
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ABSTRACT: We report semi-quantitative histological data on coronary arteries, collected at autopsy from Japanese of both sexes (Group I) who had had unstable anginal attacks and transient ST elevation or depression in ECG within 1 month before death. The cause of death in all cases was acute myocardial infarction or coronary sudden death. A control group consisted of 28 autopsied patients (Group II) who had died of causes other than heart disease and who had been free from anginal attacks. The frequency of 51-75% and 76-100% luminal narrowing in the coronary arteries in Group I was statistically higher than that in Group II (P less than 0.01). Subendothelial infiltration of monocytes/macrophages with edematous change was most evident in Group I in all segments of the coronary artery, particularly in the proximal portions of the three main branches, regardless of mural or occlusive thrombotic sites of the coronary artery. The subendothelial infiltration of monocytes/macrophages, in terms of luminal narrowing, was the most frequent in the portions with 0-50% luminal narrowing, followed by portions with 51-75% narrowing. The subendothelial infiltration of mononuclear cells with edematous change, observed mostly in the proximal portions of three main branches of the coronary artery in Group I, was attributed to increased subendothelial permeability and endothelial damage caused by coronary vasospasm of recent occurrence. We propose that repeated vasospasm may lead to further progression of coronary atherosclerosis.
Atherosclerosis 01/1988; 68(3):191-7. · 3.79 Impact Factor
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Kokyu to junkan. Respiration & circulation 05/1987; 35(4):447-52.
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ABSTRACT: In chronic hemodialysis patients, there is the major problem of occlusion in the arteriovenous fistulae. To investigate this problem, the authors have developed angioscopy for examination and detection of occlusion developing to allow early use of transluminal balloon angioplasty (PTA) or laser angioplasty and prevent occlusions. The authors have examined 27 patients using a 2.7 mm diameter Olympus flexible angioscope and 9F sheath, following-up with a 4 mm balloon catheter (BARD) or SLT Nd-YAG laser. PTA was performed for 25 cases, with 19 demonstrating after one session patency lasting 9 months to date. Three cases revealed restenosis and have each received three PTA sessions. Laser angioplasty was performed in one case of 15 cm chronic occlusion, with subsequent PTA successfully enabling hemodialysis. Angioscopically, the authors were able to observe the various rest-forms within the shunt and detected the mural thrombus attached to the punctured pore. Both circumferential and valvular stenoses were observed. Initially after laser angioplasty, rough irregularity and a mural thrombus in the vessel was observed, but 2 months later, the vessel lumen had become smooth, probably due to intimal growth. Thrombus is acute stenosed cases were clearly observed. Angioplasty enabled new observations in the A-V fistulae, which allows investigation of the mechanism of stenosis or occlusion and enables an extended use of the hemodialysis blood access.
ASAIO transactions / American Society for Artificial Internal Organs 35(3):193-6.
