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Biomedical subjects

J Yoshikawa

Publications and source records attributed to J Yoshikawa.

At least 361 records · Page 20Linked to original sources
PubMed1984

Progression from hypertrophic obstructive cardiomyopathy to typical dilated cardiomyopathy-like features in the end stage.

An autopsied patient who had shown typical dilated cardiomyopathy (DCM)-like feature in the end stage of familial obstructive hypertrophic cardiomyopathy (HCM) is presented. The patient, a 38-year-old male, had 2 sisters with HCM. Six years before death, the echocardiogram revealed marked asymmetric septal hypertrophy (ASH) with systolic anterior motion (SAM). The ventricular septum (VS) to left ventricular posterior wall (LVPW) ratio was 19 mm/10 mm and LVEDd was 47 mm. Subsequently, the signs and symptoms of congestive heart failure became progressively worse and DCM-like findings appeared insidiously. Two months before death, the echocardiogram revealed LV dilatation (LVEDd = 55 mm) with diffuse poor contraction, no ASH (VS/LVPW = 7 mm/9 mm) and no SAM. At autopsy, the heart weighed 480g and showed dilated LV hypertrophy with normal wall thickness (VS/LVPW = 9 mm/13 mm). Massive fibrosis (30% in the VS), diffuse disarray (18% in the VS) and severe narrowing of the intramural small arteries and arterioles were found in the middle and outer thirds of the VS and the anterior LV wall. The extramural coronary arteries were not stenosed. The insidious progression from HCM to typical DCM-like feature related to the chronic progression of necrosis and massive fibrosis, due to severe stenosis of the intramural coronary artery. The data indicate that patients diagnosed clinically as DCM may be HCM, especially in those with family history of HCM.

Adult↗
PubMed1984

[Echocardiographic diagnosis of cardiac tumors].

Primary tumors of the heart are uncommon lesions that can mimic any other type of cardiovascular disease, so such tumors were rarely diagnosed before autopsy until the 1950's. Recent advances in echocardiography have enabled rapid and precise diagnosis of cardiac tumors to be made noninvasively. In diagnosing cardiac tumors by echocardiography, we must recognize fully the anatomical features of the four chambers of the heart. Cardiac tumors can be differentiated from other intracavitary mass lesions and ultrasonic artifacts. In this paper we described the echocardiographic features of cardiac tumors and their differential diagnosis. Present methods cardiac surgery have made the excision of cardiac tumors a safe therapeutic procedure providing an early and precise diagnosis of the cardiac tumor is made by echocardiography.

Diagnosis, Differential↗
PubMed1984

[Treatment of cardiogenic shock and medically refractory left ventricular failure in acute myocardial infarction and acute myocarditis by intraaortic balloon counterpulsation].

Twenty-seven patients in cardiogenic shock or medically refractory left ventricular failure due to acute myocardial infarction were treated with intraaortic balloon counterpulsation. Twenty-one of them were treated with counterpulsation alone; the remaining six underwent surgery. Thirteen patients were benefited by counterpulsation alone. Three of the patients treated with counterpulsation and surgery survived and were discharged from the hospital. Thus, 16 of the 27 patients (59%) survived. Four patients in medically refractory left ventricular failure or shock due to acute myocarditis were treated with counterpulsation. All patients were weaned easily from circulatory assist and were discharged from the hospital. This study shows that intraaortic balloon counterpulsation is a very useful adjunct to currently existing medical measures for the treatment of cardiogenic shock or for medically refractory left ventricular failure in both myocardial infarction and myocarditis.

Acute Disease↗
PubMed1984

[Mechanism of post-operative abnormal septal motion: clinical and experimental studies].

