Retrograge holodiastolic flow in the abdominal aorta detected by pulsed Doppler echocardiography in patients with Kawasaki disease

Retrograde holodiastolic flow in the abdominal aorta (retrograde flow) detected by pulsed Doppler echocardiography is usually noted in patients with aortic regurgitation or patent ductus arteriosus. Similar abnormal flow often is present in patients with acute phase Kawasaki Disease (KD). In 21 patients with acute phase KD, 15 had a retrograde flow. Retrograde flow was recognised in only 3 of patients with acute infection (n = 31) and in no healthy controls (n = 10). The ratio of the time velocity integral for diastolic retrograde flow to that for antegrade flow (regurgitant fraction) was significantly greater in patients with KD (median value 23%) than in patients with acute infection (1%) or healthy individuals (1%) (P < 0.001 for both). Four patients with coronary arterial involvement (one with an aneurysm and three with transient dilation of the coronary arteries) had a greater regurgitant fraction than the 17 patients without coronary arterial involvement (median values: 31% versus 18%, P < 0.05). The C-reactive protein was increased for a longer period of time in patients with KD with a greater regurgitant fraction (P < 0.01). Plasma nitric oxide (NO) metabolite concentrations were significantly greater in patients with KD than in those with acute infection or in healthy controls (P < 0.001 for both). There was a positive correlation between plasma NO metabolite concentrations and the regurgitant fraction in patients with KD (r = 0.69). Retrograde flow in the abdominal aorta is increased in patients with Kawasaki disease. Further studies are needed to clarify the causal relationship between the abnormal flow and the overproduction of nitric oxide.


Diagnosis and natural history of isolated congenital pulmonary regurgitation in fetal life

We describe a rare instance of isolated pulmonary regurgitation caused by a dysplastic pulmonary valve which was detected prenatally. Fetal echocardiography demonstrated severe pulmonary regurgitation, and progressive cardiomegaly because of right ventricular volume overload. After birth, conservative therapy was successful in alleviating the pulmonary vascular resistance, and the pulmonary regurgitation gradually decreased.


冠動脈攣縮性狭心症による胸痛を来たした無脾症候群の1例

冠動脈攣縮性狭心症による胸痛を来たした無脾症候群の1例


Plasma concentrations of atrial and brain natriuretic peptides and cyclic guanosine monophosphate in response to dobutamine infusion in patients with surgically repaired tetralogy of fallot

We examined the plasma concentrations of atrial and brain natriuretic peptides (ANP and BNP) and cyclic guanosine monophosphate (cGMP) during dobutamine infusion and their relationship with hemodynamic parameters in 14 patients with surgically repaired tetralogy of Fallot (TOF). Dobutamine was infused at an initial dose of 5 microgram/kg/min and increased by 5 microgram/kg/min up to 20 microgram/kg/min. The plasma ANP, BNP, and cGMP concentrations were determined before infusion, at the end of each stage, and 15 minutes after discontinuing dobutamine infusion. The plasma concentrations of ANP, BNP, and cGMP were elevated in all patients before dobutamine infusion. The ANP, BNP, and cGMP concentrations decreased in 11 of the 14 patients during dobutamine infusion. In contrast, the plasma ANP and BNP concentrations increased in the remaining 3 patients without a change in the cGMP concentration. The right ventricular pressure and volume were significantly elevated in these patients. The plasma cGMP concentration correlated with the ANP concentration (r = 0.62, p < 0.01) but not the BNP concentration. The plasma ANP concentration during dobutamine infusion correlated with right ventricular systolic pressure (r = 0.71, p < 0.05), mean right atrial pressure (r = 0.29, p < 0.05), and mean pulmonary capillary wedge pressure (r = 0.32, p < 0.05). The BNP concentration correlated with right ventricular volume (r = 0.61, p < 0.05) and systolic pressure (r = 0. 46, p < 0.05). In conclusion, rapid changes in ANP, BNP, and cGMP concentrations during dobutamine infusion reflect the changes in atrial and ventricle pressure and volume overload. In surgically repaired TOF, the ANP concentration is affected by right ventricular systolic pressure, right atrial pressure, and pulmonary capillary pressure. Furthermore, the BNP concentration reflects right ventricular pressure and volume overload.


