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Experience of Torvaptan : Case Report
The 16th Annual Scientific Meeting
JHFS
S167
Free Communications: Posters (P-001 e P-136, P-143) P-001
P-004
A Case of Chronic Heart Failure with Isolated and Persistent Elevation of Free Triiodothyronine Concentrations KAZUYUKI IUCHI The Department of Cardiovascular Medicine, Saiseikai Toyama Hospital, Toyama, Japan
A Case of Successful Balloon Aortic Valvuloplasty with Refractory Heart Failure due to Aortic Stenosis TAKAYUKI SUGAI, TAKUYA MIYAMOTO, HYUMA DAIDOJI, SHINTARO SASAKI, YUKI HONDA, TETSURO SHISHIDO, TETSU WATANABE, ISAO KUBOTA Deparment of Cardiology, Pulmonology, and Nephrology, Yamagata University, School of Medicine, Yamagata, Japan
A 51-year-old man experienced symptoms of heart failure in 2005. Echocardiography revealed left ventricular dysfunction with diffuse hypokinesis as well as chronic atrial fibrillation. In July 2011, respiratory distress appeared, and he was hospitalized. His symptoms stabilized with routine treatments for acute heart failure and additional administration of b-blocker. On admission, his heart rate was 104 beats/min and atrial fibrillation was present. Echocardiography showed LVEDD of 68.5 mm, LVESD of 63.3 mm, and impaired left ventricular function with diffuse hypokinesis. Cardiac catheterization revealed neither coronary artery stenosis nor mitral regurgitation. The pulmonary capillary wedge pressure was high (19 mmHg). The results of thyroid hormone tests were: free triiodothyronine (FT3) 15.62 pg/ml, free thyroxine 1.10 ng/dl, thyroid stimulating hormone 1.272mIU/ml, thyroglobulin antibody !10 IU/ml, thyroperoxidase Ab !5 IU/ ml, TSH binding inhibitory immunoglobulin 7.5%, thyroid stimulating Ab 95%. Thyroid ultrasound showed neither enlargement of the thyroid gland nor tumors. The uptake rate was decreased to 0.2% on thyroid scintigraphy. The exact cause of the isolated high FT3 level was unknown. However, this elevation has persisted during the subsequent 9 months, indicating that high FT3 concentrations may be one of the causes of heart failure. Among various thyroid hormones, T3 has a direct effect on cardiac myocytes. Herein, we report a case whose course may facilitate understanding the association between thyroid hormones and heart failure.
P-002 Hypertonic Saline Supplemented with Furosemide is Effective in the Treatment of Heart Failure Presenting Severe Edema and Low Blood Pressure MASATAKA SUGAHARA, MIHO FUKUI, SHINICHI HIROTANI, YOSHITAKA OKUHARA, DAISUKE MORISAWA, TOMOTAKA ANDO, TOHRU MASUYAMA Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan The case is a 49 year-old male with past medical history of obesity, hypertension, diabetes mellitus, dilated cardiomyopathy, atrial fibrillation and sleep apnea syndrome. He admitted to our hospital for severe leg edema, oscheohydrocele and weight gain (+10kg). His blood pressure on admission was 87/63mmHg (supine). Heart rate was 63/min. The left ventricle was dilated (LVDd: 77mm) and globally hypokinetic. The left ventricular ejection fraction measured by echocardiography was 23%. Blood test was as follows; Na 141mEq/l, K 5.2mEq/l, Cl 104mEq/l, Cre 1.36mg/dl, UA 10.0mg/dl, UN 49mg/dl and BNP 226pg/ml. 540ml of 1.57% saline solution supplemented with 40mg furosemide infusion a day was initiated. His blood pressure rose to 109/66mmHg and his urine 24-hour volumes were 2000-2400ml. However, his body weight reduced only 2kg/9 days. Ten days after admission, we changed the regimen to 620ml of 2.67% saline solution with 40mg furosemide a day. His urine 24-hour volumes increased to 4000-4500ml and his body weight reduced 7kg/4 days. He discharged without any harmful effects of hypertonic saline solution with 40mg furosemide. Strict water and salt restriction is believed to be the must in heart failure treatment. However, administration of only loop diuretics may provoke LOS or worsen renal function. We conclude that administration of hypertonic saline with furosemide enhance effect of furosemide without occurrence of LOS and renal failure.
