bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Color Doppler Imaging in Assessment of Preoperative and Postoperative Flow Characteristics of Internal Thoracic Artery in Myocardial Revascularization
Authors: Bilgen Fuat , Alhan Cem , Alhan Sibel , Idiz Mustafa , Demiray Erdogan , Ozler Azmi
Published: July 2008

Between January 1993 and February 1993, the left internal thoracic arteries of 40 consecutive patients scheduled for aortocoronary bypass operation were examined by transthoracic B-mode imaging. Perioperative measurements correlated well with preop erative noninvasive measurements (r = 0.914). In the postoperative period, B-mode images could not be obtained in 17 (44.7%) of 38 patients. Adequate Doppler spectra of the internal thoracic artery were obtained in all patients preoperatively and in 36 (94.7%) of 38 patients postoperatively. Preoperatively a triphasic wave form was obtained with a large systolic peak followed by small reversed and diastolic components in all patients. Postoperatively this triphasic wave form had been converted into a combined systolic- diastolic wave form. In all patients peak systolic velocity of the internal thoracic artery decreased (96.4 ± 15.3 vs 64.2 ± 18.9 cm/sec., P < 0.05), and peak diastolic velocity increased (21.7 ± 8.8 vs 28.3 ± 11.2 cm/sec., P < 0.05) significantly in the postoperative period as compared with the preoperative values. A slight decrease in peak systolic and diastolic velocities was detected at twelve months postoperatively. This study indicates that transthoracic B-mode imaging and Doppler spectrum analysis are reliable techniques in the preoperative and postoperative assessment of the internal thoracic artery in myocardial revascularization.
Single Coronary Artery from the Right Sinus of Valsalva, Associated with Absence of Left Anterior Descending and an Ostium-Secundum-Type Atrial Septal Defect: A Rare Combination
Authors: Antonellis John , Rabaouni Athina , Kostopoulos Konstantinos , Margaris Nikolaos , Kranidis Athanasios , Salahas Anastasios , Ifantis George , Koroxenidis Gabriel
Published: July 2008

A case of single coronary artery from the sinus of Valsalva, with an anomalous origin of the left circumflex coronary artery from the just proximal portion of the right coronary artery, absence of the left anterior descending, and an ostium-secundum-type atrial septal defect is presented. This combination seems to be very rare.
Morphologic and Histologic Characterization of Cardiac Myxomas by Magnetic Resonance Imaging
Authors: Matsuoka Hiroshi , Hamada Mareomi , Honda Toshio , Kawakami Hideo , Abe Mitsunori , Shigematsu Yuji , Sumimoto Takumi , Hiwada Kunio
Published: July 2008

The purpose of this study was to assess the role of ECG-gated spin-echo (SE) magnetic resonance (MR) images, cine MR images, and gadolinium-diethylenetriaminepen taacetic acid (Gd-DTPA)-enhanced MR images for the morphologic and histologic diagnosis of atrial myxomas.

Four patients with left atrial myxoma were imaged with a 1.5-T MR imager. The T1-weighted images and the cine MR images were obtained before injection of Gd- DTPA. After the injection of Gd-DTPA, the T1-weighted images were obtained again. Gd-DTPA-enhanced images of the myxomas were histologically compared with the extracted specimens. (continued on next page)

The tumors were represented more clearly on the cine MR images as low-intensity areas than on the SE images as high-intensity areas. On post-Gd-DTPA images, the 2 tumors were homogeneously enhanced and the other 2 were inhomogeneously enhanced. The locus of enhancement on post-Gd-DTPA images fitted with histologic myxoma or inflammation, and the unenhanced region reflected the necrosis or cystic changes in the specimens, respectively.

The morphologic diagnosis of cardiac myxomas by MRI first should be done with SE images, and when the images are unclear, the cine MR images must be supplemented to depict the tumor clearly. Moreover, Gd-DTPA-enhanced MRI could elucidate histo logic characteristics in myxomas.
Coronary Artery Discrete Aneurysms, Ectasia, and Occlusive Disease and Extensive Arteriomegaly. Correlation, Constellation, or Coincidence? A Case Report
Authors: Gavaliatsis Isidoros P. , Dionisopoulou Chrisoula T. , Margaris Nikos G. , Tavernarakis Antonis G. , Flessas Leonidas P. , Koroxenidis Gabriel T.
Published: July 2008

The case of a sixty-five-year-old man with discrete coronary aneurysms, associated with coronary artery ectasia, stenoses, and total occlusion of the left anterior descending artery, that resulted in an acute anterior myocardial infarction, is presented. Aortography and digital subtraction angiography revealed marked aortic and iliac elongation, tortu osity, and aneurysmal dilatation as well as dilatated femoral and popliteal arteries with aneurysmal dilatation in places. It is considered that the case reflects the broad spectrum of atherosclerosis manifestations.
A Massive Calcified Left Ventricular Aneurysm with Normal Coronary Arteries and Without Myocardial Infarction
Authors: Sagkan Olcay , Ornek Ender , Erk Kamuran , Kandemir Bedri
Published: July 2008

Most cardiac aneurysms develop after myocardial infarction. Calcification in the aneurysmal wall is seen rarely. In this case report the authors present a thirty-nine-year- old man, who had been free from symptoms until eight months before, when he began to experience palpitations due to monomorphic sustained ventricular tachycardia. A chest roentgenogram disclosed an oval calcification on the left ventricular apex. Coronary angiography and left ventriculography revealed normal epicardial coronary arteries and a massive calcified and ossified left ventricular apical aneurysm. He had no chest pain, nor were there electrocardiographic findings of myocardial infarction. Attacks of ventric ular tachycardia disappeared after aneurysmectomy was performed. To the author's knowledge there is no case report in the literature of a calcified left ventricular aneurysm with normal epicardial coronary arteries and without clinical and electrocardiographic findings of infarction. They discuss the possible etiology of this case.
The Influence of Different AV Delays on Left Ventricular Diastolic Functions and on Incidence of Diastolic Mitral Regurgitation
Authors: Postaci Nursen , Yeşil Murat , Susam Ibrahim , Bayata Serdar
Published: July 2008

In patients with a DDD pacemaker (PM), programming of atrioventricular (AV) delay can influence ventricular filling and function. In this study the authors used color Doppler echocardiography to evaluate the effect of different AV delays on left ventricular diastolic function (LVDF) and on the incidence of diastolic mitral regurgitation.