Age-related endothelium-dependent vascular relazation in rat thoracic aorta in response to colforsin

Colforsin, a novel water-soluble forskolin derivative, increases intracellular cyclic AMP by direct stimulation of adenylate cyclase and has strong positive inotropic and vasodilative effects. However, it is not known whether colforsin causes nitric oxide (NO) release and enhances endothelium-dependent vascular relaxation. We studied NO production and relaxation on exposure to colforsin in thoracic aorta from rats aged 4, 12 and 60 weeks. When a low concentration of colforsin was added to a solution bathing ring segments of aorta from 12-week-old rats, relaxation was greater in the ring segments with intact endothelium than in those from which the endothelium had been removed. A high concentration of colforsin induced the same degree of relaxation of ring segments with or without endothelium, probably by a direct effect on vascular smooth muscle cells. Production of NO in response to colforsin by cultured endothelial cells from 12-week-old rat aorta was demonstrated by the electron paramagnetic resonance spin trapping method. A low concentration of colforsin relaxed aortic segments with intact endothelium from 4-week-old rats more than those from 12-week-old or 60-week-old rats. Reversal of relaxation by NG-nitro L-arginine, an NO synthesis inhibitor, was most significant in arteries from 4-week-old rats. Production of NO after exposure to colforsin was greater in aortic segments from 4-week-old rats than older rats, as detected by an NO-selective electrode. Colforsin induces vasodilation in part by releasing NO from the endothelium in rat thoracic aorta. In addition to a direct vasodilative effect on the vascular smooth muscle cells, an endothelium-dependent vasodilative effect is also important in younger arteries.


Usefulness of color kinesis imaging for evaluation of regional right ventricular wall motion in patients with surgically repaired tetralogy of Fallot.


Endothelium-derived hyperpolarizing factor activates Ca2+activated K+channels in porcine coronary artery smooth muscle cells

Although endothelium-derived hyperpolarizing factor (EDHF) activity has been demonstrated in arteries from various species, EDHF has not been chemically identified, nor its mechanism of action characterized. To elucidate this mechanism, we tested the effect of EDHF on large-conductance Ca2+-activated K+ (K(Ca)) channels in porcine coronary artery smooth muscle cells. By using a patch-clamp technique, single-channel currents were recorded in cultured smooth muscle cells; the organ bath also contained a strip of porcine coronary with endothelium, which served as the source of endothelium-derived relaxing factor(s) including EDHF. Exposure of endothelium to 10(-6) M bradykinin activated K(Ca) channels in cultured smooth muscle cells in cell-attached patches. When the experiment was performed in the presence of 10 microM indomethacin and 30 microM N(G)-nitro-L-arginine (L-NNA), which block the generation of prostaglandin I2 (PGI2) and NO, respectively, K(Ca) channel activity was stimulated by bradykinin, indicating the direct involvement of EDHF in K(Ca) channel stimulation. Neither 10 microM methylene blue nor 25 microM Rp-cAMPS inhibited bradykinin-induced K(Ca) channel activity. In inside-out patches, the addition of bradykinin to the solution was without effect on K(Ca) channel activation. However, in the presence of 0.5 mM guanosine triphosphate (GTP) and 1.0 mM adenosine triphosphate (ATP) in the bath solution, K(Ca) channels was activated by bradykinin. In outside-out patches, the addition of bradykinin also increased K(Ca) channel activity, when GTP and ATP were added to the pipette solution. The addition of GDP-beta-S (100 microM) in the cytosolic solution completely blocked the activation K(Ca) channels induced by bradykinin in inside-out and outside-out patches. Pretreatment with 30 microM quinacrine, a phospholipase A2 inhibitor, or 3 microM 17-octadecynoic acid (17-ODYA), a cytochrome P450 inhibitor, in addition to indomethacin and L-NNA, abolished bradykinin-stimulated K(Ca) channel activity in cell-attached patches. Both 14,15-epoxyeicosatrienoic acid (EET) and 11,12-EET increased the open probabilities of K(Ca) channels in cell-attached patches. These results suggest that EDHF, released from endothelial cells in response to bradykinin, hyperpolarizes smooth muscle cells by opening K(Ca) channels. Furthermore, our data suggest that EDHF is an endothelium-derived cytochrome P450 metabolite of arachidonic acid. The effect of EDHF on K(Ca) channels is not associated with an increase of cAMP and cGMP. The activation of K(Ca) channels appears to be due to the activation of GTP-binding protein.