P-003 Short-term Effects of Tolvaptan in Elder Patients Hospitalized for Heart Failure GO AONO, MITUHARU NANJYO, YUICHI KIKUCHI Miyagi Tohbu Cardiovascular Clinic, Miyagi, Japan Objective: Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure. However, it is unknown the effect of this medicine for elder patient. Method: Nine elderly patients (mean age 84.068.6) with acute heart failure who received standard medication for heart failure was treated with oral tolvaptan (15 or 30 mg/day) administration. After administration of this medicine, we evaluated the plasma levels of Na, BUN, creatinine, urinary volume and body weight change. Result: After administration of this medicine, urinary volume was increased (7006152 to 195061371 ml/day) and body weight was significantly decreased. Although plasma level of Na, BUN and creatinine did not deteriorate. Conclusions: Tolvaptan may have improved clinical course even in elder patient with heart failure.
An 85-year-old female was transferred to our hospital with medication resistant congestive heart failure. Echocardiography revealed severe aortic stenosis with systolic dysfunction (peak pressure gradient 160 mmHg, Peak flow velocity 6.3 m/s, aortic valve area 0.34 cm2, ejection fraction 21%), and BNP was 6830 pg/ml. She denied aortic valve replacement and requested percutaneous balloon aortic valvuloplasty (BAV). Retrograde BAV was performed. The catheter guidewire passed through the aortic valve, and then the aortic valve was dilated with a peripheral percutaneous transluminal angioplasty balloon. The pressure gradient decrease from 135 to 43 mmHg, and AVA increased from 0.23 to 0.43 cm2. Echocardiography also showed increased AVA from 0.34 to 0.41cm2, ejection fraction improved from 21 to 33%, and BNP improved from 6830 to 1760 pg/ml. She recovered from refractory heart failure and she was discharged on day 9 postoperatively on foot. BAV is useful therapheutic option in patient with refractory heart failure due to aortic stenosis.
P-005 Severe Aortic Regurgitation due to Unruptured Right Coronary Sinus of Valsalva Aneurysm HIRONORI KISO, MASARU ISHIDA, KENJI IINO, TOSHIMITSU KOSAKA, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan A 38-year-old man, who was pointed out systolic and diastolic heart murmur three years before, was visited local hospital because of heart failure. Past medical history was unremarkable. Echocardiography revealed severe aortic regurgitation (AR), and he was transferred to our hospital for pre-operation examination after medical treatment. On admission our hospital, echocardiography showed severe AR due to right coronary cusp prolapse, left ventricle enlargement (80.2mm) and reduced ejection fraction of left ventricle (55%). CT angiography showed unruptured right coronary sinus of Valsalva aneurysm with anomalous origin of the right coronary artery. For this reasons, we diagnosed that severe AR due to unruptured right coronary sinus of Valsalva aneurysm lead to heart failure. We referred the patient to cardiac surgeons to repair aortic valve and sinus of Valsalva aneurysm. To our best knowledge, severe AR due to unruptured coronary sinus of Valsalva aneurysm is rare cause of heart failure. We will report with some other case reports and reviews.
P-006 Experience of Torvaptan : Case Report ATSUSHI SAKAKIBARA1, KAORU SAKURAI1, YASUHIRO SATOH1, MITSUAKI ISOBE2 1 NHO Disaster Medical Center, Tokyo, Japan, 2Department of Cardiovascular Medicine, Tokyo Medical and Dental University Tokyo, Japan Eighty one years old man was admitted our hospital because of ischemic heart failure. He was received percutaneous coronary intervention and put stent in left main trunk, according to acute myocardial infarction at Feburary 2010. He was transferred our hospital by complaining chest discomfort at July 2011. We treated with catecholamine and PDE3 inhibitor. At first, these drugs was effective, but his renal function was deteriorated gradually. We used tolvaptan twice a week, his condition was improved and we have succeeded in withdrawal of catecholamine. This was a valuable case the usefulness of intermittent administration of tolvaptan. We also report several experiences of tolvaptan use to severely impaired heart failure patients.
