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Antegrade Diastolic Pulmonary Artery Flow With Restrictive Right Ventricle: a Case Report
S150 Journal of Cardiac Failure Vol. 16 No. 9S September 2010 mmHg, p50.04); diastolic BP tended to decrease (7867 to 7067 mmHg, p50.17). There were no significant changes in serum creatinine (1.360.3 to 1.360.2 mg/dl, p50.78) and eGFR (4867 to 4566 ml/min, p50.46). Meanwhile, BNP significantly decreased (4296115 to 218643 pg/ml, p50.03). Conclusions: This study result demonstrated that the treatment with aliskiren had favorable neurohumoral effects in heart failure and appeared to be tolerated in Japanese patients with heart failure.
018 b Blocker Reduces Cardiac Troponin T Level in Patients With Heart Failure by Highly Sensitive Assay SEIJI TAKASHIO, MEGUMI YAMAMURO, HISAO OGAWA Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Background: Cardiac troponin T (TnT) is established as a specific biomarker of ongoing myocardial damage (OMD). Because it is not fully understood how to reduce TnT level, we evaluated effect on OMD by bblocker (BB) in heart failure (HF) patients by measurement of high sensitive TnT (hs-TnT)level. Method and Result: Five HF patients due to dilated cardiomyopathy (male: 4, median age: 59 years, EF: 26.6%) with optimal therapy except BB were enrolled and added on BB. After 1 month, hsTnT level was significantly decreased (0.0148 to 0.0109 ng/mL: p50.043), but BNP tended to be increased (108 to 221.2pg/mL: p50.22). Conclusion: BB reduced hs-TnT level in HF patients, but BNP was increased after 1 month. This may suggest that BB ameliorated OMD independently of left ventricular filling pressure.
in heart failure patients and is associated with adverse prognosis. It has been reported that CSR is improved by optimal medications for heart failure and CRT. Recently, we have demonstrated that adaptive servo ventilation (ASV) improves cardiac function in heart failure patients with CSR. We report a case that ASV improved CSR remained after CRTD implantation. A 70 years old male patient had been implanted VDD pacemaker due to complete atrioventricular block in March 2000. He repeated hospitalization due to worsening heart failure several times, although medications for heart failure including beta-blocker were given. Therefore, he was implanted CRTD in December 2008. However, he again hospitalized for worsening heart failure, and polysomnography revealed severe CSR (apnea-hypopnea index 47.3 times/hr, central apnea index 24.2 times/hr). ASV was effective for CSR in this patient, and we also observed improvement in cardiac function after ASV. We here demonstrate that ASV improved CSR and cardiac function in heart failure patients with CRTD implantation.
021 Severe Mitral Regurgitation Induced by Straight Back Syndrome and a Congenital Epicardial Defect MASATO SHIMIZU1, HIROYUKI FUJII1, NORIYOSHI YAMAWAKE1, MITSUHIRO NISHIZAKI1, TADASHI MURAI2, NAOKI HASHIYAMA4, MAKOTO MO4, MITSUAKI ISOBE3 1 Department of Cardiology, Yokohama Minami-Kyosai Hospital, Yokohama, Japan, 2 Department of Cardiology, Tsuchiura-Kyodo General Hospital, Tsuchiura, Japan, 3 Department of cardiovascular medicine, Tokyo medical and dental university, Tokyo, Japan, 4Department of Cardiovascular Surgery, Yokohama Minami-Kyosai Hospital, Yokohama, Japan The patient was a 67-year-old man who was undergoing treatment for chronic heart failure since 1998. Since 2009, the dyspnea on effort exacerbated. Echocardiography revealed severe mitral regurgitation. The lateral thoracic X-ray film showed lack of natural kyphosis (straight back). Thoracic computed tomography revealed that the anteroposterior thoracic diameter had reduced and that his heart had prolapsed into the left thoracic cavity (see figure). Cardiac catheterization performed in February 2010 revealed Sellers IV degree mitral regurgitation, indicating the need for cardiac surgery. Mitral valve replacement was performed in February 2010 (31-mm St. Jude Medical valve). A left-sided epicardial defect was detected during surgery. The mitral regurgitation was thought to be induced by the patient’s straight back and the congenital epicardial defect. The postoperative course was good.