Effect of acidosis on Ca2+-activatecd K+ channels in cultured porcine coronary artery smooth muscle cells

Pflügers Archiv : European Journal of Physiology


Lactate-induced vascular relaxation in porcine coronary arteries is mediated by Ca2+activated K+ channels

Under ischemic conditions and during strenuous exercise, lactate concentrations increase in coronary artery smooth muscle cells. Although lactate causes pH-independent vasorelaxation, the mechanisms responsible for this effect are unclear. We investigated the effect of lactate on K+ channels in smooth muscle cells from porcine coronary arteries. Neutralized lactate (3-100 mm) induced vasorelaxation in ring segments of porcine coronary arteries precontracted with KCl in a dose-dependent manner. One millimolar tetraethylammonium (TEA), an inhibitor of Ca2+-activated K+ channels (KCa channels), reversed the lactate-induced relaxation, while 60 microM glibenclamide, an inhibitor of ATP-sensitive K+ channels (KATP channels), did not. In both inside-out and cell-attached patch clamp technique with cultured smooth muscle cells, the KCa channels were activated by lactate. In inside-out patches, lactate activated KCa channels, even under acidic conditions. This is in contrast to the effect of H+ which inactivated KCa channels. We conclude that vasodilation of porcine coronary arteries induced by lactate is, at least in part, mediated by activation of KCa channels. This effect may be self-protective by maintaining coronary blood flow during ischemia.

Journal of Molecular and Cellular Cardiology


Hydrogen peroxide-induced vascular relaxtion in porcine coronary arteries is mediated by Ca2+-activated K+ channels


パルスオキシメーターの容積脈波を用いた末梢循環評価に関する研究 --- 第2編 末梢循環不全評価の臨床的有用性に関する検討


パルスオキシメーターの容積脈波を用いた末梢循環評価に関する研究 --- 第1編 健康児の容積脈波伝達時間に影響を与える因子に関する検討


β遮断薬が奏効したアントラサイクリン系抗腫瘍剤に起因すると思われた心筋症の1例

β遮断薬が奏効したアントラサイクリン系抗腫瘍剤に起因すると思われた心筋症の1例


運動負荷中の心肺機能からみた運動処方

運動負荷中の心肺機能からみた運動処方


Absence of the inferior vena cava in a patient with omphalocele: tow-dimensional echocardiographic and cineangiographic findings


Usefulness of QRST isointegral maps for the diagnosis of right ventricular pressure overload in patients with surgically repaired tetralogy of Fallot complicated with right bundle branch block

Right ventricular pressure overload was evaluated in 29 patients, 8-12 years old, with surgically repaired tetralogy of Fallot by using body surface QRST isointegral maps. In patients with right ventricular systolic pressure above 50 mmHg, the maxima of the isointegral maps tended to shift toward the lower right-hand region of the map. The maximum value was significantly correlated with right ventricular systolic pressure (r = .58; P < .01). There was a correlation between the right ventricular systolic pressure and the percentage +2SD and percentage +5SD departure areas, which are defined as the area (expressed as a percentage of the total chest area) in which the QRST integral values are greater than the normal mean +2SD or +5SD, respectively (r = .61 and .84, P < .01). The QRST isointegral map can be used to evaluate right ventricular pressure overload in postoperative patients with tetralogy of Fallot complicated by right bundle branch block. The percentage +5SD departure area is the most valuable parameter for the quantitative evaluation of the right ventricular systolic pressure.