P-007 Diagnostic Usefulness of an Implantable Loop Recorder in a Patient with Repetitive Syncope due to Paroxysmal Complete Atrioventricular Block MASATERU KONDO, KOJI FUKUDA, YUJI WAKAYAMA, MAKOTO NAKANO, AKIKO KAWANA, YUHI HASEBE, MOHAMED A SHAFEE, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan A 70-year-old man had experienced syncope several times a year for 5 years before admission. The past history showed no positive findings for his syncope. In August
JHFS
S167
Free Communications: Posters (P-001 e P-136, P-143) P-001
P-004
A Case of Chronic Heart Failure with Isolated and Persistent Elevation of Free Triiodothyronine Concentrations KAZUYUKI IUCHI The Department of Cardiovascular Medicine, Saiseikai Toyama Hospital, Toyama, Japan
A Case of Successful Balloon Aortic Valvuloplasty with Refractory Heart Failure due to Aortic Stenosis TAKAYUKI SUGAI, TAKUYA MIYAMOTO, HYUMA DAIDOJI, SHINTARO SASAKI, YUKI HONDA, TETSURO SHISHIDO, TETSU WATANABE, ISAO KUBOTA Deparment of Cardiology, Pulmonology, and Nephrology, Yamagata University, School of Medicine, Yamagata, Japan
A 51-year-old man experienced symptoms of heart failure in 2005. Echocardiography revealed left ventricular dysfunction with diffuse hypokinesis as well as chronic atrial fibrillation. In July 2011, respiratory distress appeared, and he was hospitalized. His symptoms stabilized with routine treatments for acute heart failure and additional administration of b-blocker. On admission, his heart rate was 104 beats/min and atrial fibrillation was present. Echocardiography showed LVEDD of 68.5 mm, LVESD of 63.3 mm, and impaired left ventricular function with diffuse hypokinesis. Cardiac catheterization revealed neither coronary artery stenosis nor mitral regurgitation. The pulmonary capillary wedge pressure was high (19 mmHg). The results of thyroid hormone tests were: free triiodothyronine (FT3) 15.62 pg/ml, free thyroxine 1.10 ng/dl, thyroid stimulating hormone 1.272mIU/ml, thyroglobulin antibody !10 IU/ml, thyroperoxidase Ab !5 IU/ ml, TSH binding inhibitory immunoglobulin 7.5%, thyroid stimulating Ab 95%. Thyroid ultrasound showed neither enlargement of the thyroid gland nor tumors. The uptake rate was decreased to 0.2% on thyroid scintigraphy. The exact cause of the isolated high FT3 level was unknown. However, this elevation has persisted during the subsequent 9 months, indicating that high FT3 concentrations may be one of the causes of heart failure. Among various thyroid hormones, T3 has a direct effect on cardiac myocytes. Herein, we report a case whose course may facilitate understanding the association between thyroid hormones and heart failure.
P-002 Hypertonic Saline Supplemented with Furosemide is Effective in the Treatment of Heart Failure Presenting Severe Edema and Low Blood Pressure MASATAKA SUGAHARA, MIHO FUKUI, SHINICHI HIROTANI, YOSHITAKA OKUHARA, DAISUKE MORISAWA, TOMOTAKA ANDO, TOHRU MASUYAMA Cardiovascular Division, Hyogo College of Medicine, Nishinomiya, Japan The case is a 49 year-old male with past medical history of obesity, hypertension, diabetes mellitus, dilated cardiomyopathy, atrial fibrillation and sleep apnea syndrome. He admitted to our hospital for severe leg edema, oscheohydrocele and weight gain (+10kg). His blood pressure on admission was 87/63mmHg (supine). Heart rate was 63/min. The left ventricle was dilated (LVDd: 77mm) and globally hypokinetic. The left ventricular ejection fraction measured by echocardiography was 23%. Blood test was as follows; Na 141mEq/l, K 5.2mEq/l, Cl 104mEq/l, Cre 1.36mg/dl, UA 10.0mg/dl, UN 49mg/dl and BNP 226pg/ml. 540ml of 1.57% saline solution supplemented with 40mg furosemide infusion a day was initiated. His blood pressure rose to 109/66mmHg and his urine 24-hour volumes were 2000-2400ml. However, his body weight reduced only 2kg/9 days. Ten days after admission, we changed the regimen to 620ml of 2.67% saline solution with 40mg furosemide a day. His urine 24-hour volumes increased to 4000-4500ml and his body weight reduced 7kg/4 days. He discharged without any harmful effects of hypertonic saline solution with 40mg furosemide. Strict water and salt restriction is believed to be the must in heart failure treatment. However, administration of only loop diuretics may provoke LOS or worsen renal function. We conclude that administration of hypertonic saline with furosemide enhance effect of furosemide without occurrence of LOS and renal failure.
