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We directly assessed the anomalous and collateral coronary flow profiles of a 58 year-old-man with Bland-White-Garland syndrome using pulsed Doppler echocardiography. Doppler recordings in this patient document the utility of pulsed Doppler echocardiography in the assessment of a cardiac shunt associated with a congenital coronary anomaly in an adult.

We examined the effectiveness and safety of performing angioplasty on stenoses adjacent to aneurysmal coronary artery disease. Out of 386 consecutive lesions (270 patients) on which we performed angioplasty, 13 lesions (13 patients) were within one balloon length of aneurysmal disease (group A) and 373 lesions (257 patients) were not (group NA). Angioplasty had previously been performed on 10 lesions (77%) in group A but only on 112 lesions (30%) in group NA (p less than 0.01). In group A the angioplasty success rate was 100% (13/13). The maximum inflation pressure was 6.5 +/- 1.1 atm, the frequency of inflation was 6.1 +/- 2.8, the average inflation duration was 60 +/- 0 sec, and the balloon/artery ratio was 1.20 +/- 0.11. There were no major complications. Restenosis occurred in only one lesion. There were no significant differences in the angioplasty results, procedures, complications and the incidence of restenosis between both groups. The ratio of the diameter of the aneurysmal disease to the mean diameter of the normal adjacent segments remained unchanged throughout the follow-up period. These data suggest that angioplasty may be an effective and safe treatment for those stenoses that are adjacent to aneurysmal coronary artery disease.

The left ventricular (LV) wall motion was assessed in 66 patients with ischemic heart disease and other diseases by means of real-time, phased-array, cross-sectional echocardiography (ECHO). The LV wall was divided into 7 anatomic segments, according to the AHA Committee Report, and the motion of each segment (a total of 462 segments) was compared with that in the cineangiographic observation (ANGIO). Two tomographic planes, corresponding to the LAO and RAO views of ANGIO, were employed in ECHO. The LV chamber volume and ejection fraction (EF) were calculated from the RAO plane by an arealength method.The following results were obtained; (1) The motions of 414 segments (89.6%) were visualized by ECHO. The apical area showed the poorest visualization. (2) Three hundred and ninety segments (94.2%) showed a concordant finding between ECHO and ANGIO. Twentyfour slight discrepancies were noted. (3) Calculated LV volume and EF were well correlated with the results from ANGIO (r=0.84 and 0.88, respectively), even in the presence of LV asynergy.It was concluded that ECHO was an useful method for detecting the LV asynergy and the determination of the LV functional parameters. Discrepancies between ECHO and ANGIO in the assessment of the LV asynergy might well be attributed to some factors including the difference between the methods, that is, non-invasive and invasive.

脳出血, 脳梗塞に伴う心電図変化の成因を検討する目的で, 発作前1カ月内及び発作後の心電図, 臨床検査成績が得られ, 剖検上確認された老年者脳出血18例, 脳梗塞29例について, 発作前後の心電図, 臨床検査成績, 血圧の変化, 剖検による冠狭窄度, 脳病変の部位, 大きさ等を対比検討した.発作前後の心電図変化は脳出血88.9%, 脳梗塞89.7%に認められST, T変化がそれぞれ61.1%, 69.0%と高頻度に見られ, 高度な虚血性変化は脳梗塞で多く見られた. 不整脈は脳出血55.6%, 脳梗塞41.4%に見られ, 発作時の心房細動出現は脳梗塞にのみ10.3%に見られた. 期外収縮は脳出血に多く上室性22.1%, 心室性11.1%, 脳梗塞ではそれぞれ10.3%, 3.4%であった.脳卒中発作前後のヘマトクリット上昇は脳梗塞で大きい傾向があり, 虚血性ST, T変化を示した群では脳出血2.44±0.57, 脳梗塞6.04±1.74の上昇を示し, 著明なヘマトクリットの上昇による冠微小循環の障害が虚血性ST, T変化を斉すことを示唆した.脳卒中発作時の収縮期血圧上昇は脳出血では52.5±8.9mmHgで心電図変化の程度に拘らず200mmHg以上の高値を示したが脳梗塞では8.7±10.4とその変動は僅かで血圧上昇が心電図変化の原因とはいえなかった.冠動脈狭窄の程度は脳出血, 脳梗塞共各心電図変化群の間に狭窄指数の差が見られず, 虚血性心電図変化が太い冠動脈の狭窄によるものではないことを示した. 一方心筋梗塞の合併は脳出血5.6%に比し脳梗塞で50.0%と有意に高頻度であった.脳病変の部位, 大きさでは外側型脳出血に虚血性ST, T変化の多い傾向が見られたが, 脳梗塞では中大脳動脈領域の梗塞に於ても心電図変化に一定の傾向はなく, 部位による特徴は認められなかった. また両群共病巣の大きさと心電図変化には一定の傾向は見られなかった.脳出血, 脳梗塞の虚血性心電図変化は病巣の部位, 大きさ, 冠硬化, 血圧上昇等とは関連が認められず, ヘマトクリット上昇による冠微小循環の障害がその一因と考えられた.