高周波カテーテルアブレーションが奏効した潜在性WPW症候群の1例

高周波カテーテルアブレーションが奏効した潜在性WPW症候群の1例


輸血後C型肝炎の慢性期における血清学，ウイルス学および組織学的検討

輸血後C型肝炎の慢性期における血清学，ウイルス学および組織学的検討


摘出ラット大動脈に対するアムリノンの内皮依存性血管弛緩作用と加齢による影響

摘出ラット大動脈に対するアムリノンの内皮依存性血管弛緩作用と加齢による影響


摘出ブタ大動脈でのアムリノンによる一酸化窒素(NO)産生の測定

摘出ブタ大動脈でのアムリノンによる一酸化窒素(NO)産生の測定


QRST isointegral mapによる先天性心疾患開心術後心室頻拍発生の予測に関する検討


乳児期早期のFallot四徴症におけるballoon pulmonary valvuloplasty の有用性に関する検討


Anomalous inferiorvena cava in association with omphalocele: a case report

We present the case of a 6-year-old boy who had an omphalocele repaired at day 1 of life. He had a secundum atrial septal defect and an anomalous inferior vena cava of a type which has not been previously reported. Cine-MRI was a useful noninvasive tool for diagnosing the anomalous subaortic innominate vein and four immature vessels which make up the venous drainage systems of the lumbar region. The recognition of this malformation is important in planning and executing surgical repair or cardiac catheterization for postoperative patients with omphaloceles.


Echoicardiographic evaluation of the development of aortic valve prolapse in supracristal ventricular septal defect


The first report of a patient with interrupted inferior vena cava, multiple post-renal veins and azygos-hemiazygos continuation


心エコー図による左房コンプライアンス評価の試み

心エコー図による左房コンプライアンス評価の試み


ファロー四徴症術後患者における運動負荷時呼吸パターンの検討

ファロー四徴症術後患者における運動負荷時呼吸パターンの検討


大動脈弓下無名静脈走行異常の6例 DSA, MRI, 心エコー所見

大動脈弓下無名静脈走行異常の6例 DSA, MRI, 心エコー所見


先天性心疾患開心術後患児における体表面加算平均心電図 --- 高速フーリエ変換を用いた異常高周波数成分の検出


Serologic, virologic, and histologic characteristics of chronic phase hepatitis C virus disease in children infected by transfusion


Post-transfusion chronic hepatitis in children

Two hundred and twenty-six patients who received blood products for open-heart surgery in childhood were screened by a second-generation enzyme-linked immunosorbent assay and with surrogate markers for hepatitis C virus (HCV) infection, such as alanine aminotransferase (ALT). Twenty-two (14%) of the 161 recipients who received blood products before 1989 and none of the subjects who had received blood products after 1990 (the year that the blood bank began to screen for HCV antibody) were HCV seropositive. Virologic and histologic studies showed that 10 (45%) of 24 seropositive patients had persistent hepatitis C virus infection, many with ongoing hepatitis. The remaining 12 seropositive patients with absent HCV RNA had normal ALT levels, indicating resolved hepatitis C infection. Enrolment in screening is important to detect chronic hepatitis C in children who received blood products prior to screening of blood donors for HCV antibody.


