Bifurcation percutaneous coronary intervention of left main trunk treated using a proximal optimizing technique and proximal balloon edge dilation technique.

We present a case of bifurcation percutaneous coronary intervention (PCI) of the left main trunk (LMT) using a proximal balloon edge dilation (PBED) technique following a proximal optimizing technique (POT). The procedure of the PBED technique entailed precise positioning of the balloon for SB dilation, with the proximal radiopaque marker lying in the cross-sectional plane of the stent struts at the left circumflex artery (LCx) ostium. The PBED technique might prevent stent deformation induced by side branch (SB) dilation and eliminates the need for the second POT procedure in the re-POT sequence. In fact, three-dimensional reconstruction of optical coherence tomography (3D-OCT) revealed good opening of stent cells overlying the LCx ostium without deformation of stent struts causing incomplete stent apposition at the site opposite the LCx, so the second POT procedure was unnecessary in this case. .

Acute coronary syndrome demonstrating plaque rupture in calcified plaque visualized by optical coherence tomography and near-infrared spectroscopy combined with intravascular ultrasound.

Optical coherence tomography (OCT) can visualize calcification of the coronary plaque as a low-intensity lesion with sharp borders. However, residual lipid tissue inside the calcification could pose a problem in plaque evaluation by OCT. We present a case of acute coronary syndrome (ACS) demonstrating plaque rupture in the calcified plaque. In this case, OCT demonstrated a cavity suspected to represent rupture in the calcified plaque and near-infrared spectroscopy revealed a lipid component behind the calcified plaque. Although calcified plaque is not considered a reason for ACS except for calcified nodules, residual lipid tissue inside the calcification might cause ACS if the thin fibrous cap over the lipid tissue is disrupted, even if surrounded by calcification. .

Neointimal coverage of jailed side branches in coronary bifurcation lesions: an optical coherence tomography analysis.

OBJECTIVES: The jailed strut at the side-branch (SB) orifice may be a cause of delayed neointimal coverage and SB flow disturbance after single stenting to bifurcation. The aim of this study was to characterize the exact relationship between the jailed strut pattern at the SB orifice immediately after stent implantation and neointimal coverage of the jailed SB orifice in the chronic phase. PATIENTS AND METHODS: A total of 29 bifurcation (left anterior descending coronary artery and diagonal branch) lesions treated by optical coherence tomography-guide single-stent implantation and followed at 18 months after a percutaneous coronary intervention were included in this study. RESULTS: Using three-dimensional optical coherence tomography images, the jailed stent strut pattern was classified into two groups on the basis of the presence of a stent strut link at the SB orifice (link group: n=11, and no-link group: n=18). SB orifice obstruction by neointima was significantly greater in the link group than in the no-link group during the 18-month follow-up period (26.8±21.9 vs. 9.5±22.1%, P=0.049). CONCLUSION: This single-center observational study with a small sample size showed that a jailed strut pattern at the SB orifice might be related to neointimal coverage of the SB orifice in bifurcation lesions treated with single-stent implantation. Further large-scale studies with long-term follow-up will be necessary to determine the exact relationship between the jailed strut pattern at the SB orifice and SB flow disturbance because of delayed neointimal coverage as well as clinical outcome.

The Role of Emergency Coronary Artery Bypass Grafting for Acute Coronary Syndrome / 日本心臓血管外科学会雑誌

Between April 1990 and December 1995, a total of 32 patients underwent emergency coronary artery bypass grafting for acute refractory coronary ischemia. The IABP group (Group A) included 27 patients who could be stabilized hemodynamically only by preoperative intraaortic balloon pump support, and the PCPS group (Group B) included 5 patients who required percutaneous cardiopulmonary support as well as IABP because of profound cardiogenic shock. In addition to surgical patients, the PTCA group (Group C) included 6 patients who were managed with catheter intervention under PCPS and IABP support for acute myocardial infarction associated with severe cardiogenic shock. Patients undergoing CABG (groups/A & B) had more prevalent three-vessel disease and left main coronary artery disease than patients receiving PTCA alone. The hospital mortality was significantly lower (7.4%, 2/27) in patients of Group A. While only one of five patients in group B could be weaned from PCPS and is alive, five of six patients in group C could be weaned from PCPS, but eventually only one of them survived. Emergency CABG is beneficial for patients who have multi-vessel disease or left main coronary artery lesion with relatively small myocardial infarction. In contrast, for patients with massive irreversible myocardial damage due to acute infarction, culprit lesions should be managed with catheter interventional therapy including balloon dilatation or stent placement and elective surgery should be planned for selected patients.

Effects of hypoxic exposure and endurance exercise training on the oxidative potentials of soleus muscle fibers and motoneurons in the rat / 体力科学

Thirty (n=30) seven week old male Sprague-Dawley rats were divided into six groups of five rats (n=5) in each group. The groups were designated Sc=sea level controls; St=sea level trained; Fc=hypoxic exposed (16% O<SUB>2</SUB>) controls; Ft =hypoxic exposed (16% O<SUB>2</SUB>) trained; Pc=intermittent hypoxic exposed (18%, 16%, 14%, 16%, 18% O<SUB>2</SUB> for two days each) controls; and Pt=intermittent hypoxic exercise trained. Exercise training consisted of 45min/day running on a rat treadwheel for 24 consecutive days. Fiber type distribution, succinate dehydrogenase (SDH) activity and glycogen content of the soleus muscle and the oxidative enzyme activity of the motoneurons of the soleus were measured in each group after the 24 days of hypoxic exposure and exercise training. In comparison to each training group's control the glycogen concentration of the soleus muscle was increased (P<0.05) regardless of hypoxic exposure. Only the intermittently hypoxic exercise trained group (Pt) demonstrated a fiber type shift of slow-twitch oxidative to fast-twitch oxidative glycolytic fibers. Neither hypoxia or exercise training altered the oxidative enzyme capacity of the soleus motoneurons.

Surgical Treatment of Infective Endocarditis / 日本心臓血管外科学会雑誌

In the past 9 years, 37 patients with infective endocarditis underwent valve replacement. The aortic valve was involved in 17 patients, the mitral valve in 10, and both valves in 10, respectively. 35 patients had native valve and 2 had prosthetic valve endocarditis. Bacterial findings were <i>Streptococcus</i> in 20 patients (54%), <i>Staphylococcus</i> in 5 (13.5%), gram-negative in 3 (8%), and undetected in 10 (27%). 10 patients developed aortic annular abscess. After aggressive debridement of all apparently infected tissue of annular abscess, the defects left in the left ventricular outflow tract were repaired by interrupted mattress sutures with pledgets in 4 patients, by autologous pericardial patch in 4, and by valved conduit in 2 PVE patients, respectively. Retrograde cardioplegic infusion from the coronary sinus not only facilitated operative manipulation but also provided superior myocardial protection in such patients. Operative mortality was 11% (4/37). Reoperation was necessary in 2 patients; one for periprosthetic leak, and the other for newly developed severe left coronary ostial stenosis after the first operation, but both died eventually. Late mortality was 8% (3/37). Mean follow-up of 31 months was achieved in all 30 survivors, in whom there was no recurrence of infection and clinical improvement was excellent.