Sugar-pendant diamines.

A set of 1,3-propanediamine derivatives connected to carbohydrates (5) has been prepared in four steps from peracetylated sugar and 1,3-dibromo-2-propanol in 60-73% yields. D-Glucose, D-mannose, D-galactose, D-xylose, D-ribose, and maltose are utilized as sugar molecules in this work. The diamine moiety was connected to the C1 carbon of the glycopyranose ring via an O-glycoside bond. All of the anomeric configurations and sugar puckering conformations, except in the D-maltose derivative, were determined by X-ray crystallography of the diazido or dibromo precursors. While glycosidation of peracetylated galactopyranose with 1,3-dibromo-2-propanol in the presence of boron trifluoride afforded both anomers, the neighboring group participation of the 2-acetoxy group yielded a single anomer for the other substrates. This method has been used to synthesize a library of sugar-pendant diamines including an OH-protected derivative (6), and an N,N'-diisopropyl-substituted derivative (7). A similar series of reactions using 2,3-dibromo-1-propanol gave ethylenediamine-type derivatives (11), and bis(bromomethyl)bis(hydroxymethyl)methane (12) gave bisglucose-pendant derivatives (16).

Successful repair of intimal dissection following coronary angioplasty with a 48-hour inflation of spiral inflation coil and local delivery of heparin.

We report on an unusual patient with a threatened occlusive dissection, in whom prolonged (48-hr) inflation of a balloon catheter with localized heparin infusion proved successful. This intracoronary infusion catheter maintained distal coronary flow on a unique spiral coil design, and may provide an alternative or a bridge to emergency operation or stent implantation.

Primary cardiac hemangiopericytoma causing rupture of the right atrium and chronic cardiac tamponade.

A 53-year-old woman presented with symptoms of dyspnea on exertion and edema of lower extremities. Chronic cardiac tamponade caused by the rupture of the right atrial wall was diagnosed by two-dimensional contrast echocardiography. Autopsy findings revealed primary cardiac hemangiopericytoma.

Prediction of degree of residual stenosis in coronary thrombolysis.

In order to predict the residual stenosis in coronary thrombolysis, the factors easily obtained from clinical history--age, gender, history of angina before acute myocardial infarction (AMI), family history, hypertension, diabetes, hypercholesterolemia, smoking, and interval between onset of AMI and recanalization--were observed in 114 patients with successful coronary thrombolysis. In 55 patients with angina before AMI, 29 patients had residual stenosis greater than or equal to 75% and 26 patients had residual stenosis less than 75%. In 59 patients without angina before AMI, 15 patients had residual stenosis greater than or equal to 75%, and 44 patients had residual stenosis less than 75%. The presence or absence of angina before AMI was the main variable that discriminated the groups of residual stenosis of more or less than 75%, which was the only significant independent variable to predict the residual stenosis. These data suggest that the presence of angina pectoris before AMI is likely to be associated with a significant degree of residual stenosis after thrombolysis.

A case of cardiac amyloidosis presenting with symptoms of exertional syncope.

A 54-year-old man presented with symptoms of exertional syncope. Cardiac amyloidosis was diagnosed by endomyocardial biopsy. Exercise tolerance test revealed a failure of increased heart rate followed by sinus arrest, associated with syncope. Autopsy revealed amyloid deposits in the sinoatrial node.

Multiple coronary thrombosis in a patient with thrombocytosis.

A 59-year-old woman was admitted with acute inferior myocardial infarction. Cardiac catheterization revealed total occlusion in the right coronary artery and thrombus-like filling defect in the left anterior descending coronary artery. With simultaneous intracoronary urokinase infusion to the right and left coronary arteries, the right coronary artery became patent and the thrombus in the left anterior descending coronary artery was released to the distal coronary artery. Thrombocytosis was disclosed by laboratory examination. The relationship between myocardial infarction and thrombocytosis is discussed.

Difficult deflation of Probe balloon due to twisting the system.

While using the balloon-on-a wire device, we experienced a case of difficult deflation of the Probe balloon system. Blockage of the balloon system was possibly caused by twisting the system to reach and pass the lesion in the branch of left circumflex coronary artery. The duration of inflation was 20 min, causing prolonged ischemia.

Echocardiographic assessment of aneurysm of the aortic valve caused by infective endocarditis--a case report.

No aneurysm of the aortic valve associated with infective endocarditis has yet been reported. This report describes the clinical echocardiographic and pathologic findings in a patient who developed infective endocarditis resulting in aneurysm of the non-coronary cusp with aortic regurgitation. Surgical treatment was performed because of gradual expansion of the aneurysm and gradual thinning of its wall. Two-dimensional and color Doppler echocardiographies proved useful for the initial diagnosis and serial follow-up of this unusual case and for its successful surgical management.

Presence of angina pectoris before acute myocardial infarction and degree of residual stenosis after coronary thrombolysis.