In a previous report, we showed that pericardium closure is responsible for post-operative abnormal septal motion. To elucidate this hypothesis, we performed additional clinical and experimental studies. Twenty-six patients were studied during cardiac surgery. We also studied five dogs during cardiopulmonary bypass using M-mode and two-dimensional echocardiography. M-mode echograms and short-axis views of the left ventricle were obtained before and after pericardiotomy, and before and after pericardium closure. In the clinical study, the patients were divided into three groups according to pre-operative septal motion: Group 1 included six patients with atrial septal defect showing paradoxical motion, Group 2 included thirteen patients with aortic or mitral regurgitation of hyperdynamic motion, and Group 3 consisted of seven patients with ventricular septal defects or mitral stenosis showing normal systolic motion. In Group 1, septal motion became normal after closure of atrial septal defect and then, became abnormal just after pericardium closure. Again in Group 2, septal motion became normal following surgical repair, but abnormal motion appeared immediately after pericardium closure. In Group 3, normal septal motion persisted until just prior to closure of the pericardium. Abnormal septal motion in all groups persisted following chest closure. In all dogs, paradoxical septal motion resulted from pericardium closure after cardio-pulmonary bypass. We conclude that both pericardium closure and cardio-pulmonary bypass are responsible for post-operative abnormal septal motion.

Adolescent↗
PubMed1984

[Inferior vena caval angiography: a new angiographic method for evaluating tricuspid regurgitation].

It is well known that right ventriculography has unavoidable disadvantages as a method for diagnosing tricuspid regurgitation. In this study, inferior vena caval angiography (IVC angiography) was tested as a new method for quantitatively diagnosing tricuspid regurgitation. With this method, no catheter passes through the tricuspid valve, and only a small amount (10 ml) of contrast material injected into the upper portion of the inferior vena cava visualizes the entire right atrium, and tricuspid regurgitation is manifested by turbulence or a negative jet in the right atrium. With respect to the degree, tricuspid regurgitation was graded as absent (0), mild (1+), moderate (2+) and severe (3+) using the criteria shown in Fig. 1. Mild tricuspid regurgitation was diagnosed when systolic turbulence was observed in the right atrium and did not reach the right atrial wall. Moderate tricuspid regurgitation was diagnosed when systolic turbulence reached the right atrial wall. Severe tricuspid regurgitation was diagnosed when systolic turbulence entered the inferior vena cava. Sixty-four patients with valvular heart disease and four having coronary heart disease were studied using IVC angiography and pulsed Doppler echocardiography. Using Doppler, the severity of tricuspid regurgitation was determined according to the distribution of the regurgitant signal in the right atrium. The degree of tricuspid regurgitation by IVC angiography correlated well with that by Doppler. All patients with severe (3+) regurgitation and 15 of 22 patients with moderate (2+) regurgitation required surgery, but all with no (0) regurgitation and 12 of 14 with only mild (1+) regurgitation required no surgical correction of the tricuspid valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1983

[Coronary ostial stenosis due to aortitis syndrome (Takayasu's arteritis) in a young female: report of a case].

A young female with aortitis syndrome (Takayasu's arteritis) and angina pectoris due to severe narrowing of the right and left coronary arterial ostia was presented. The thoracic and abdominal aorta and the distal coronary arteries were not involved. The exercise electrocardiogram and thallium-201 scanning were indicative of myocardial ischemia. Two-dimensional echocardiography did not disclose the stenosis of the ostia of the right and left coronary arteries. The final diagnosis was made by arteriography and coronary angiography. At the time of coronary arterial bypass graft operation, the ascending aorta in the vicinity of the coronary ostia was confirmed to be markedly thickened. Severe stenosis of the coronary ostia appeared to be due to proliferation of the aortic intima. Microscopic examination of the ascending thoracic aorta demonstrated lymphatic cell infiltrate and collagen fiber destruction in the adventitia and media. Angina pectoris may be the first symptom of the disease, when the coronary ostia are involved and the thoracic and abdominal aorta are not affected by arteritis. Both exercise electrocardiography and thallium-201 scanning prior to coronary angiography are recommended in evaluating this condition.

Adolescent↗
PubMed1983

[Pericardial closure causing post-operative abnormal septal motion: an echocardiographic study during cardiac surgery].

