[Analysis by ultrasonic diagnostics in acute myocardial infarction].
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Humans↗
Biomedical subjects
J Yoshikawa
Publications and source records attributed to J Yoshikawa.
Noninvasive assessment of left internal mammary artery graft patency using duplex Doppler echocardiography from supraclavicular fossa.
OBJECTIVES: The purpose of this study was to clarify the usefulness of duplex Doppler echocardiography from the supraclavicular fossa for assessment of left internal mammary artery graft patency. BACKGROUND: A noninvasive method to assess coronary artery bypass graft patency would be useful for clinical diagnosis and long-term follow-up of graft outcome. METHODS: Duplex Doppler echocardiography from the supraclavicular fossa was performed in 56 consecutive patients who underwent postoperative cardiac catheterization studies, including quantitative angiography. All patients underwent coronary artery bypass graft surgery using the left internal mammary artery graft to the left anterior descending coronary artery. RESULTS: The left internal mammary artery graft and its flow were detected in 55 (98%) of the 56 patients with duplex Doppler echocardiography from the supraclavicular fossa. According to the quantitative angiographic data, the patients were assigned to three groups: group A (36 patients) with a normal left internal mammary artery graft (< 50% diameter stenosis), group B (9 patients) with intermediate (50% to 75% diameter) graft stenosis and group C (10 patients) with severe (> 75% diameter) graft stenosis. The diastolic/systolic peak velocity ratio was smaller in group C than in groups A and B (p < 0.05), but there was no significant difference between groups A and B. A diastolic/systolic peak velocity ratio < 0.6 predicted severe left internal mammary artery graft stenosis (> 75% diameter stenosis) with a sensitivity and specificity of 100% and 80%, respectively. The diastolic fraction of time-velocity integral was smaller in group C than in groups A and B (p < 0.05), but there was no significant difference between groups A and B. A diastolic fraction < 0.5 predicted significant left internal mammary artery graft stenosis (> 75% diameter stenosis) with a sensitivity and specificity of 90% and 100%, respectively. CONCLUSIONS: Duplex Doppler echocardiography from the supraclavicular fossa is useful for noninvasive assessment of left internal mammary artery graft patency.
Adult↗
Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization.
The effectiveness of subsegmental transcatheter arterial embolization (TAE) therapy for small hepatocellular carcinomas (HCCs) was retrospectively analyzed. TAE was performed in 100 patients with liver cirrhosis. There was a total of 124 nodular-type HCCs less than 4 cm in diameter. TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by gelatin sponge particles or a mixture of iodized oil and absolute ethanol into the more distal branches of the subsegmental artery. Complete necrosis was seen at histologic examination in seven of 11 resected lesions. Among the remaining 113 lesions in 90 patients followed up without surgery, the 1-and 4-year local recurrence rates after TAE were 18% and 33%, respectively. The 1- and 4-year survival rates for 82 patients with Child class A or B disease were 100% and 67%, respectively. No substantial deterioration of liver function was observed. Subsegmental TAE improved the prognosis of the patients with liver cirrhosis associated with small HCCs.
Carcinoma, Hepatocellular↗
[Usefulness of cardiovascular imaging techniques in the diagnosis and treatment of aortic dissection].
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Adult↗
[Reliability of biplane transesophageal color Doppler echocardiography in evaluating mitral valve prolapse: comparison with surgical findings].
The reliability of biplane transesophageal color Doppler echocardiography for the evaluation of mitral valve prolapse was assessed by comparison with surgical findings in 27 patients. The mitral valve prolapse site was classified as the medial, central, and lateral portions of the anterior leaflet, and medial, middle, and lateral scallops of the posterior leaflet. The prolapsed sites were determined by the site of systolic displacement using two-dimensional echocardiography, the site of flow acceleration and the direction of the mitral regurgitant jet using color Doppler echocardiography. The sensitivity of transesophageal echocardiography for detecting prolapse at the medial, central, and lateral portions of the anterior leaflet, and the medial, middle and lateral scallops of the posterior leaflet was 91, 100, 86, 83, 100, and 80%, respectively. The specificity was 100, 100, 96, 100, 89, and 100%, respectively. Biplane transesophageal echocardiography is a reliable method for detecting the site of mitral valve prolapse.