In 26 patients with DDD PM, the following parameters were evaluated during five different AV delays by echocardiography: (1) mitral E wave amplitude (by pulsed Doppler), (2) mitral A wave amplitude (by pulsed Doppler), (3) isovolumetric relaxation time (IVRT), (4) deceleration time (DT), (5) LV diastolic dimension (LVDd), (6) LV systolic dimension (LVDs), (7) ejection fraction (EF), and (8) diastolic mitral regurgita tion (DMR). Patients had been paced for symptomatic AV block (n: 16, 62%) and sick sinus syndrome (n: 10, 38%). Mean age of patients was fifty-two (nineteen to sixty- three) and 13 (50%) of them were women. (continued on next page)

Correlation was sought between AV delay and investigated parameters. The correla tion coefficients of AV delay and E wave, A wave, IVRT, DT, LVDd, LVDs, and EF were -0.137, 0.243, 0.541, 0.031, 0.210, 0.241, and -0.184 respectively. DMR was detected in all cases when AV delay was increased more than 150 msec.

In conclusion, a slight correlation was found between AV delay and IVRT (r: 0.541). Other parameters of LV diastolic and systolic function did not correlate with AV delay. Second, DMR was observed in all patients when the AV delay was prolonged more than 150 msec.
Severe Spontaneous Carotid Artery Dissection and Multiple Aneurysmal Dilatations
Authors: Plaschke Michael , Auer Dorothee , Trapp Thorsten , Trenkwalder Peter , Trenkwalder Claudia
Published: July 2008

Spontaneous cervical artery dissections or arterial aneurysms associated with deficien cies of α1-antitrypsin (α 1-AT) or other inhibitors of proteolytic enzymes have occasion ally been reported. However, a coexistence of severe spontaneous internal carotid artery dissection and multiple aneurysmal dilatations associated with α1-AT phenotype M1S have not yet been presented; herein the authors describe such a patient. In order to avoid the risks associated with intraarterial angiography in a patient in whom an under lying arteriopathy is suspected, only noninvasive techniques were employed. This case demonstrates that magnetic resonance imaging combined with magnetic resonance angiography is a valuable noninvasive method for use in diagnosis and follow-up of carotid artery dissection.
Detection of Myocardial Viability in the Prediction of Improvement in Left Ventricular Function After Successful Coronary Revascularization by Using the Dobutamine Stress Echocardiography and Quantitative SPECT Rest-Redistribution-Reinjection 201TI Imaging After Dipyridamole Infusion
Authors: Kostopoulos Konstantinos G. , Kranidis Athanasios I. , Bouki Konstantina P. , Antonellis John P. , Kappos Kostas G. , Rodogianni Fivi E. , Zamanis Nikolaos J. , Tavernarakis Anthony G. , Lolas Christos T. , Anthopoulos Lambros P.
Published: July 2008

The aim of this study was to assess the feasibility, safety, and respective diagnostic accuracy of low-dose dobutamine infusion and rest-redistribution-reinjection thallium 201 single photon emission computed tomography (SPECT) after dipyridamole infusion (Th-DIP), in the prediction of functional improvement of asynergic infarcted zones, after successful revascularization in patients with chronic ischemic heart disease. Thirty-one patients with a previous myocardial infarction and left ventricular dysfunction (mean ejection fraction: 41 ±5.8%) were studied. The regional wall motion of the left ventricle was evaluated by basic echocardiography before and 14 ± 1.7 weeks after successful revascularization (19 by percutaneous transluminal coronary angioplasty and 12 by coronary artery bypass grafting). Dobutamine stress echocardiography (DSE) was performed in all patients with dobutamine infusion of 5 and 10 μg/kg/minute over five minutes. Within three days after DSE and prior to revascularization, all patients underwent Th-DIP for myocardial viability assessment. A 16-ventricular-segment model was used for basic, DSE, and Th-DIP images. Viability was assessed by applying the (continued on next page) standard criteria for each technique. In the 31 patients, 496 segments were analyzed. By basic echocardiography, 164 (33%) of them were classified as asynergic. The DSE detected viable tissue in 69/496 (14%) segments, whereas Th-DIP identified viability in 95/496 (19%) segments. When the postrevascularization basic echocardiographic study was used as the gold standard in identifying myocardial viability, the sensitivity and specificity for the DSE and Th-DIP were 86.5%, 94.4% and 90.5%, 69%, respectively. No major side effects were observed with both techniques.

In conclusion, DSE seems to be an accurate method for identifying viable but asynergic myocardium in patients with chronic ischemic heart disease, whereas Th-DIP overestimates the postrevascularization recovery. Detection of hibernating myocardium can be obtained by these two noninvasive methods. However, DSE seems to be more useful in determining the prospective selection of patients who are going to benefit from revascularization.
Quantitative Assessment of Coronary Atherosclerotic Plaque Profile by Morphometric Analysis of Angiographic Images
Authors: Palmieri Cataldo , Sicari Marco Paterni Rosa , Picano Eugenio , Biagini Andrea , Marzilli Mario
Published: July 2008

Coronary plaque morphology (simple or complex) has a recognized clinical, pathophys iologic, and prognostic importance, but its routine use is hampered by the subjective and qualitative nature of the assessment. The aim of this study was to assess the feasibility and accuracy of mathematical, objective, operator-independent assessment of plaque morphology, by means of algorithms based on vector and fractal analysis, previously developed for describing continuous curves. Twenty coronary angiograms were analyzed: 10 with "simple-type" stenosis (defined according to Ambrose type I pattern, Group I) and 10 with "complex-type" stenosis (Ambrose type II pattern, Group II).