To assess a possible mechanism of abnormal interventricular septal motion following cardiac surgery, 16 patients were studied during cardiac surgery by M-mode and two-dimensional echocardiography. All 16 patients underwent open heart surgery using cardiopulmonary bypass. M-mode echocardiogram and short-axis views of the left ventricle by two-dimensional echocardiography were obtained before and after pericardiotomy, and before and after the closure of the pericardium. Interventricular septal motion did not change after pericardiotomy. Interventricular septal motion just after cardiac surgery was variable and dependent on each underlying condition. In all the 16 patients, interventricular septal motion became abnormal after the closure of pericardium. The abnormal septal motion persisted following the chest closure. We conclude that pericardial closure is responsible for post-operative abnormal septal motion.

Adult↗
PubMed1982

Noninvasive visualization of the dilated main coronary arteries in coronary artery fistulas by cross-sectional echocardiography.

Real-time cross-sectional echocardiographic studies of the main coronary arteries were performed in 20 normal subjects, 12 patients with patent ductus arteriosus and 14 patients with coronary artery fistula in whom the diagnosis was established by angiography. In 12 patients, the coronary artery that formed the fistula was dilated: The right coronary artery was involved in eight and the left coronary artery in four. The dilated coronary artery appeared as two dominant parallel echoes of wide lumen originating from the aorta in the region of the involved artery. Th echo diameter of the coronary artery correlated well with the angiographically estimated diameter of the artery. In the normal subjects and the patients with patent ductus arteriosus, we found no echocardiographic findings of coronary artery dilatation. This study demonstrates that cross-sectional echocardiography is useful in identifying the dilated coronary artery in coronary artery fistula and distinguishing this entity from patent ductus arteriosus.

Adolescent↗
PubMed1982

[Left ventricular myxoma with special reference to diagnostic approach: report of a case].

A 36-year-old male with left ventricular myxoma was presented. The patient had no significant cardiac symptoms except for premature ventricular contractions. The diagnosis was made by two-dimensional echocardiography and cineangiography. The both visualized a tumor of 1.5 cm in diameter which was mobile in the anterior portion of the left ventricle at the level of the chordae tendineae. The accuracy of these techniques was confirmed at the time of operation. In the diagnosis of this lesion, two-dimensional echocardiography was superior to angiography because the stalk connecting the tumor with the anterior left ventricular wall was well visualized. M-mode echocardiography visualized an abnormal echo behind the interventricular septum, but failed to demonstrate the shape, size, mobility and stalk of the tumor. The tumor was not visualized by computerized tomography and RI angiography. The importance of two-dimensional echocardiography was emphasized in the diagnosis of a left ventricular myxoma, even if it is small.

Adult↗
PubMed1982

[Criteria for the diagnosis of prolapsed mitral valve using phonocardiography and echocardiography].

Our criteria for the diagnosis of prolapsed mitral valve were proposed in this paper. With this abnormality, the principal alterations in the mitral valve consist of an abnormal systolic leaflet motion and mitral regurgitation with or without systolic clicks. Our criteria include: (1) auscultatory or phonocardiographic findings suggestive of mitral regurgitation or mitral complex abnormality, (2) a posterior displacement of the mitral valve throughout the latter half of systole by M-mode echocardiography, and (3) a systolic bulging or an apparent systolic ballooning of the mitral valve by two-dimensional echocardiography. A diagnosis of prolapsed mitral valve is justified in a given case if (1) plus one or two other findings are present. Several confusing M-mode and two-dimensional echocardiographic findings for the diagnosis of this condition are neglected in this criteria. We believe that the diagnosis of prolapsed mitral valve, as a rule, should depend on the presence of significant auscultatory or phonocardiographic finding which is a major manifestation of our criteria. However, our criteria seem to be inadequate for the diagnosis of a systolic ballooning of the mitral valve toward the left atrium which is frequently associated with atrial septal defect, since an apical systolic murmur is often absent. The mitral valve ballooning in atrial septal defect, however, is of functional origin, and should be differentiated from an organic prolapsed mitral valve. Thus, to be significant of prolapsed mitral valve, an apical auscultatory or phonocardiographic findings should be unequivocal.

Echocardiography↗
PubMed1981

[Tricuspid valve motion and tricuspid valve ring size in normals and patients with atrial septal defect (author's transl)].

