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Purpose: Accurate measurement of right ventricular (RV) size using transthoracic echocardiography (TTE) is important for evaluating the severity of congenital heart diseases. The RV end-diastolic area index (RVEDAi) determined using TTE is used to assess RV dilatation; however, the tracing line of the RVEDAi has not been clearly defined by the guidelines. This study aimed to determine the exact tracing method for RVEDAi using TTE.Methods: We retrospectively studied 107 patients with atrial septal defects who underwent cardiac magnetic resonance imaging (CMR) and TTE. We measured the RVEDAi according to isoechoic and high-echoic lines, and compared it with the RVEDAi measured using CMR. The isoechoic line was defined as the isoechoic endocardial border of the RV free wall, whereas the high-echoic line was defined as the high-echoic endocardial border of the RV free wall more outside than the isoechoic line. Results: RVEDAi measured using high-echoic line (high-RVEDAi) was more accurately related to RVEDAi measured using CMR than that measured using isoechoic line (iso-RVEDAi). The difference in the high-RVEDAi was 0.3 cm2/m2, and the limit of agreement (LOA) was −3.7 to 4.3 cm2/m2. With regard to inter-observer variability, high-RVEDAi was superior to iso-RVEDAi. Conclusion: High-RVEDAi had greater agreement with CMR-RVEDAi than with iso-RVEDAi. High-RVEDAi can become the standard measurement of RV size using two-dimensional TTE.

Serial changes of electrocardiograms (ECG) could be used to assess their clinical features in atrial septal defects (ASD) after transcatheter closure together with other clinical parameters. We retrospectively studied 100 ASD patients who underwent transcatheter closure. Complications of persistent atrial fibrillation occurred in five ASD patients, and they were excluded. We divided the other 95 patients according to PQ intervals before closure (normal

The purposes of this study were: (1) to confirm the prevalence of sleep-disordered breathing (SDB) in Japanese children using nocturnal pulse oximetry (NPOx) as a screening tool and (2) to examine what kind of parameters are suitable for the evaluation of SDB in children. We conducted a study of 99 children between 4 and 15-year-old and obtained their demographic characteristics and the presence of SDB-related symptoms by questionnaire from their parents. In our study, 36% had been Down syndrome (DS), 25% had cardiovascular disease and 34% had dental/oral abnormality. As SDB-related symptoms, snoring (35%), awake disturbance (48%), arousal (41%) and nocturia (19%) were reported. We analyzed each parameter based on the previous reported data of children and temporary defined normal range as follows; 3%ODI 89% and McGill oximetry score = 1. In non-DS group, each parameter showed abnormal value especially in younger group (abnormality; 61–94%), but the abnormality was decreased during the growth (abnormality; 11–63%). Interestingly, in DS group the value of each parameter was kept on abnormal during the growth (abnormality; 55–100%). We investigated the correlation between McGill oximetry score and ODI or SpO2 nadir. There was a significant positive correlation between McGill oximetry score and 3% or 4% ODI. Moreover, there was a significant negative correlation between McGill oximetry score and SpO2 nadir. Based on NPOx screening, prevalence of SDB was high; however, it was decreased during the growth in non-DS group. Each parameter might be useful for SDB screening in children.

Sleep quality is often impaired in patients with chronic heart failure (HF), which may worsen their quality of life and even prognosis. Leg thermal therapy (LTT), topical leg warming, has been shown to improve endothelial function, oxidative stress, and cardiac function in patients with HF. However, its short-term influence to sleep quality has not been evaluated in HF patients. Eighteen of 23 patients with stable HF received LTT (15 min of warming at 45 °C and 30 min of insulation) at bedtime for 3 consecutive nights and 5 patients served as control. Subjective sleep quality was evaluated by St. Mary’s Hospital Sleep Questionnaire, Oguri–Shirakawa–Azumi Sleep Inventory, and Epworth sleepiness scale, and also objectively evaluated by polysomnography. LTT significantly improved subjective sleep quality indicated by depth of sleep (p

The pathophysiology of non-pulmonary vein (PV) triggers of atrial fibrillation (AF) is unclear. We hypothesized that left atrial non-PV (LANPV) triggers are associated with atrial tissue degeneration. This study analyzed 431 patients that underwent catheter ablation (mean age 62 yrs, 303 men, 255 paroxysmal AF [pAF] patients). Clinical and electrophysiological characteristics of non-PV trigger were analyzed. Fifty non-PV triggers in 40 patients (9.3%) were documented; LANPV triggers were the most prevalent (n = 19, 38%). LANPV triggers were correlated with non-paroxysmal AF (non-pAF) (OR 3.31, p = 0.04) whereas right atrial non-PV (RANPV) triggers (n = 14) and SVC triggers (n = 17) were not. The voltage at the LANPV sites during SR was 0.3 ± 0.16 mV (p

People with Down syndrome (DS) are prone to develop sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA) and they are reported to sleep in unusual sleep postures. The purpose of this study was to determine the relationship between sleep postures and SDB parameters, including the objective nocturnal oxygen desaturation in people with DS in Japan. Overnight pulse oximetry was measured in 32 people with DS (male 44%, mean age 18 ± 10 years) and a questionnaire was completed to obtain information on sleep postures and OSA-related symptoms. Subjects were divided by their dominant sleep postures into three groups: usual postures (supine and lateral), prone, and unusual postures (leaning forward and sitting). Subjects who slept mainly in unusual postures were younger (9.6 ± 5.0 years) than those who slept in prone (18.6 ± 12.4 years) and in usual postures (21.1 ± 8.9 years) (P < 0.05). Snoring was the most reported symptom (81.3%) and was the only symptom positively correlated with 4% oxygen desaturation index (ODI) (r = 0.386, P < 0.05). There was no significant association between 4% ODI and sleep postures among the three groups. DS children with prone and unusual sleep postures had significantly better 4% ODI and minimum SpO2 level compared with those of usual postures (P < 0.05). Our results indicated that prone and unusual sleep postures in DS children might be compensation to alleviate against SDB. These postures could be related to alleviation of SDB resulting from the immaturity of people with DS.