Five morphometric parameters effectively separated simple and complex-type stenosis: peaks/cm (Group I = 0.24 ±0.31 vs Group II= 2.46 ± 1.83, P < .01); summed maximum error/cm (I = 0.94 ±1.19 vs II = 4.53 ±0.56, P < .01); integrated error/cm (I = 0.22 ±0.27 vs II = 2.25 ± 1.68, P < .01); number of features/cm (I = 0.02 ±0.05 vs II = 1.19 ±0.65, P < .01); standard deviation curvature (I = 0.07 ±0.01 vs II = 0.22 ±0.21, P = 0.06). The scaled edge-length ratio—the only parameter based on fractal analysis—was not different between the two groups (I = 1.03 ±0.01 vs II = 1.13 ±0.10, P = ns). Hence, a quantitative description of plaque morphology is feasible and allows an effective discrimination of simple and complex plaque profiles with morphometric para meters based on vector analysis.
Effects of Morphologic Restenosis, Defined by MRI After Coarctation Repair, on Blood Pressure and Arm-Leg and Doppler Gradients
Authors: Günthard Joëlle , Buser Peter T. , Miettunen Risto , Hagmann Andreas , Wyler Felix
Published: July 2008

Ten years after coarctation repair, 36 adolescents and young adults were studied in order to evaluate the relationship of anatomy at the resection site to blood pressure and arm- leg and Doppler gradients. The patients underwent magnetic resonance imaging (MRI), exercise testing, and continuous wave (CW) Doppler echocardiography.

On MRI, residual narrowing at the resection site was measured as 1-(ø anastomosis/ ø descending aorta) and expressed as percent stenosis. Residual stenosis on MRI was negatively correlated with the leg pressure at rest (P=0.0003) and during exercise (P=0.002). Residual stenosis correlated positively with the arm-leg gradient at rest (P<0.0001) and during exercise (P<0.0001) and with the peak CW Doppler gradient across the anastomosis (P<0.0001). However, residual stenosis was not related to the systolic blood pressure of the arm at rest or during exercise. The systolic arm pressures did not differ between patients with residual stenosis of less than 30% (group I), patients with residual stenosis of equal to or greater than 30% but less than 45% (group II), and patients with residual stenosis of equal to or greater than 45% (group III).

In conclusion residual anatomic stenosis influences blood pressure in the legs, the arm-leg gradient, and the Doppler gradient across the anastomosis. Arm hypertension late after coarctation repair seems not to be related to residual stenosis, and the benefit of reintervention in these patients remains questionable.
Cardiovascular Risk Factors in Commercial Flight Aircrew Officers Compared with Those in the General Population
Authors: Ekstrand Karin , Boström Per-Ake , Arborelius Måns , Nilsson Jan-Åke , Lindell Sven-Eric
Published: July 2008

Cardiovascular disease is the most common reason for loss of license among commercial flight pilots. This study was done to explore cardiovascular risk factors among aircrew officers. The study group consisted of 113 male commercial flight aircrew officers (aviators), aged thirty-five to forty-four years (mean: 38.8 years) who participated in the compulsory health screening. Men investigated at the Health Screening Centre, Malmö, were used as the reference group. Group 1, for ECG, (n 771), aged thirty-eight to forty-four years (mean: 42.1). Group 2, for height, weight, body mass index (BMI) (weight kg/height m 2), blood pressure, serum cholesterol (total), and smoking habits (n 5005), aged thirty-five to forty-four years (mean: 39.2).

The aviators did not differ from the reference population in regard to height, weight, BMI, diastolic blood pressure, or smoking habits. However, the incidences of electrocar diographic left ventricular hypertrophy, increased systolic blood pressure, and the level of cholesterol were significantly higher in the aviators when compared with the controls. Aircrew members may primarily be selected by criteria that differ from the male popu lation in general. Excessive environmental stress, ie, shift work, jet lag, fatigue, as well as dietary factors, may also contribute to anomalies in the group. The clinical consequences of these anomalies for the aviators should be further evaluated, for they are important both for the aviators and for flying safety.
Epidural Spinal Cord Stimulation Does Not Improve Microvascular Blood Flow in Neuropathic Pain
Authors: Devulder Jacques , Duprez Daniel , De Laat Martine , Rolly Georges
Published: July 2008

For many years, spinal cord stimulation (SCS) has been used successfully in various pain syndromes. SCS is also used to treat vascularly-impaired patients since it apparently improves the microcirculation. The exact physiological mechanisms involved are still unclear. There are even some anecdotal reports of a cooling of the legs during SCS. This study investigated the vascular effects of SCS in 15 patients with failed back surgery syndrome, using infrared thermography of the affected foot and capillaroscopy in the nailfold of the big toe. There were no statistically significant differences (Student's t test) in temperature (P = 0.923) or red blood cell velocity (P = 0.819 first day and P = 0.218 second day) in the affected foot with or without stimulation. A physiological difference in relation to neuropathic pain might explain the lack of improvement in skin microcir culation with SCS.
Portal Vein Obstruction Accompanied by Intrahepatic Stones
Authors: Tanaka Koki , Komokata Teruo , Ikoma Akira , Yamaoka Akihiro , Fukumoto Yoshihiro , Taira Akira
Published: July 2008