To investigate the normal configuration of the tricuspid valve and the normal size of the tricuspid valve ring, 17 normals, 20 patients with atrial septal defect, 4 patients with tricuspid valve prolapse, and 41 patients with various diseased conditions were studied by cross-sectional echocardiography. The tricuspid valve ring diameter in atrial septal defect was judged to be increased in comparison with that of normals. All the patients with tricuspid valve prolapse exhibited an excessive systolic ballooning of the leaflets toward the right atrium. However, a systolic ballooning of the leaflets alone was frequently observed in normals and many other conditions. Therefore, we conclude that cross-sectional echocardiography has some clinical limitations in the differential diagnosis between tricuspid valve prolapse and normals.

Adult↗
PubMed1981

[Cross-sectional and M-mode echocardiographic diagnosis of vegetative endocarditis in the right-sided heart (author's transl)].

M-mode and cross-sectional echocardiograms of 3 cases with vegetative endocarditis in the right-sided heart were reported. The location of vegetative lesions was the tricuspid valve in one, the parietal band of the right ventricle and chordae tendinae in one, and the pulmonary artery wall in the remaining patient. Ruptured chordae tendinae were observed in the patient with tricuspid valve vegetation. M-mode echocardiography detected vegetative lesions in all patients. However, the precise size and location of these lesions, and a complication of the destructive process were not evaluated by M-mode echocardiography. On the other hand, cross-sectional echocardiography not only documented the presence but also assessed the morphologic characteristics of the lesions, since this technique provides spatial orientation concerning moving structures. Furthermore, ruptured chordae tendineae in the patient with tricuspid valve vegetation was correctly estimated. However, the lesions should be differentiated from other conditions including a localized calcified lesion, abscess and thrombus. In conclusion, cross-sectional echocardiography in combination with M-mode echocardiography is recommended in diagnosing vegetative lesions in the right-sided heart.

Adolescent↗
PubMed1981

[Abnormal left ventricular configuration and contraction in patients with mitral stenosis: a cross-sectional echocardiographic study (author's transl)].

To assess left ventricular shape and contraction pattern under the condition of the narrowed mitral orifice, 41 patients with mitral stenosis were studied by cross-sectional and M-mode echocardiography. Abnormal left ventricular configuration and asynergy were observed in 23 patients (56%). The change in configuration persisted during the cardiac cycle and was mainly due to a straightening and abnormal motion of the interventricular septum. Furthermore, hypokinesis or akinesis of the posterior left ventricular wall contributed to the change of left ventricular shape. Consequently the left ventricular shape became from circular to half moon- or pear-like configuration. Of these 23 patients, 19 had a severe degree of subvalvular lesion, whereas such a lesion was noted in only 6 of the 18 patients with normal left ventricular shape and contraction pattern. It is considered that a rigid mitral complex immobilizes the posterior wall of the left ventricle in patients with mitral stenosis. In addition, tricuspid regurgitation, which was frequently observed in our patients, may play an important role in abnormal septal motion. This study showed that abnormal left ventricular shape and asynergy in the posterior wall are not rare in patients with mitral stenosis and are due to a rigid mitral complex and associated tricuspid regurgitation.

Echocardiography↗
PubMed1981

[Cross-sectional echocardiographic features of mobile left ventricular thrombi (author's transl)].

To assess the frequency, characteristics and relation to systemic embolization of mobile left ventricular thrombi, 154 patients with myocardial infarction were studied by cross-sectional echocardiography. In 5 (3%) a mobile left ventricular thrombus was detected. The electrocardiograms of all these patients showed anterior wall myocardial infarction pattern. One had cerebral embolism and two died suddenly. The cause of sudden death was not known, but it may be related to the presence of mobile left ventricular thrombi. In the remaining 149 patients, only 3 (2%) had cerebral or peripheral embolism. Mobile left ventricular thrombi was shown as rotating abnormal echoes arising from the left ventricular wall (infarcted area) by cross-sectional echocardiography. The size of thrombus was variable in each case. We concluded that cross-sectional echocardiography was useful in detecting mobile left ventricular thrombi, and that mobile left ventricular thrombi may be related to cerebral or peripheral emboli secondary to myocardial infraction.

Aged↗