This study tested the hypothesis that the degree of residual stenosis after coronary thrombolysis reflected that of original stenosis presented by symptom of angina before acute myocardial infarction (AMI). The relation between the presence of angina before AMI and the degree of residual stenosis after coronary thrombolysis was observed in 57 patients with successful coronary thrombolysis for AMI. Patients with significant coronary artery stenoses other than the artery responsible for AMI were excluded from this study. In 22 patients with chronic angina for 2 weeks or longer before AMI, 14 patients had a residual stenosis of 75% or more and 8 patients had a residual stenosis of less than 75%. In 35 patients with angina for less than 2 weeks or not at all before AMI, 9 patients had a residual stenosis of 75% or more, and 26 patients had a residual stenosis of less than 75% (p less than 0.01). In the course of progression of coronary artery disease, some patients had AMI without severe underlying stenosis and others with severe underlying stenosis. Patients with chronic angina before AMI might tend to have AMI with acute occlusion superimposed on the severe organic stenosis. Patients without chronic angina before AMI would be more at risk for AMI caused by acute occlusion without underlying severe stenosis.

Angiography of right gastroepiploic artery for coronary artery bypass graft.

We describe the angiographic technique of grafting the right gastroepiploic artery to the coronary artery. With the femoral approach, our specially devised catheter was placed in the common hepatic artery or gastroduodenal artery. The gastroepiploic artery and graft to the coronary artery were visualized satisfactorily by manual injection of contrast media.

Recurrence of myocardial infarction related to different vessels in a patient with diffuse coronary artery spasm without underlying severe organic stenosis.

A 59-year-old man had a first myocardial infarction in the right coronary artery, followed by an another infarction in the left anterior descending coronary artery. Coronary thrombolysis for both occasions of acute myocardial infarction was successfully performed without severe residual stenosis. In the chronic phase after the second myocardial infarction, ergonovine test showed diffuse coronary artery spasm. The etiology of myocardial infarction is briefly discussed.

Recurrence of coronary artery spasm after successful percutaneous transluminal coronary angioplasty.

A 47-year-old man presented with angina, and coronary angiograms showed a significant organic stenosis with spasm in the left anterior descending coronary artery. Percutaneous transluminal coronary angioplasty was successfully performed for the organic lesion in the left anterior descending coronary artery. Symptom of angina due to coronary artery spasm recurred, even without restenosis at the site of successful angioplasty.

Release of intracoronary thrombus during coronary arteriography in a patient with unstable angina.

A case of release of an intracoronary thrombus in a patient with unstable angina is presented. The thrombus was observed in the right coronary artery just distal to the severe stenosis and was released during coronary arteriography.

Catheter-induced spasm during spontaneous attack of variant angina.

The simultaneous occurrences of spontaneous spasm and catheter-induced spasm during coronary angiography were obtained in 3 patients. Catheter-induced spasm was seen in the right coronary artery in 3 patients: 1 patient had spontaneous spasm in the distal right coronary artery and 2 patients had spontaneous spasm in the proximal left anterior descending coronary artery. These findings suggest that patients with variant angina may be susceptible to mechanical induction of spasm.

Coronary spasm as a cause of perioperative myocardial infarction.

The case of a patient with severe left main trunk disease is presented, in which spasm of the right coronary artery resulted in intraoperative myocardial ischemia and perioperative myocardial infarction. It is suggested that coronary spasm may be a cause of perioperative myocardial infarction, and has to be considered in case of unknown etiology.

[Exercise echocardiography: II. Interventricular septal wall dynamics in patients with left anterior descending coronary disease during recovery (author's transl)].

Supine ergometer exercise test was performed in 10 healthy subjects and 9 patients who had severe stenosis in the left anterior descending coronary artery [5 patients with stenosis proximal to the septal perforator (proximal LAD disease) and 4 patients with stenosis distal to the septal perforator (distal LAD disease)]. In healthy subjects and patients with distal LAD disease, the increment of septal excursion (IVS Ex) and percent systolic thickening of the septum (% delta Th) during exercise returned to the pre-exercise level with a few minutes after exercise. In patients with proximal LAD disease, IVS Ex decreased to 1.4 +/- 1.2 mm during exercise form the pre-exercise level (7.4 +/- 0.7 mm) and % delta Th decreased to 6.4 +/- 5.1% during exercise from the pre-exercise level (37.2 +/- 8.4%). After exercise, IVS Ex and % delta Th increased to 8.6 +/- 0.9 mm at 2 min and 38.0 +/- 9.8% at 3 min respectively and then returned to the pre-exercise level. End-diastolic wall thickness (WTh) did not change during and after exercise in healthy subjects and patients with distal LAD disease, while in patients with proximal LAD disease, WTh increased for a few minutes after exercise and returned to the pre-exercise level. The change of electrocardiogram and symptom of angina pectoris lasted longer than the abnormal wall motion.