This study was conducted to clarify the pathogenesis of portal vein obstruction (PVO) associated with intrahepatic stones. Five cases with PVO and intrahepatic stones were studied retrospectively. The coincidence rate of PVO in intrahepatic stones was 5.8% (5 of 86 cases), and that of intrahepatic stones in PVO, 45.5% (5 of 11 cases). All cases had one or more symptoms of cholangitis, such as high-grade fever, abdominal pain, and jaundice prior to diagnosis of PVO. The portal vein was occluded at the main trunk in 4 and in the left branch in 1. Intrahepatic stones were found in bilateral hepatic lobes in 3 and in the left lobe in 2. Numerous calcium bilirubinate stones were packed in dilatated intrahepatic bile ducts of an excised specimen of the liver. Microscopically, arterial structures could be seen, but the portal vein ceased to be evident about the involved bile duct.

Based on the results of this study, persistent cholangitis and packed gallstones were concluded essential to the development of PVO accompanied by intrahepatic stones.
Hemodynamic Consequences of Stenosis Remodeling During Coronary Angioplasty
Authors: Back Martin R. , White Rodney A. , Kwack Eug Y. , Back Lloyd H.
Published: July 2008

Quantitative hemodynamic assessment during various endovascular interventions including balloon angioplasty is lacking. Translesional pressure drops measured by angio plasty catheters can cause flow blockage and thus lead to inaccurate estimates of prein tervention and postintervention flow rates. A new analytical model of the flow rate- pressure drop relation across vascular stenoses is utilized that is nonlinear yet relatively simple in principle, easily applicable in vivo, and compatible with the presence of catheters. The model incorporates in vitro experimental evidence, angiographic data on the dimensions and shapes of coronary arterial stenoses before and after balloon angio plasty, reported translesional pressure gradients, and measurements of coronary flow reserve. Reasonable estimates of mean coronary artery flow rates and translesional pressure drops in the absence of angioplasty catheters are obtained.

Prior to angioplasty significant flow restriction across a 68% diameter stenosis exists during hyperemic flow conditions. Following successful balloon dilation, increased minimal cross-sectional area (residual 40% diameter stenosis) results in an improved flow rate-pressure drop relation. Despite minimal flow restriction during hyperemic conditions following angioplasty remodeling, residual luminal constriction leads to elevated wall shear stress levels within the entry region of the stenosis. The flow analysis described may be of clinical utility in evaluating the hemodynamic significance of the anatomic severity of stenoses in coronary and peripheral arteries before and after endovascular therapeutic interventions.
Effect of Calcium Channel Blockade on Skin Blood Flow in Diabetic Hypertension: A Comparison of Isradipine and Atenolol
Authors: Rendell Marc S. , Shehan Mary Ann , Kahler Kennis , Bailey Kristina L. , Eckermann August J. , Rendell Marc S.
Published: July 2008

In previous studies, using laser Doppler techniques, the authors have demonstrated a duration-dependent reduction in skin blood flow reserve at sites of nutritive (NUTR) perfusion that occurs in diabetes and correlates with the presence of diabetic retinopathy and proteinuria. They speculated that it might be possible to reverse this decrease in blood flow by using agents with peripheral vasodilating properties. They chose the calcium channel blocking agent isradipine as a prototype. As a contrast agent, they chose atenolol, which has an equivalent antihypertensive effect but minimal peripheral vasodi lating properties.

They studied 24 diabetic hypertensive patients in a randomized, two-way crossover design. They assigned patients randomly to one or the other active drug and titrated to a maximum tolerated maintenance dose. Skin blood flow was measured at the end of the titration and maintenance phases. Patients then entered a four-week washout period, followed by crossover to the alternative drug, and measurements were repeated.

At baseline, the twenty-four-hour mean ambulatory systolic blood pressure was 150 ±2 mm Hg with a twenty-four-hour mean diastolic blood pressure of 93 ±1 mm Hg. Thermally stimulated skin blood flow reserve was about 50% lower in these patients as compared with an age-, sex-, and weight-matched group of 28 nondiabetic, nonhyper tensive patients. There was no difference in skin blood flow between the two groups at basal skin temperature or at a controlled temperature of 35°C. Both atenolol and isradipine successfully lowered blood pressure in the study patients. There was a slightly greater decrease in systolic blood pressure with isradipine and a greater decrease in heart rate with atenolol. Neither isradipine nor atenolol treatment affected skin blood flow values at the maximal 44°C temperature. However, at basal skin temperature and at 35°C, isradipine-treated patients had substantial increases in skin blood flow at NUTR sites. For example, skin blood flow at the knee at 35°C with isradipine treatment was 3.1 ±0.4 mL/min/100 g compared with 1.1 ±0.2 with atenolol, 1.3 ±0.1 with placebo, and 0.9 ±0.1 for the nondiabetic controls (all P<0.01).