完全房室ブロック患者における体表面加算平均心電図に関する研究

完全房室ブロック患者における体表面加算平均心電図に関する研究


サッカー選手に対する多角的メディカルチェック

サッカー選手に対する多角的メディカルチェック


進行性筋ジストロフィー症における肺静脈血流分析

進行性筋ジストロフィー症における肺静脈血流分析


右脚ブロックを有するファロー四徴症心内修復術後患者の右室圧負荷評価におけるQRST isointegral mapの有用性に関する検討


Hyperuricemia in an infant with Taussig-Bing anomaly and interruption of the aortic arch

Hyperuricemia is commonly recognized in adolescents and adults with cyanotic congenital heart disease. We report a case of a male infant with hyperuricemia, Taussig-Bing anomaly, and interruption of the aortic arch. The patient underwent correction of interrupted aortic arch and pulmonary arterial banding at the age of 7 days. Hyperuricemia appeared when he was 2 months old (max 17.7 mg/dl) and persisted until he underwent a Jatene operation at the age of 10 months. The hyperuricemia improved gradually after the disappearance of hypoxia and polycythemia. The laboratory findings suggest that hyperuricemia can result from uric acid overproduction due to secondary polycythemia, impairment of uric acid excretion by the kidney, or the acceleration of anaerobic metabolism. Allopurinol and benzbromarone together were partially effective treatments for hyperuricemia in this patient with cyanotic congenital heart disease.


運動負荷時における体表面加算平均心電図検査の有用性と限界について

運動負荷時における体表面加算平均心電図検査の有用性と限界について


Singnal-averaged electrocardiographic late potentials in children with complete heart block


体表面加算平均心電図によるWolff-Parkinson-White症候群における房室回帰性頻拍の予測に関する検討


Age-related criteria for signal-averaged electrocardiographic late potentials in children

This study examined the age-related criteria of signal-averaged electrocardiographic (SA-ECG) parameters in children. SA-ECGs were obtained in 82 healthy volunteers in six groups depending on age (group 1: 1 day to < 1 month; group 2: 1 month to < 1 year; group 3: 1 to < 6 years; group 4: 6 to < 12 years; group 5: 12 to < 20 years; group 6: 20 to < 40 years). To examine the effect of heart rate on the parameters of SA-ECG, right atrial pacings were performed in 4 children with a ventricular septal defect aged 1-7 years. The root mean square voltage (RMS) was high; and the filtered QRS (f-QRS) duration and the duration of the low amplitude signal (LAS) were low during childhood, especially in infants (group 2), compared with those in adults. Late duration (LD) had no significant difference among age groups. The criteria for ventricular late potential were as follows: RMS < 25 microV, LAS > 35 ms, f-QRS duration > 110 ms, and LD > 35 ms for those age 1 day to < 1 month; RMS < 40 microV, LAS > 30 ms, f-QRS duration > 100 ms, and LD > 35 ms for those age 1 month to < 1 year; RMS < 20 microV, LAS > 40 ms, f-QRS duration > 130 ms, and LD > 35 ms for those age 1 to < 20 years; and RMS < 15 microV, LAS > 45 ms, f-QRS duration > 135 ms, and LD > 35 ms for those age 20 to < 40 years. RMS and LAS correlated with f-QRS duration (r = -0.78 and 0.76, respectively; p < 0.05), suggesting that these parameters are associated with the thickness of the ventricular muscle and the ventricular conduction time. Right atrial pacing had no effect on the measured SA-ECG parameters. The age-related differences in SA-ECG parameters might be due to age-related differences in the thickness of the ventricular muscle and the ventricular conduction time but are not due to differences in the heart rate. The age difference of each parameter on SA-ECG should be considered for ventricular late potentials.