Adult↗
[Quantification of mitral regurgitant stroke volume by the proximal isovelocity surface area method].
Although color Doppler flow mapping has been used to quantitate the severity of mitral regurgitation, this approach has various limitations. Doppler color flow mapping of a proximal isovelocity surface area (PISA), defined by a blue-red aliasing interface, has been shown in vitro to be accurate for estimating volume flow rate across an orifice. Volume flow rate can be calculated as PISA x aliasing velocity. To evaluate the clinical applicability of the PISA method, we compared the regurgitant stroke volume estimated by the PISA method with the conventional pulsed wave Doppler method in 18 patients with mitral regurgitation. The mean systolic aliasing radius was calculated from color overlayed M-mode (Q/M-mode) images. The mitral regurgitant stroke volume calculated by the PISA method correlated well with that calculated by the pulsed Doppler method (r = 0.89, SEE = 6.0 ml). Thus, the color Doppler PISA method can be applicable to calculating the regurgitant volume in patients with mitral regurgitation.
Adult↗
[Percutaneous transvenous mitral commissurotomy vs open mitral commissurotomy: evaluation of results by color Doppler and two-dimensional echocardiography].
The effects of percutaneous transvenous mitral commissurotomy (PTMC) and open mitral commissurotomy (OMC) were evaluated in 18 patients who underwent PTMC and 16 patients who underwent OMC, before and within one month of the procedure, using two-dimensional and color Doppler echocardiography. There was no significant difference between the two groups in the mitral valve area, the severity of mitral stenosis, or cardiac function before the procedure. The mitral valve area after PTMC as measured by two-dimensional echocardiography and continuous wave Doppler echocardiography increased from 1.07 +/- 0.24 cm2 to 2.01 +/- 0.42 cm2 (p < 0.001), and from 0.99 +/- 0.26 cm2 to 1.76 +/- 0.23 cm2 (p < 0.001), respectively. The mitral valve area after OMC measured by two-dimensional echocardiography and continuous wave Doppler echocardiography increased from 1.04 +/- 0.24 cm2 to 1.78 +/- 0.41 cm2 (p < 0.001), and from 0.95 +/- 0.32 cm2 to 1.62 +/- 0.46 cm2 (p < 0.001), respectively. The mitral valve areas after PTMC did not differ significantly from those after OMC by either method.
Echocardiography↗
Value of acceleration flow signals proximal to the leaking orifice in assessing the severity of prosthetic mitral valve regurgitation.
To test the value of acceleration flow signals proximal to the leaking orifice in assessing the severity of prosthetic mitral valve regurgitation, 39 consecutive patients undergoing left ventriculography were examined by Doppler color flow imaging. Acceleration flow signals proximal to the regurgitant orifice were detected in 27 of the 31 patients who had prosthetic mitral regurgitation by left ventriculography (sensitivity 87%). All four patients without acceleration flow signals had mild prosthetic mitral regurgitation by angiography. No acceleration flow signals were detected in any patient without prosthetic regurgitation by left ventriculography (specificity 100%). Individual values of the maximal area of acceleration flow signals obtained from three orthogonal planes in seven patients with mild prosthetic mitral regurgitation by angiography ranged from 0 to 17 mm2 (mean 4 +/- 6). In 8 patients with moderate prosthetic mitral regurgitation by angiography, the maximal area of acceleration flow signals ranged from 21 to 58 mm2 (mean 33 +/- 15), whereas the maximal area of acceleration flow signals in 16 patients with severe prosthetic regurgitation ranged from 20 to 173 mm2 (mean 102 +/- 41). The maximal area of the acceleration flow signals from three planes correlated well with the angiographic grade of prosthetic mitral regurgitation. There was a significant difference in the maximal area of acceleration flow signals between mild and moderate (p less than 0.001), moderate and severe (p less than 0.001) and mild and severe (p less than 0.001) prosthetic mitral regurgitation. Thus, measurement of acceleration flow signals by Doppler color flow imaging is useful in assessing the severity of prosthetic mitral regurgitation.
Bioprosthesis↗
Relationships of site of infarction and history of previous infarction with short- and long-term prognosis after acute myocardial infarction in Japan.