The authors found a twofold to threefold increase in basal skin blood flow at NUTR sites with isradipine treatment. This degree of increase is substantially greater than that previously demonstrated by their group using pentoxifylline. Locally reduced skin blood flow is a factor in promoting skin breakdown and delayed healing. Further study is needed to explore the possibility that isradipine treatment may enhance healing of diabetic skin ulcers.
Superior Vena Cava Tumoral Thrombosis Revealing a Burkitt's Lymphoma and a Lymphoblastic Non-Hodgkin's Lymphoma
Authors: Juimo A.G. , Temdemno A. M. Dzogang , Tapko J.B. , Yomi J. , Teyang A. , Tagny G. , Tchokoteu P.F. , Lysinge A. , Pagbe J.J. , Mbakop A. , Juimo A.G.
Published: July 2008

Superior vena cava thrombosis (SVCT) is a rare pathology, though of great significance since it implies the development of a malignant process. The most common etiologies are basically bronchopulmonary and mediastinal tumors. Observations involving 2 patients presenting with superior vena cava syndrome (SVCS) are reported in this study, in which radiologic investigations (chest roentgenogram, computed tomography scan of the thorax, and superior vena cavography) revealed thrombosis of the SVC disclosing in both cases a non-Hodgkin's lymphoma. The first case was a mediastinal Burkitt's lymphoma in a thirty-eight-year-old man (exceptional form) and in the second case a lymphoblastic non-Hodgkin's lymphoma in a nine-year-old girl. In the patient with Burkitt's lymphoma healing was satisfactory twenty-four months after treatment by surgery, chemotherapy, and radiotherapy. The second patient died suddenly. In both cases the SVCT revealed the tumor. The causes of SVCT are reviewed and discussed.
Interferon Alpha-2a Therapy for Disseminated Intravascular Coagulation in a Patient with Blue Rubber Bleb Nevus Syndrome
Authors: Kunishige Makoto , Azuma Hiroyuki , Masuda Kenjiro , Shigekiyo Toshio , Arii Yoshiharu , Kawai Hisaomi , Saito Shiro , Kunishige Makoto
Published: July 2008

The authors present a sixteen-year-old girl with blue rubber bleb nevus syndrome (BRBNS) associated with disseminated hemangiomas involving the skin, oral cavity, skeletal muscle, and cerebrum. Although she denied neurologic symptoms, magnetic resonance imaging of the brain demonstrated dilatated cerebral veins and the Chiari I malformation. Examination of hemostasis revealed disseminated intravascular coagula tion (DIC) manifesting as Kasabach-Merritt syndrome, with the potential for life-threat ening bleeding or thrombosis in the central nervous system. Since successful management of life-threatening hemangiomas with interferon alpha-2a (IFN α-2a) has been reported, the authors administered IFN α-2a with an improvement in hemostasis. These findings suggest that IFN α-2a therapy is beneficial for relieving the life-threatening consumptive coagulopathy associated with BRBNS.
Percutaneous Transvenous Mitral Balloon Valvuloplasty Alone in Patients with Combined Aortic and Mitral Stenosis
Authors: Lee Tsung-Ming , Su Sheng-Fang , Chen Ming-Fong , Liau Chiau-Suong , Lee Yuan-Teh
Published: July 2008

To investigate the feasibility of percutaneous transvenous balloon dilatation of the mitral valve in patients with combined aortic and mitral stenosis, 12 patients were studied by echocardiography and catheterization before and after mitral valvuloplasty. Aortic stenosis was defined from prevalvuloplasty catheterization study as a transaortic pressure gradient of more than 25 mm Hg. All 12 patients underwent transvenous balloon mitral valvuloplasty successfully. Immediately after the procedure, all patients experienced improvement in clinical symptoms and in hemodynamic variables. Mitral valve areas were significantly increased from 0.78 ±0.18 to 1.73 ±0.21 cm2 (P<0.0001) by planimetry method. Cardiac output was significantly increased from 3.6 ±0.1 to 4.2 ±0.5 L/min (P=0.01). Mean transaortic flow rate increased 33% (from 198 ±68 to 254 ±41 mL/s, P=0.002). Mean pressure gradient across the aortic valve after mitral valvulo plasty was not significantly increased, from 34 ±7 to 37 ±13 mm Hg. Aortic valve areas, derived from the Gorlin formula, were significantly increased from 0.57 ±0.12 to 0.73 ±0.14 cm2 (P=0.006) after mitral valvuloplasty. However, continuity equation-derived aortic valve area was independent of increasing flow rate after mitral valvuloplasty from 1.29 ±0.35 to 1.30 ±0.29 cm2. During follow-up with a mean of twenty four ±fourteen months, 8 patients were in New York Heart association functional class I, 3 in class II, and 1 in class IV who received pericardiotomy owing to constrictive pericarditis without aortic valve replacement. In conclusion, mitral valvuloplasty alone may be safe and effective in alleviating symptoms in mitral stenosis patients with transaortic pressure gradient >25 mm Hg. Continuity equation-derived aortic valve areas seem to be flow independent in evaluation of aortic stenosis and are important for decision making.
Simultaneous Multiple Brain Hemorrhage Associated with Migraine
Authors: Nakamura Kensei , Saku Yoshisuke , Ibayashi Setsuro , Fujishima Masatoshi , Nakamura Kensei
Published: July 2008

A fifty-five-year-old woman with a history of migraine suddenly developed an occipital headache and visual disturbance after a typical migrainous attack. On admission, she had a left homonymous hemianopsia, and computed tomography of the brain demon strated intracranial hematomas in the occipital subcortices bilaterally. Cerebral arteriog raphy revealed diffuse vasospasm of the intracranial arteries attributed to the migraine. The cystatin C concentration in the cerebrospinal fluid was low, which suggested the existence of cerebral amyloid angiopathy. According to the clinical course and angio graphic findings, it is suggested that the vasospasm associated with migraine played an important role in developing multiple brain hemorrhage in this patient.
Epidemiology and Costs of Venous Diseases in Central Italy
Authors: Cesarone M.R. , Belcaro G. , Nicolaides A.N. , Laurora G. , De Sanctis M.T. , Incandela L. , Barsotti A. , Belcaro G.
Published: July 2008

The Prevalence of Early Atherosclerosis study aims to define the prevalence of subclinical atherosclerosis in a typical population of central Italy. A concomitant study evaluates the prevalence of venous diseases. The prevalence of superficial and deep venous disease, the prevalence of venous thrombosis and pulmonary embolism, and the prevalence of the most common venous malformations were studied through use of medical history, a questionnaire, and noninvasive investigations. The costs of venous problems were also considered.