019 Antegrade Diastolic Pulmonary Artery Flow With Restrictive Right Ventricle: a Case Report TAKAKO IINO, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine Akita University Graduate School of Medicine, Akita, Japan End-diastolic opening of pulmonary valve and subsequent diastolic antegrade flow into the pulmonary artery are infrequently demonstrated by echocardiography in right heart failure. We show herein two patients in which antegrade diastolic pulmonary artery flow was observed as a result of restrictive right ventricle.Case 1: 44-year-old man with pulmonary stenosis after surgical treatment of complete transposition of great arteries. He has repeated hospitalization due to recurrent right heart failure.Case 2: 36-year-old woman with end-stage dilated cardiomyopathy with right ventriclular contractile dysfunction. Heart failure worsened despite intensive care including administration of catecholamines. She underwent implantation of left ventricular assist system for bridging to heart transplantation.In these patients, the simultaneous recording of right ventricle pressure and pulmonary artery pressure, revealed the marked elevation of right ventricular diastolic pressure which exceeded pulmonary artery pressure at the time of atrial contraction.These findings suggested that right ventricle compliance markedly reduced, and that the cavity became stiff and had a function as a passive conduit between the right atrium and the pulmonary artery during atrial systole.Antegrade diastolic pulmonary artery flow is useful sign for reduction of right ventricular compliance, and resultant right ventricle restrictivity.
022 020 Adaptive Servo Ventilation Improved Cheyne-Stokes Respiration in Heart Failure Patients After CRTD Implanta ATUROU MASUDA, AKIOMI YOSHIHISA, HIROYUKI MIZUKAMI, HIRONORI UEKITA, KOUICHI SUGIMOTO, HIROYUKI KUNII, KAZUHIKO NAKAZATO, HITOSHI SUZUKI, SHU-ICHI SAITHO, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical Uiversity Cardiac resynchronization therapy (CRT) is effective for heart failure patients with left ventricular dyssynchrony. Cheyne-Stokes respiration (CSR) is often observed
Low Dose Landiolol During Very Acute Phase of Acute Myocardial Infarction Improves Brain Natriuretic Peptide Level in the Chronic Phase MASAKI FUJITA, TATSUYA YAMASHITA, MAROHITO NAKATA, TOSHIYUKI NISHIKIDO, TOSHIYA CHINEN, TATSUO KIKUCHI, KENTARO NAKAMURA, KENTARO MEGURO, TAKEHIKO KEIDA, HIROSHI OHIRA Department of cardiology, Edogawa Hospital, Tokyo, Japan Background: Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study was to investigate the long-term effect of landiolol therapy in very acute phase of AMI. Method: 48
018 b Blocker Reduces Cardiac Troponin T Level in Patients With Heart Failure by Highly Sensitive Assay SEIJI TAKASHIO, MEGUMI YAMAMURO, HISAO OGAWA Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan Background: Cardiac troponin T (TnT) is established as a specific biomarker of ongoing myocardial damage (OMD). Because it is not fully understood how to reduce TnT level, we evaluated effect on OMD by bblocker (BB) in heart failure (HF) patients by measurement of high sensitive TnT (hs-TnT)level. Method and Result: Five HF patients due to dilated cardiomyopathy (male: 4, median age: 59 years, EF: 26.6%) with optimal therapy except BB were enrolled and added on BB. After 1 month, hsTnT level was significantly decreased (0.0148 to 0.0109 ng/mL: p50.043), but BNP tended to be increased (108 to 221.2pg/mL: p50.22). Conclusion: BB reduced hs-TnT level in HF patients, but BNP was increased after 1 month. This may suggest that BB ameliorated OMD independently of left ventricular filling pressure.
in heart failure patients and is associated with adverse prognosis. It has been reported that CSR is improved by optimal medications for heart failure and CRT. Recently, we have demonstrated that adaptive servo ventilation (ASV) improves cardiac function in heart failure patients with CSR. We report a case that ASV improved CSR remained after CRTD implantation. A 70 years old male patient had been implanted VDD pacemaker due to complete atrioventricular block in March 2000. He repeated hospitalization due to worsening heart failure several times, although medications for heart failure including beta-blocker were given. Therefore, he was implanted CRTD in December 2008. However, he again hospitalized for worsening heart failure, and polysomnography revealed severe CSR (apnea-hypopnea index 47.3 times/hr, central apnea index 24.2 times/hr). ASV was effective for CSR in this patient, and we also observed improvement in cardiac function after ASV. We here demonstrate that ASV improved CSR and cardiac function in heart failure patients with CRTD implantation.