Cerebral infarction in a patient with congenital heart block


加算平均心電図を利用したWPW症候群における早期脱分極電位の検討

加算平均心電図を利用したWPW症候群における早期脱分極電位の検討


ファロー四徴症術後症例における平均加算心電図の研究:時間領域および周波数領域解析併用の有用性について


Duchenne型進行性筋ジストロフィー症における加算平均心電図の周波数解析

Duchenne型進行性筋ジストロフィー症における加算平均心電図の周波数解析


Abnormal signal-averaged electrocardiogram in patients with Duchenne muscular dystrophy: Comparisonof time and frequency domain analyses from the signal-averaged electrogram


Abnormal signal averaged ECG after surgical repair of tetralogy of Fallot - a combined analysis in time and frequency domain


乳児期より著明な高尿酸血症を呈したTaussig-Bing奇形·大動脈弓離断の1例


Duchenne型進行性筋ジストロフィー症における心室遅延電位の研究 --- 加算平均心電図の周波数領域および時間領域の解析


先天性心疾患術後右脚ブロック患者における体表面加算平均心電図所見

先天性心疾患術後右脚ブロック患者における体表面加算平均心電図所見


チアノーゼ性先天性心疾患における高尿酸血症の発症に関する検討

チアノーゼ性先天性心疾患における高尿酸血症の発症に関する検討


Abnormal signal-averaged electrocardiogram in patients with Duchenne muscular dystrophy: Comparison of time and frequency domain analyses from the signal-averaged electrocardiograms


Abnormal findings in the signal-averaged electrocardiogram in patients with Ebstein's anomaly


右脚ブロックを有する先天性心疾患術後患者のにおける体表面加算平均心電図所見

右脚ブロックを有する先天性心疾患術後患者のにおける体表面加算平均心電図所見


不顕性リウマチ熱による弁膜症の診断·治療基準について

不顕性リウマチ熱による弁膜症の診断·治療基準について


小児における体表面加算平均心電図による心室遅延電位の判定基準に関する研究

小児における体表面加算平均心電図による心室遅延電位の判定基準に関する研究


Hyperuricaemia in cyanotic congenital heart disease


先天性心疾患術後右脚ブロックの部位診断におけるsignal-averaged ECGの有用性


Ebstein奇形における体表面加算平均心電図の異常所見について

Ebstein奇形における体表面加算平均心電図の異常所見について


遠位型大動脈肺動脈中隔欠損の1新生児例

遠位型大動脈肺動脈中隔欠損の1新生児例


心筋炎による多臓器不全を呈した1治験例

心筋炎による多臓器不全を呈した1治験例


関節痛により発見されたマンノシドーシスの姉妹例

関節痛により発見されたマンノシドーシスの姉妹例


Assessment of sinus node function in patients with congenital long QT syndrome


Developmental changes in the left ventricular diastolic wall strain on M-mode echocardiography.

Normal values for the DWS of the left ventricle change with age. The data reported in this study can be used as normal values for the DWS of the left ventricle determined by M-mode echocardiography.

The DWS in the just after birth group was 0.28 ± 0.11, which was significantly lower than that of the remaining groups (p < 0.05), except for the neonate group at 5-10 days after birth. The DWS was highest in the 1-9 years of age group, and then gradually decreased with age. Stepwise regression of various echocardiographic parameters showed that e' was the most relevant parameter for the DWS (β = 0.64).


チアノーゼ性先天性心疾患における脳膿瘍の疫学

Pediatric Cardiology and Cardiac Surgery


Williams症候群の表現型-心疾患およびその他年齢別に注意すべき症状の頻度 --- 平成17∼19年度研究課題報告


無脾症，多脾症における重症感染症の疫学 --- 平成17∼19年度研究課題報告

無脾症，多脾症における重症感染症の疫学 --- 平成17∼19年度研究課題報告


18および13トリソミーの心表現型・遺伝子型と予後 --- 平成17∼19年度研究課題報告


Nihon Rinsho. Japanese Journal of Clinical Medicine


収縮期雑音 心室中隔欠損 大動脈弁下狭窄

収縮期雑音 心室中隔欠損 大動脈弁下狭窄

症状と所見から考える心血管エコー

症状と所見から考える心血管エコー


進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

進行性に3枝ブロックを認め，ペースメーカー治療を要した新生児例

第18回日本小児心電学会

第18回日本小児心電学会