Of some 2000 inhabitants, 746 (379 women; mean age 46.3 ±7 years; range eight to nienty-four) have been screened. No significant difference in trend increase of the rela tionship age/percent of subjects with venous problems was observed for superficial venous disease. The increase in the proportion of subjects with lipodermatosclerosis and venous ulcerations appeared to be correlated with age (r=0.543). Evidence accepted for pulmonary embolisms was pulmonary angiogram or evidence on ventilation+perfusion lung scans. According to these criteria the number of documented deep vein thromboses and pulmonary embolisms was very limited with a larger number of suspected disease entities. There was no significant correlation between age and pulmonary embolism or deep venous thrombosis distribution. The number of venous and/or arteriovenous malfor mations was comparable along the age axis in the different age groups. Only a limited number of these malformations (in less that 1% of subjects) had caused a clinical problem. The treatments used for venous problems have been reported in a question naire and subdivided into occasional treatments and chronic treatments (when used for periods longer than twelve months). The percent of subjects using different treatment was also studied. Treatments were divided in: (1) over-the-counter products (or any treatment not requiring prescription); (2) specialized drug (for venous diseases); (3) compression; (4) surgery (any type of surgical treatment); (5) sclerotherapy; (6) combined treatments (ie, sclerotherapy and surgery); (7) alternative treatments (herbal products etc). Finally, the average costs per year for treatment, for investigations, and the costs due to lost working days were recorded. In conclusion some 12% of the evaluated population sample (male population 46%) had or had been affected in the past by a venous problem and 50% of them had received some type of treatment.
Incidence of Atheroembolic Renal Failure After Coronary Angiography
Authors: Saklayen Mohammad G. , Gupta Satyendra , Suryaprasad Agaram , Azmeh Wayel , Saklayen Mohammad G.
Published: July 2008

Atheroembolic renal failure (AERF) is often seen after vascular procedures in elderly atherosclerotic patients. To estimate the incidence of AERF after coronary angiography, all patients undergoing coronary angiography at the V.A. Medical Center, Dayton, were prospectively evaluated for AERF. Since, unlike contrast nephropathy, AERF develops about a week after the vascular procedure and persists or progresses over weeks and months, serum creatinine was measured just prior to and 3 weeks after coronary angiog raphy. Peripheral signs of cholesterol emboli were also looked for at follow-up visits. Two hundred sixty-seven patients underwent coronary angiography over a fifteen-month period. Most of the patients were sixty years old or older. Mean serum creatinine in these patients prior to coronary angiography was 1.2 mg/dL. Mean serum creatinine after coronary angiography was unchanged (1.2 mg/dL) . Only 7 patients had serum creatinine > 2 mg/dL prior to coronary angiography. Two patients died within a week of coronary angiography and 2 did not return for follow-up. Of the remaining 263 patients, 5 had a serum creatinine increase by 0.5 mg/dL or more at three weeks after coronary angiog raphy. Three of 5 had a serum creatinine increase by 1.0 mg/dL or more. Two of these 3 patients eventually died of renal failure. None of these 5 patients had peripheral signs of cholesterol emboli. In selected patients, the incidence of AERF after coronary angiog raphy appears to be very low (<2%) .
Left-Sided Approach to Renal Cell Carcinoma Tumor Thrombus Extending into Suprahepatic Inferior Vena Cava by Resection of the Left Caudate Lobe
Authors: Ohwada Susumu , Satoh Yoshihiro , Nakamura Seiji , Tanahasi Yoshifumi , Otani Yoshimi , Iino Yuichi , Morishita Yasuo , Kobayashi Mikio , Yamanaka Hidetoshi , Ohwada Susumu
Published: July 2008

A new operative approach to resecting tumor thrombus originating from a right renal cell carcinoma extending into the suprahepatic inferior vena cava (IVC) is reported. Complete local control of the IVC must be obtained above and below the tumor thrombus to remove it under direct vision. The caudate lobe of the liver was resected to expose the retrohep atic IVC and open the lesser omentum. The subhepatic IVC was encircled just below the confluence of the hepatic veins. Caval tumor thrombus was removed en bloc, including the right kidney, by use of the total hepatic vascular exclusion technique (THVE) and IVC exclusion. The retrohepatic IVC was clamped just below the confluence of the hepatic veins once the thrombus was removed, and the suprahepatic IVC clamp was then released and the THVE was terminated. The sequential clamping from the suprahepatic IVC to the retrohepatic IVC below the confluence of the hepatic veins shortened the THVE time.
Absent Conal Septum in Tetralogy of Fallot
Authors: Goel Pravin K. , Shahi Madhukar , Mahant T.S. , Mittal P.K. , Radhakrishnan S. , Goel Pravin K.
Published: July 2008

Absent conal septum in tetralogy of Fallot (TF) is usually noted intraoperatively when the ventricular septal defect (VSD) is found abutting the pulmonary valve, its superior rim being nearly inaccessible transatrially, and the posterior rim being separated from the tricuspid valve (TV) by a muscular ridge. The authors retrospectively analyzed angiograms of 208 consecutive patients with TF seen at their center from July 1989 to December 1995 for absence of the conal septum and the presence of an interval between the TV and the margin of the VSD in 30° right anterior oblique view. In 13 (6%) patients, angiograms were inadequate or of poor quality for assessment and were excluded. Twenty-two of the remaining 195 (11%) patients had a large muscular interval between the tricuspid annulus and the margin of the VSD, which was associated with an absent conal septum in 14 (7.2%) and a diminutive septum in 8 (4%) patients. Nine of the 14 patients with an absent conal septum at angiography underwent surgery, and this finding was confirmed in all. The authors conclude that absent conal septum is not uncommon in TF and constitutes an important variation in its anatomy that can be identified preop eratively at angiography for optimal surgical management.
Postoperative Thrombosis of the Superior Caval Vein in a Patient with Primary Asymptomatic Behçet's Disease
Authors: Kröger K. , Ansasy M. , Rudofsky G. , Kröger Knut
Published: July 2008