僧帽弁輪石灰化 (MRC) の大きさと弁膜症発生要因を検討した. 対象は昭和47年2月より昭和50年2月までに行った60歳以上の老年者600例の連続剖検で, MRC例の臨床所見および病理所見を調査した.(1) 頻度. MRCは計600例中60例 (10%) で, 男6.7%, 女13.3%と性差は有意である (p

The incidence, the size of mitral ring calcification (MRC) and its relation to the mitral valve disease were examined in a total of 600 consecutive autopsy cases of over 60 years of age. (1) The incidence of MRC was 10% (60 cases among 600), and the sex difference was statistically significant with 6.7% in male and 13.3% in female (p less than 0.01). The age was 82 years in average, and an increase of its incidence with aging was significant only in female (p less than 0.005). (2) MRC was found in the annulus of the posterior mitral leaflet. The length of MRC was 12.5 +/- 10.3 mm in male, and 31.8 +/- 23.5 mm in female (p less than 0.01). Large MRC more than 30 mm were found in 1 man and 19 women. (3) The relationship between the length and cross sectional diameter of the MRC showed a positive correlation (r=0.75). Three cases of mitral stenosis or combined stenosis and regurgitation belonged to the extremely large MRC group. (4) There were 27 cases with systolic murmur; 3 holosystolic and 24 ejection type. In large and small MRC groups, systolic murmurs were found in 70% and 33% (p less than 0.05), MRC extending to the anterior leaflet in 65% and 2.5% (p less than 0.005), moderate to severe calcification of the aortic valve in 40% and 20% (n.s.), respectively. (5) X-ray films were examined retrospectively, and large MRC was diagnosed in 85%, and incidence of calcification in the other soft tissues (trachea, bronchi, costal cartilage, aortic arch, thoracic and abdominal aorta) was higher in large MRC group than in the control group (87 cases) without MRC (p less than 0.005).

M-mode and cross-sectional echocardiograms were obtained in 30 patients with rheumatic mitral valve disease (24 : MS, 6 : MR) pre and post-operatively for the evaluation of their severity. Echocardiographic findings were compared with operative findings. Mitral valve area (MVA), E-F slope (DDR) and mean circumferential fiber lengthening during rapid filling course (mVcF(RF)) were measured in patients with MS (1.2 cm2, 14mm/sec 1.3 circ/sec respectively) and they were significantly improved after operation (2.2 cm2, 35mm/sec, 19 circ/sec respectively). Assessment of fusion of both commissures could be detected in 8 of 13 cases (62%) who underwent papillotomy in addition to commissurotomy. In patients with MR, short axis images of cross-sectional echocardiogram showed mitral incompetence during systole with marked enlargement of left atrium and mitral annulus (63 mm, 46 mm respectively). It was suggested that M-mode echocardiogram was more useful to estimate the axial dimensions and the cardiac cycle and was sensitive to detect rheumatic mitral valve disease, but it was of limited valve for the assessment of its severity. On the other hand, cross-sectional echocardiogram was proved to be valuable for the assessment of the whole mitral complex, which was useful not only for the evaluation of the severity of mitral valve disease but for the assignment of operative category.

A practical analyzing procedure has been developed to evaluate dynamic images with reference to time series data from the same object. A special recording and analyzing system has been contructed, and its validity and an analyzing procedure are demonstrated using actual dynamical cardiac images. Echocardiogram and X-ray TV images were recorded on the video tape simultaneously with physical parameters. These data were fed into the computer and analyzed in reference to each other. Actual experiments were then executed to analyze myocardial ultrasound and X-ray images quantitatively, using subtraction and densitometry techniques. In both images, abnormalities of myocardial perfusion were clearly described by the subtraction image with reference to the ECG signal and the M-mode image, in the case of the echocardiogram. The temporal change of myocardial images was also represented by subtraction, and the details were described by densitometry. These image processing techniques can be a useful tool in evaluating cardiac dynamics in daily practice.

The duration of the acceleration phase of pulmonary systolic flow was measured by pulsed Doppler echocardiography in 39 normal subjects and 67 patients with heart disease to evaluate the reliability of this Doppler index as an estimate of pulmonary arterial pressure. The mean (SD) Doppler index in patients with abnormal mean pulmonary arterial pressure (greater than 15 mm Hg) was significantly shorter than that in normal subjects (110 (30) ms vs 150 (10) ms). The Doppler index was significantly related to the mean pulmonary arterial pressure (r = -0.75) the pulmonary blood flow (r = 0.46), and the total pulmonary vascular resistance (r = -0.68). Forty four of 45 patients with an abnormal index (less than or equal to 120 ms) showed abnormal mean pressure (greater than 15 mm Hg). Without exception patients with a low index (less than or equal to 90 ms) had distinct pulmonary hypertension (greater than or equal to 25 mm Hg). Twelve of 22 patients with a normal index (greater than or equal to 130 ms), however, also showed abnormal pressures. Nine of the 12 had an atrial septal defect and they had high pulmonary arterial pressure associated with high blood flow. Eighteen patients with valvar heart disease, whose mean pulmonary arterial pressure ranged from 16 mm Hg to 24 mm Hg, had a significantly shorter acceleration phase and a higher total vascular resistance than 11 patients with atrial septal defect in whom the pressure range was similar (120(20) ms vs 140 (20) ms, 3.8 (1.1) hybrid resistance unit vs 1.6 (0.5)). Thus although the acceleration time of the pulmonary systolic flow is useful for the evaluation of pulmonary hypertension, it is a complex index that is affected not only by pulmonary arterial pressure but also by pulmonary blood flow and pathological changes in the pulmonary vascular bed.