We studied the outcome in 308 patients with acute myocardial infarction (MI) admitted to the coronary care unit of Kobe General Hospital. Short-term outcome (within 28 days after MI) and long-term outcome (more than 28 days) were examined with survival curves to find any relationship with a history of previous MI and with the site of the MI. In the short term, 38 of the 308 patients died of cardiac causes. The group with anterior MI tended to have higher mortality than the group of patients with inferior MI, and among patients without a previous MI, patients with anterior MI had significantly higher mortality (p = 0.01). In multivariate analysis by the logistic regression model, the site of the MI was found to be independently associated with the short-term outcome. In the long term, with a mean follow-up of 3.4 years, 23 of the 308 patients died of cardiac causes. Different sites of the MI did not result in different outcomes in patients with or without a previous MI. Of patients with anterior or inferior MI, those with a previous MI tended to have higher mortality, and of patients with an inferior MI, the difference was significant (p = 0.001). In multivariate analysis by the proportional hazards model, a history of MI was more predictive than the site of the MI. In conclusion, the site of the MI was associated more with the short-term outcome than with the long-term outcome, and a history of MI was associated more closely with the long-term outcome.
Aged↗
Posterior decompression and stabilization for multiple metastatic tumors of the spine.
Although the value of surgical decompression and stabilization for solitary spinal metastasis is well documented, indication for surgery for advanced multiple metastatic tumors of the spine is controversial. In this study, the clinical effect of posterior decompression and stabilization was investigated in 11 patients with advanced multiple spinal metastases with unfavorable conditions. Mean blood loss during surgery was 3000 g. Disseminated intravascular coagulation occurred in three patients. Neurologic improvement was observed in nine patients. There was no neurologic deterioration due to surgery in any patients. A measure of pain relief was obtained in all patients. However, the postoperative longevity was short and the patients died 2.5 months (on average) after operation, except in cases of breast cancer. The effect of the posterior surgery on multiple spinal metastases depended on primary diseases. In cases of short life expectancy, the effect of the surgery was limited only to the short duration of neurologic improvement, pain relief, and ease of nursing care while confronted with grave surgical morbidity. In cases of long life expectancy with tumors like breast cancer, however, posterior decompression and stabilization were expected to exert long-term therapeutic effect. Therefore, the posterior surgery for multiple spinal metastases is cautiously indicated considering the nature of the primary tumor.
Adult↗
Prognosis of temporal lobe epilepsy: report of a multi-institutional study.
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Adolescent↗
Differentiation of hepatocellular carcinomas from hyperplastic nodules induced in rat liver with ferrite-enhanced MR imaging.
The potential of superparamagnetic ferrite particles in magnetic resonance (MR) imaging to help differentiate between hyperplastic nodular lesions in the liver and hepatocellular carcinomas was evaluated with chemically induced liver tumors in cirrhotic rats. Ferrite particles decreased the signal intensity of hyperplastic nodules but not that of hepatocellular carcinomas, and stainable iron was found in the former but not in the latter with Prussian blue iron stain. T1-weighted spin-echo images made little contribution to the differentiation between these two lesions, while T2-weighted spin-echo images were effective for this purpose, since ferrite particles cause T2 shortening. Ferrite-enhanced MR imaging may be useful in differentiating these two lesion types according to their signal intensity changes on images, because Kupffer cells are present in hyperplastic nodular lesions but rarely in hepatocellular carcinomas.
Animals↗
Obstruction of inferior vena caval orifice by giant left atrium in patients with mitral stenosis. A Doppler echocardiographic study from the right parasternal approach.