P-003 Short-term Effects of Tolvaptan in Elder Patients Hospitalized for Heart Failure GO AONO, MITUHARU NANJYO, YUICHI KIKUCHI Miyagi Tohbu Cardiovascular Clinic, Miyagi, Japan Objective: Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure. However, it is unknown the effect of this medicine for elder patient. Method: Nine elderly patients (mean age 84.068.6) with acute heart failure who received standard medication for heart failure was treated with oral tolvaptan (15 or 30 mg/day) administration. After administration of this medicine, we evaluated the plasma levels of Na, BUN, creatinine, urinary volume and body weight change. Result: After administration of this medicine, urinary volume was increased (7006152 to 195061371 ml/day) and body weight was significantly decreased. Although plasma level of Na, BUN and creatinine did not deteriorate. Conclusions: Tolvaptan may have improved clinical course even in elder patient with heart failure.
An 85-year-old female was transferred to our hospital with medication resistant congestive heart failure. Echocardiography revealed severe aortic stenosis with systolic dysfunction (peak pressure gradient 160 mmHg, Peak flow velocity 6.3 m/s, aortic valve area 0.34 cm2, ejection fraction 21%), and BNP was 6830 pg/ml. She denied aortic valve replacement and requested percutaneous balloon aortic valvuloplasty (BAV). Retrograde BAV was performed. The catheter guidewire passed through the aortic valve, and then the aortic valve was dilated with a peripheral percutaneous transluminal angioplasty balloon. The pressure gradient decrease from 135 to 43 mmHg, and AVA increased from 0.23 to 0.43 cm2. Echocardiography also showed increased AVA from 0.34 to 0.41cm2, ejection fraction improved from 21 to 33%, and BNP improved from 6830 to 1760 pg/ml. She recovered from refractory heart failure and she was discharged on day 9 postoperatively on foot. BAV is useful therapheutic option in patient with refractory heart failure due to aortic stenosis.
P-005 Severe Aortic Regurgitation due to Unruptured Right Coronary Sinus of Valsalva Aneurysm HIRONORI KISO, MASARU ISHIDA, KENJI IINO, TOSHIMITSU KOSAKA, HIROYUKI WATANABE, HIROSHI ITO Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita, Japan A 38-year-old man, who was pointed out systolic and diastolic heart murmur three years before, was visited local hospital because of heart failure. Past medical history was unremarkable. Echocardiography revealed severe aortic regurgitation (AR), and he was transferred to our hospital for pre-operation examination after medical treatment. On admission our hospital, echocardiography showed severe AR due to right coronary cusp prolapse, left ventricle enlargement (80.2mm) and reduced ejection fraction of left ventricle (55%). CT angiography showed unruptured right coronary sinus of Valsalva aneurysm with anomalous origin of the right coronary artery. For this reasons, we diagnosed that severe AR due to unruptured right coronary sinus of Valsalva aneurysm lead to heart failure. We referred the patient to cardiac surgeons to repair aortic valve and sinus of Valsalva aneurysm. To our best knowledge, severe AR due to unruptured coronary sinus of Valsalva aneurysm is rare cause of heart failure. We will report with some other case reports and reviews.
P-006 Experience of Torvaptan : Case Report ATSUSHI SAKAKIBARA1, KAORU SAKURAI1, YASUHIRO SATOH1, MITSUAKI ISOBE2 1 NHO Disaster Medical Center, Tokyo, Japan, 2Department of Cardiovascular Medicine, Tokyo Medical and Dental University Tokyo, Japan Eighty one years old man was admitted our hospital because of ischemic heart failure. He was received percutaneous coronary intervention and put stent in left main trunk, according to acute myocardial infarction at Feburary 2010. He was transferred our hospital by complaining chest discomfort at July 2011. We treated with catecholamine and PDE3 inhibitor. At first, these drugs was effective, but his renal function was deteriorated gradually. We used tolvaptan twice a week, his condition was improved and we have succeeded in withdrawal of catecholamine. This was a valuable case the usefulness of intermittent administration of tolvaptan. We also report several experiences of tolvaptan use to severely impaired heart failure patients.
P-007 Diagnostic Usefulness of an Implantable Loop Recorder in a Patient with Repetitive Syncope due to Paroxysmal Complete Atrioventricular Block MASATERU KONDO, KOJI FUKUDA, YUJI WAKAYAMA, MAKOTO NAKANO, AKIKO KAWANA, YUHI HASEBE, MOHAMED A SHAFEE, HIROAKI SHIMOKAWA Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan A 70-year-old man had experienced syncope several times a year for 5 years before admission. The past history showed no positive findings for his syncope. In August