SUMMARYA 27-year-old woman with atrial septal defect (ASD) and a sensation of squeezing in the anterior chest by effort was admitted to our hospital. In addition to the ASD, the coronary angiogram showed an abnormal anomalous position of the right coronary artery. Exercise thallium (Tl)-201 cardiac scintigram with an electrocardiogram clearly detected myocardial ischemia in the inferior area. In the operative findings, the orifice of the right coronary artery was positioned high above the commissure between the right and left sinuses of Valsalva, and it ran between the aorta and pulmonary trunk. Considering myocardial ischemia possibly caused by the anomalous origin of the right coronary artery, a coronary artery bypass graft (CABG) was simultaneously performed to the right coronary artery with direct closure of ASD. The myocardial ischemic finding in the inferior area disappeared after the operation, and she was also relieved from the chest pain. In view of these findings, we suggest that an active combination treatment such as CABG and ASD closure is highly successful in a patient with a threatening coronary anomaly and congenital heart disease. (Jpn Heart J 2001; 42: 371-376)
A case of polycystic kidney disease (PKD) associated with Klippel-Trenaunay-Weber syndrome is described. A 58-year-old man with chronic renal failure experienced urinary retention following gross hematuria. Intermittent drainage was necessary for significant urination for five days. Thereafter his urinary retention was relieved, but renal failure progressively developed and hemodialysis was started. Right hydronephrisis and hydroureter disappeared one month later. In spite of relief of obstruction, of which the cause was likely blood clots, renal function was not restored. Obstructive nephropathy was most likely explicable for notable deterioration in renal function. Our case might have susceptibilities to PKDdevelopment in terms of angiogenesis.
Introduction: Landiolol hydrochloride is an ultra-short-acting -blocker that is administered intravenously and has many advantages in cardiac surgery. This study was performed to examine the safety and efficacy of low-dose landiolol continuous infusion in cardiac surgery.Methods and Results: Nineteen patients who underwent either aortic valve replacement or coronary artery bypass surgery received low-dose continuous infusion of landiolol (2:8 AE 0:75 mg/kg/min) from the time of skin incision until the second postoperative day. Nineteen patients who did not receive landiolol served as controls. Heart rate, arterial pressure, cardiac index, and stroke volume were measured and the occurrence of supraventricular tachyarrythmia was monitored for one week after surgery. Landiolol decreased the heart rate without causing hemodynamic deterioration. The incidence of supraventricular tachyarrythmia was 32% and 47% in the landiolol and control groups, respectively (P ¼ 0:50).Conclusions: Landiolol is effective for decreasing heart rate while maintaining other hemodynamic parameters. Our data did not show a clear prophylactic effect of landiolol on postoperative supraventricular tachyarrythmia. (J Arrhythmia 2011; 27: 57-62)
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