BACKGROUND: To examine whether an extremely enlarged left atrium (giant left atrium) obstructs the venous return from the inferior vena cava (IVC), the velocity of IVC flow was measured at its junction with the right atrium (IVC orifice) in patients with mitral stenosis by use of color and pulsed-wave Doppler echocardiography from a right parasternal longitudinal plane. METHODS AND RESULTS: The maximum dimension of the IVC orifice by two-dimensional echocardiography and the maximum IVC orifice flow velocity by pulsed-wave Doppler echocardiography were measured in 74 patients with mitral stenosis and atrial fibrillation (mean age, 59 years). The control population consisted of 16 subjects with atrial fibrillation alone (mean age, 61 years). Flow velocities in the superior vena cava and hepatic vein were also obtained by pulsed-wave Doppler echocardiography from the supraclavicular and subcostal views, respectively. Fifty-one mitral stenosis patients without severe tricuspid regurgitation were divided into two groups according to the left atrial dimension (LAD), which was measured by the standard left parasternal long-axis view (group A: n = 33, LAD less than 65 mm; group B: n = 18, LAD greater than or equal to 65 mm). Peak inspiratory and expiratory velocities of IVC orifice flow in diastole averaged over three consecutive inspirations in group B (mean +/- SD, 93.4 +/- 32.0 and 47.6 +/- 19.8 cm/sec) were significantly greater (p less than 0.01) than in the control subjects (67.9 +/- 12.8 and 34.5 +/- 7.0 cm/sec) and in group A (70.2 +/- 18.4 and 38.1 +/- 11.5 cm/sec, respectively). However, there were no significant differences in superior vena caval and hepatic vein flow velocities among the three groups. The maximum IVC orifice dimension in group B (11.4 +/- 4.4 mm) was significantly smaller than in the control subjects (20.1 +/- 2.1 mm) and in group A (18.6 +/- 5.4 mm) because of displacement of the atrial septum into the right atrium. There were significant negative correlations between the IVC orifice dimension and the peak IVC orifice flow velocity (r = -0.62, SEE = 0.33 cm/sec, n = 67, y = e(-0.01x + 3.6), p less than 0.01) as well as the left atrial dimension (r = -0.71, SEE = 0.32 mm, n = 67, y = e(-0.02x + 3.8), p less than 0.01) in these 51 patients and control subjects. In the remaining 23 patients with severe tricuspid regurgitation, the peak inspiratory IVC orifice velocity (n = 9, 88.6 +/- 30.0 cm/sec) was significantly greater (p less than 0.05) and the IVC orifice dimension (23.8 +/- 9.7 mm) significantly smaller (p less than 0.05) in patients with a giant left atrium than in those without (n = 14, 69.9 +/- 15.3 cm/sec and 30.5 +/- 9.6 mm, respectively); in the latter, the IVC orifice dimension was significantly (p less than 0.05) greater than in the controls. CONCLUSIONS: A giant left atrium in patients with mitral stenosis obstructs venous return at the IVC orifice by marked displacement of the atrial septum toward the right atrium.
Adult↗
Intravascular ultrasound imaging--in vitro and vivo validation.
Intravascular ultrasound imaging is a new technique for visualizing arterial structures. The purpose of this study was twofold; first, to assess the ability of this intravascular ultrasound catheter to generate cross-sectional images of human artery segments in vitro and second, to determine the reliability of intravascular ultrasound technique in the evaluation of human arteries in vivo. For the vitro study, ultrasound images of the arteries were presented as a two-dimensional, 360 degrees display of vessel cross-section perpendicular to the long-axis of the probe. The ultrasound scanning provided an accurate description with high resolution of lumen structure and lumen-intima interface in all vessel specimens. There was a good correlation between the planimetric luminal area on the ultrasound images and the area obtained from histologic images (r = 0.92). There was also a good correlation in the plaque thickness between ultrasound and histological examination (r = 0.88). In the in vivo study, the ultrasound catheter was easily introduced, readily manipulated, and images were successfully obtained in all patients. No untoward effects were noted during manipulation of the catheter. There was a good correlation in the arterial dimension between ultrasound and angiographic measurements (r = 0.93). Thus, intravascular ultrasound imaging appears to be useful for characterizing and quantitating arterial lesions.
Carotid Arteries↗
Benign and malignant nodules in cirrhotic livers: distinction based on blood supply.
