Simple detection of severe coronary stenosis using transthoracic Doppler echocardiography at rest.

Coronary flow velocity can be measured by transthoracic Doppler echocardiography (TTDE). The purpose of this study was to detect severe coronary stenosis using the diastolic-to-systolic flow velocity ratio (DSVR) determined by TTDE at rest. We prospectively examined 190 consecutive patients with angina pectoris for whom coronary angiography was planned. Doppler spectral tracings of flow velocity in the distal left anterior descending artery were recorded by TTDE at rest. The mean and peak DSVR values were computed using mean and peak coronary flow velocities. DSVR measurement by TTDE at rest was performed within 24 hours before angiography, and in patients who underwent coronary intervention it was performed again within 48 hours after the intervention. The success rate for DSVR measurement by TTDE was 83.7%. There were significant differences in peak DSVR and mean DSVR between the patients with severe stenosis (percent diameter stenosis >85%) and those without severe stenosis (1.3 +/- 0.4 vs 1.9 +/- 0.50 and 1.2 +/- 0.4 vs 1.8 +/- 0.5, respectively; p <0.0001). In the 17 patients with successful intervention, DSVR was significantly increased after the procedure (mean 1.2 +/- 0.1 vs 2.0 +/- 0.2; peak 1.2 +/- 0.2 vs 2.0 +/- 0.3, respectively; p <0.0001). For percent diameter stenosis >85%, the best cut-off points were 1.6 for peak DSVR (sensitivity 79.0%, specificity 75.7%) and 1.5 for mean DSVR (sensitivity 77.0%, specificity 77.9%). Thus, DSVR measurement by TTDE is a simple, noninvasive method for detection of severe coronary stenosis at rest.

Coronary artery bypass grafting in patients with dialysis-dependent renal failure.

The aim of this study was to define short- and long-term results of coronary artery bypass grafting (CABG) in dialysis patients. A retrospective review was carried out on 73 consecutive patients dependent on chronic dialysis who underwent CABG. In 63 isolated CABGs, 9 operations were performed under normal beating heart because of severe atherosclerotic changes in the ascending aorta or carotid arteries. The operative mortality (30 days' mortality) was 4.1%, and causes of death were closely related to cardiopulmonary bypass use. In the last 29 operations after introduction of the beating heart bypass, no hospital deaths occurred. The actual survival rates dropped to 45% at 70 months mainly for noncardiac late death. CABG for dialysis patients as undertaken with an acceptable operative risk. Extended application of beating heart bypass to these patients may produce further positive early results.

[Atherectomy in patients with arteriosclerosis obliterans: angiographic follow-up study of 186 lesions in 146 patients].

Atherectomy (ATE) is a new catheter-mediated technique for the removal of atheroma in patients with arteriosclerosis obliterans (ASO). ATE was performed using 7-10 Fr. Simpson Peripheral Athero Track catheters at 186 sites in 146 patients, whose lesions involved 49 common iliac arteries, 66 external iliac arteries, 68 femoral arteries and three other arteries. The initial success rate was 94.1%. The mean percent of the diameter stenosis was reduced from 79.0 +/- 1.2% (mean +/- SD) to 22.7 +/- 1.0%. There were two cases of perforation that required surgical treatment (1.1%). The complication rate was 4.4%. The 0.5-, 1-, 2- and 3-year patency rates were 87.6%, 79.6%, 62.5% and 62.5%, respectively. The rate of long-term patency in each segment of arterial lesions revealed that the patency rate in the common iliac artery was significantly higher than the rates in the external iliac artery (p < 0.05) and femoral artery (p < 0.01). The patency rates for long lesions (> or = 2.0 cm) and occluded lesions were significantly (p < 0.01) lower than those for short lesions (< 2.0 cm). Diabetic patients had a higher re-stenosis rate than nondiabetic patients (p < 0.05). In conclusion, ATE is an effective new method for the treatment of patients with ASO.

Left main coronary trunk compression by dilated main pulmonary artery in atrial septal defect. Report of three cases.

Narrowing of the left main coronary trunk, which was compressed by the dilated pulmonary artery, was associated with atrial septal defect in three adults. One of them had severe pulmonary hypertension. Coronary angiograms revealed localized narrowing of the left main coronary trunk, and the left main coronary trunk had a concave shape. No stenosis of other coronary arteries was observed. In all patients the atrial septal defect was closed with a polytetrafluoroethylene patch. In the patient with 75% narrowing of the left main coronary trunk, aorta-coronary bypass was performed; it was not performed in the two with 50% narrowing. In two survivors postoperative coronary angiograms showed that the narrowing of the left main coronary trunk improved or disappeared. These results suggest that markedly dilated pulmonary arteries easily compress the left main coronary trunk and cause narrowing, which improves after atrial septal defect closure.

[Surgical experiences of Cor triatriatum in infancy].

Three operative cases with Cor triatriatum, age ranged from 30 days to 16 months, were presented. All types were IB1 of Lucas-Schmidt's classification and one patient was associated with right upper PAPVC. One patient died of low output syndrome due to preoperative shock. Communication of abnormal diaphragm in left atrium varied from small and multiple to 5 mm in diameter. Their preoperative diagnoses were established by two-dimensional echocardiogram prior to angiocardiogram and the intracardiac communications were well evaluated by color doppler echocardiogram which was superior to angiocardiogram in this evaluation. Postoperatively, no abnormal diaphragm were detected in two survivors. The diagnosis and operative procedure for this anomaly were discussed on.

[A case report of compression of right pulmonary artery and bronchus by aneurysmal dilated ascending aorta in tetralogy of Fallot--suspension of ascending aorta].

The patient was a 63-days-old boy who was admitted to our hospital because of moderate cyanosis and tachypnea. After admission, severe respiratory distress and emphysematous change of the right lung on the chest X-ray developed progressively. Echocardiogram and angiocardiogram demonstrated that a tetralogy of Fallot associated with right aortic arch and absence of pulmonary valve, and revealed remarkably dilated ascending aorta which compressed the right pulmonary artery and bronchus. Therefore, the emergency operation in that the ascending aorta was suspended to the 2nd rib was performed through a right thoracotomy. After surgery, his respiratory distress and emphysema of the right lung completely disappeared. To our knowledge, this is the 2nd reported case in which suspension of ascending aorta was successfully performed for pulmonary complication in congenital cardiovascular anomalies as this patient.