021 Severe Mitral Regurgitation Induced by Straight Back Syndrome and a Congenital Epicardial Defect MASATO SHIMIZU1, HIROYUKI FUJII1, NORIYOSHI YAMAWAKE1, MITSUHIRO NISHIZAKI1, TADASHI MURAI2, NAOKI HASHIYAMA4, MAKOTO MO4, MITSUAKI ISOBE3 1 Department of Cardiology, Yokohama Minami-Kyosai Hospital, Yokohama, Japan, 2 Department of Cardiology, Tsuchiura-Kyodo General Hospital, Tsuchiura, Japan, 3 Department of cardiovascular medicine, Tokyo medical and dental university, Tokyo, Japan, 4Department of Cardiovascular Surgery, Yokohama Minami-Kyosai Hospital, Yokohama, Japan The patient was a 67-year-old man who was undergoing treatment for chronic heart failure since 1998. Since 2009, the dyspnea on effort exacerbated. Echocardiography revealed severe mitral regurgitation. The lateral thoracic X-ray film showed lack of natural kyphosis (straight back). Thoracic computed tomography revealed that the anteroposterior thoracic diameter had reduced and that his heart had prolapsed into the left thoracic cavity (see figure). Cardiac catheterization performed in February 2010 revealed Sellers IV degree mitral regurgitation, indicating the need for cardiac surgery. Mitral valve replacement was performed in February 2010 (31-mm St. Jude Medical valve). A left-sided epicardial defect was detected during surgery. The mitral regurgitation was thought to be induced by the patient’s straight back and the congenital epicardial defect. The postoperative course was good.
019 Antegrade Diastolic Pulmonary Artery Flow With Restrictive Right Ventricle: a Case Report TAKAKO IINO, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine Akita University Graduate School of Medicine, Akita, Japan End-diastolic opening of pulmonary valve and subsequent diastolic antegrade flow into the pulmonary artery are infrequently demonstrated by echocardiography in right heart failure. We show herein two patients in which antegrade diastolic pulmonary artery flow was observed as a result of restrictive right ventricle.Case 1: 44-year-old man with pulmonary stenosis after surgical treatment of complete transposition of great arteries. He has repeated hospitalization due to recurrent right heart failure.Case 2: 36-year-old woman with end-stage dilated cardiomyopathy with right ventriclular contractile dysfunction. Heart failure worsened despite intensive care including administration of catecholamines. She underwent implantation of left ventricular assist system for bridging to heart transplantation.In these patients, the simultaneous recording of right ventricle pressure and pulmonary artery pressure, revealed the marked elevation of right ventricular diastolic pressure which exceeded pulmonary artery pressure at the time of atrial contraction.These findings suggested that right ventricle compliance markedly reduced, and that the cavity became stiff and had a function as a passive conduit between the right atrium and the pulmonary artery during atrial systole.Antegrade diastolic pulmonary artery flow is useful sign for reduction of right ventricular compliance, and resultant right ventricle restrictivity.
022 020 Adaptive Servo Ventilation Improved Cheyne-Stokes Respiration in Heart Failure Patients After CRTD Implanta ATUROU MASUDA, AKIOMI YOSHIHISA, HIROYUKI MIZUKAMI, HIRONORI UEKITA, KOUICHI SUGIMOTO, HIROYUKI KUNII, KAZUHIKO NAKAZATO, HITOSHI SUZUKI, SHU-ICHI SAITHO, YASUCHIKA TAKEISHI Department of Cardiology and Hematology, Fukushima Medical Uiversity Cardiac resynchronization therapy (CRT) is effective for heart failure patients with left ventricular dyssynchrony. Cheyne-Stokes respiration (CSR) is often observed
Low Dose Landiolol During Very Acute Phase of Acute Myocardial Infarction Improves Brain Natriuretic Peptide Level in the Chronic Phase MASAKI FUJITA, TATSUYA YAMASHITA, MAROHITO NAKATA, TOSHIYUKI NISHIKIDO, TOSHIYA CHINEN, TATSUO KIKUCHI, KENTARO NAKAMURA, KENTARO MEGURO, TAKEHIKO KEIDA, HIROSHI OHIRA Department of cardiology, Edogawa Hospital, Tokyo, Japan Background: Beta blockers have a proven benefit in the management of patients with acute myocardial infarction (AMI). The aim of this study was to investigate the long-term effect of landiolol therapy in very acute phase of AMI. Method: 48