The blood supplies of nodular lesions associated with liver cirrhosis were analyzed in vivo with various imaging modalities. The portal blood supply was evaluated with computed tomography (CT) during arterial portography (CTAP); the arterial blood supply was evaluated with hepatic angiography, CT angiography, CT following intraarterial injection of iodized oil, or ultrasound following intraarterial injection of carbon dioxide microbubbles. A total of 84 surgically confirmed hepatocellular carcinomas (HCCs) (less than or equal to 3 cm) and 25 areas of adenomatous hyperplasia (AH) were included in the study. At CTAP, a portal blood supply was seen in 96% of cases of AH and only 6% of HCCs (chi 2, P less than .005). In contrast, an arterial supply greater than that of the surrounding liver was verified in 94% of the HCCs and only 4% of the cases of AH (chi 2, P less than .005). The blood supply of areas of AH with atypical hepatocytes and the blood supply of well-differentiated HCCs (Edmondson grade 1) tended to be intermediate between that of AH without atypia and that of HCC that was Edmondson and Steiner grade 2 or greater. Evaluation of the blood supply of the nodular lesions associated with liver cirrhosis is considered to be useful in the differential diagnosis and treatment of early-stage HCC.
Carcinoma, Hepatocellular↗
Assessment of aortic regurgitation by the acceleration flow signal void proximal to the leaking orifice in cinemagnetic resonance imaging.
BACKGROUND: The proximal acceleration flow region is a laminar flow field that is located immediately upstream from the leaking orifice. The purpose of this study was to evaluate whether cinemagnetic resonance imaging can provide information regarding the proximal acceleration flow region in patients with aortic regurgitation and to analyze the relation between the area of the proximal acceleration flow delineated by cinemagnetic resonance imaging and the severity of aortic regurgitation delineated by angiography. METHODS AND RESULTS: Thirty-eight consecutive patients who underwent aortography were examined by cinemagnetic resonance imaging. The region of proximal flow acceleration was identified as a semicircular-shaped signal void in the aorta during diastole. Cinemagnetic resonance imaging detected the proximal acceleration flow region in 26 of the 30 patients who were proved to have this lesion (sensitivity, 87%). In eight patients without aortic regurgitation according to aortography, no proximal acceleration flow region was detected (specificity, 100%). The area of the acceleration flow signal void from the long-axis view was well correlated with angiographic degree of aortic regurgitation. CONCLUSIONS: Cinemagnetic resonance imaging is useful in detecting the proximal acceleration flow region and permits noninvasive assessment of the severity of aortic regurgitation.
Adult↗
Infective endocarditis--analysis of 116 surgically and 26 medically treated patients.
We have reviewed 116 cases of bacterial endocarditis treated surgically and 26 cases treated medically since 1973. There were 123 patients with native valve endocarditis and 19 patients with prosthetic valve endocarditis. Overall, the left-sided valves were infected most frequently. There were 10 cases with right-sided valves involved. Multiple valves were infected in 6 patients. There were 6 perioperative deaths in the surgical group. The most common cause of death was multi-organ failure associated with uncontrollable sepsis. The overall operative mortality for active endocarditis was 7.7% (4/55), and for healed endocarditis, 3.3% (2/61). For active native valve endocarditis, the mortality was 4.2% (2/48), for healed native valve endocarditis, 3.6% (2/55), for active prosthetic valve endocarditis, 28.6% (2/7), and for healed prosthetic valve endocarditis, 0%. There was no difference in the operative mortality between active native valve endocarditis and healed native valve endocarditis. The mortality of active prosthetic valve endocarditis was significantly higher than that of active native valve endocarditis (p less than 0.01). Of the 26 patients treated medically, 7 died during the initial hospitalization. The major factor related to mortality in the medically treated patients was persistent sepsis (four patients), and congestive heart failure (three patients). The overall mortality of the medical group for active valve endocarditis was 15% (3/20), and for active prosthetic valve endocarditis, 67% (4/6). We conclude that patients with infective endocarditis with significant valve lesions who are unresponsive to medical therapy should be considered for urgent surgery.
Aortic Valve↗
Dilated cardiomyopathy complicated by a pedunculated and mobile left ventricular thrombus on ruptured false tendons.
A 68-year-old man was admitted with congestive heart failure. He was treated with diuretics and digitalis; thereafter, the two-dimensional echocardiogram suggested a pedunculated and mobile left ventricular thrombus. He underwent surgical thrombectomy because of the high risk of systemic embolization. To our knowledge, this is the first case of dilated cardiomyopathy with a mobile left ventricular thrombus that was attached to ruptured false tendons.
Aged↗