Behçet's disease is a systemic vasculitis of unknown cause. In 1937 Behçet described 3 patients with oral and genital ulceration and hypopyon iritis. The disease shows worldwide distribution with the highest prevalence in the eastern Mediterranean region and Japan. The most common manifestation is recurrent oral ulceration. Other manifes tations include genital ulceration, eye lesions, skin lesion, arthritis or arthralgia, and cerebral lesions. Venous thrombosis and thrombophlebitis are also recorded as manifes tations. One of the causes of superior caval vein obstruction is Behçet's disease. Especially in Turkey, this association is common. Management must be directed against the primary disease plus the caval vein obstruction. The authors describe a patient with multisymp tomatic presentation of Behçet's disease with thrombosis of the superior caval veins and successful lysis with streptokinase.
Retrohepatic Cavoatrial Shunt with a Ringed Polytetrafluoroethylene Graft for the Budd-Chiari Syndrome
Authors: Tanaka Koki , Toyohira Hitoshi , Murata Ryuji , Shibuya Hiroshi , Shimokawa Shinji , Hamada Nobuo , Taira Akira , Tanaka Koki
Published: July 2008

This report describes a patient with Budd-Chiari syndrome who was operated on success fully by means of shunt formation with polytetrafluoroethylene graft between the inferior vena cava (IVC) and right atrium. The patient is a sixty-two-year-old woman suffering from persistent edema of the lower limbs for four years. The examination disclosed complete obstruction of the IVC at the level of the diaphragm with a patent right inferior hepatic vein. Following the operation, edema of the limbs disappeared, hypersplenism improved, and the serum ammonium concentration decreased to the normal range. In conclusion, a retrohepatic cavoatrial shunt is feasible and useful in treating a patient with the Budd-Chiari syndrome who has patent major hepatic veins.
Comparison of Thallium Scintigraphy and Positron Emission Tomography
Authors: Niemeyer M.G. , Kuijper A.F.M. , Meeder J.G. , Cramer M.J.M. , Cleophas A.J.M. , van der Wall E.E. , Niemeyer Menco G.
Published: July 2008

Assessment of tissue viability has become an important issue in recent years. Scintigraphic measurements have provided important diagnostic, therapeutic, and prognostic infor mation in patients with myocardial dysfunction, who may improve in left ventricular function after revascularization. For detection of regional myocardial ischemia and viability, thallium 201 (201T1) has been the most widely used tracer in single-photon scintigraphy. However, 201T1 scintigraphy may underestimate regional viability, espe cially after myocardial infarction. Positron emission tomography (PET) provides an advanced imaging technology that permits the accurate definition of regional tracer distribution. In combination with nitrogen (13N) ammonia, PET allows for the sensitive and specific detection of coronary artery disease. Several studies indicate the superiority of this approach in comparison with standard 201T1 tomographic (SPECT) imaging. In addition, regional blood flow can be accurately measured with 13N ammonia PET, and this approach can be employed in conjunction with pharmacologic stress imaging to quantify regional flow reserve. In combination with metabolic markers, such as fluorine 18 (18F) deoxyglucose, an indicator of glucose uptake, PET is capable of assessing myocardial viability. Furthermore, the PET approach may differentiate between various forms of cardiomyopathy. More studies are needed to define the cost-benefit ratio of both the 201 T1 reinjection and the PET technique for the management of patients with coronary artery disease or cardiomyopathy.
Comparison of Multiple-Dose and Once-Daily Nitrate Therapy in 1212 Patients with Stable Angina Pectoris: Effects on Quality of Life Indices
Authors: Niemeyer Menco G. , Kleinjans Huub A. J. , de Ree Rob , Zwinderman Aeilko H. , Cleophas Ton J. M. , van der Wall Ernst E. , Cleophas A.J.M. ,   Dutch Mononitrate Quality of Life Study Group
Published: July 2008

Background: Nitrates, although important for the management of anginal symptoms, produce significant side effects. Little is known about their net effects on health-related, quality-of-life indices.

Methods: In a self-controlled, 6-month study, the effects on symptoms and quality of life of multiple-dose and once-daily nitrate therapy were evaluated in 1212 patients with stable angina pectoris. Quality of life was assessed by a test battery based on the exercise- tolerance index of Wiklund, the psychological well-being index of Dupuy, and the Short Form 36 questionnaire of Stewart. The internal consistency and reliability of the multi- item scales were estimated by Cronbach's alpha coefficients.

Results: The effects of the two treatment regimens on pain index and number of addi tional sublingual nitrate tablets required were not different. However, based on the New York Heart Association (NYHA) angina classification, patients improved better on the once-daily than on the multiple-dose regimen: by > 1 category in 281 vs 62 of the patients (P<0.0001) ; mobility and psychological distress indices also improved (P = 0.006, and P=0.007). Conclusions: Once-daily nitrate therapy not only provides a better NYHA angina classifi cation than multiple-dose therapy does, but also provides a better quality of life as estimated by improvement of mobility and distress indices, the most important indicators of quality of life in this category of patients.
Errors of Computer Electrocardiography
Authors: RuDusky Basil M. , RuDusky Basil M.
Published: July 2008

A review of 6938 computer-generated electrocardiogram interpretations was undertaken by a single cardiologist. The computer-assisted program correctly interpreted 51.6% of the tracings. One or more corrections were necessary in 48.4%. The greatest number of incorrect interpretations involved repolarization (T wave) abnormalities, followed by ST segment changes. It is mandatory that computer-generated ECG interpretations be reviewed by an experienced electrocardiographer. Reliance on nonreviewed ECG inter pretations may result in incorrect diagnoses that could lead to inappropriate manage ment decisions.
Acute Electrophysiological Effects of Dipyridamole on Sinus Node Function in Patients with Sick Sinus Syndrome
Authors: Yeşil Murat , Bayata Serdar , Postacl Nursen , Aydin Çetin
Published: July 2008

One of the most widely used tests for evaluation of sinus node function is sinus node recovery time (SNRT), which requires right heart catheterization. On the other hand SNRT has high specificity but only moderate sensitivity in the diagnosis of sick sinus syndrome (SSS). The authors studied acute electrophysiologic effects of dipyridamole (0.40 mg/kg IV) in 16 patients with clinical SSS. All of them had normal SNRT and had undergone permanent DDD pacemaker implantation. By the aid of temporary pacing inhibition, the authors noninvasively measured the corrected sinus node recovery time (SNRTc) and sinus cycle length (SCL) before and after dipyridamole administration.

SCL was slightly decreased from a mean basal value of 1025 ±323 to 913 ±213 msec after dipyridamole administration (mean -10%), but this was not statistically signif icant. SNRTC was increased from a mean basal value of 344 ±91 to 606 ±156 msec after dipyridamole administration (+76% P≤0.004).

These results suggest that dipyridamole must be used cautiously in patients with SSS. Intravenous dipyridamole may be a useful test to assess sinus node function. SNRT measurement after intravenous dipyridamole may increase sensitivity of this test in patients with suspected SSS and normal SNRT.
The First Report of Successful Carotid Stent Implant Using Argatroban Anticoagulation in a Patient with Heparin-Induced Thrombocytopenia and Thrombosis Syndrome
Authors: Rangel Yadira , Fareed Jawed , Lewis Bruce E.
Published: July 2008

We report the first successful carotid stent implant in a patient with heparin-induced thrombocytopenia and thrombosis syndrome who presented with recurrent neurologic deficits secondary to severe carotid stenosis. Argatroban anticoagulation was used for the carotid stent deployment. We also present laboratory data that document effective procedural anticoagulation.
Coronary Artery Mycotic Aneurysm Following Endocarditis of a Composite Aortic Graft
Authors: Berkowitz Jonathan M. , Lansman Steven , Fyfe Billie
Published: July 2008

Mycotic aneurysms of the coronary arteries are rare, with 15 reported cases. These frequently fatal lesions usually occur in a setting of subacute bacterial endocarditis involving native valves. The authors present the first report of mycotic aneurysm of the first diagonal coronary artery following infection of a composite aortic graft.
Beneficial Hemodynamic Effects of Oral Prostacyclin (PGI2) Analogue, Beraprost Sodium, on a Patient with Primary Pulmonary Hypertension
Authors: Hashida Hidetoshi , Hamada Mareomi , Shigematsu Yuji , Ikeda Shuntaro , Kuwahara Taishi , Kawakami Hideo , Hara Yuji , Kodama Koji , Kohara Katsuhiko , Hiwada Kunio
Published: July 2008

A 65-year-old woman was admitted to our hospital because of exertional dyspnea in 1987. A diagnosis of primary pulmonary hypertension was confirmed by right heart catheterization. She had received conventional therapy in the outpatient clinic. She was readmitted with the deterioration of exertional dyspnea in 1995. Stabilization of pulmonary hemodynamics, while not achieved with conventional therapy, was achieved with additive administration of an oral prostacyclin (PGI2) analogue, beraprost sodium.
Effect of Coacervated α-Elastin on Proliferation of Vascular Smooth Muscle and Endothelial Cells
Authors: Ito Shigeki , Ishimaru Shin , Wilson Samuel E.
Published: July 2008

The arterial wall injury associated with arterial graft implantation causes smooth muscle cells (SMCs) in the media to migrate and proliferate in the intima at the graft-artery junction resulting in anastomotic intimal hyperplasia (AIH). An important step in devel oping a small-diameter prosthesis may be to stimulate endothelialization and thereby inhibit AIH. In this study, we investigated the effect of coacervated and crosslinked α-elastin on proliferation of SMCs and endothelial cells (ECs) in vitro. Coacervation is an important step in the conversion of proelastin to make an elastin fiber in vivo.

SMCs and ECs were prepared from porcine aortic media and endothelium, respec tively. SMCs and ECs (three to five passages, 4 x 10 4 cells/well) were seeded onto 12 well plates, coated and crosslinked with 0 or 10 mg/mL of coacervated α-elastin. After the 1st, 2nd, or 3rd day of cultivation, proliferation was assayed by scintillation counting of [3H]-thymidine incorporation. For the 4th day only, 0, 0.1, 1, 10 mg/mL concentration of coacervated α-elastin was coated and crosslinked. (continued on next page) SMC proliferation (1st, 2nd day: p<0.005; 3rd, 4th day: p<0.0001) was significantly inhibited over time and dose dependently, eg, 0.1 mg/mL (45.7 ±2.3%: % of control p<0.005), 1 mg/mL (5.9 ±0.7%, p<0.0005), 10 mg/mL (2.8 ±0.4%, p<0.0005). EC proliferation was inhibited over time by 10 mg/mL of coacervated α-elastin (2nd, 3rd day: p<0.005; 4th day: p<0.0001), but proliferation (132.8 ±9.9%: % of control p=NS) was stimulated by 0.1 mg/mL of coacervated α-elastin.

These results suggest that coating and crosslinking a coacervated α-elastin into the structure of arterial prosthesis may inhibit AIH and stimulate endothelialization.