No abstract

These results demonstrate that during increased ventricular contraction, chronically decreased aortic distensibility contributes to a further decrease in the coronary flow reserve ratio, impairs endocardial blood flow and may induce subendocardial ischemia even in the absence of coronary artery stenosis.

A two-dimensional clinical intravenous coronary angiography system, comprising a large-size view area produced by asymmetrical re¯ection from a silicon crystal using intense synchrotron radiation from a multipole wiggler and a two-dimensional detector with an image intensi®er, has been completed. An advantage of the imaging system is that two-dimensional dynamic imaging of the cardiovascular system can be achieved due to its two-dimensional radiation ®eld. This world-®rst two-dimensional system has been successfully adapted to clinical applications. Details of the imaging system are described in this paper.

eripartum cardiomyopathy is a rare cardiac disorder leading to heart failure in the last month of pregnancy or up to 5 months postpartum. 1 Although the etiology has not been determined, investigators have noted a high incidence of embolism with peripartum cardiomyopathy; 2 cardiac mural thrombi have been found at autopsy in some patients and thrombi have been demonstrated in the left ventricle, and in a few instances in the right ventricle, by 2-dimensional (D) echocardiography. 3 Furthermore, the course of intracardiac thrombus associated with peripartum cardiomyopathy has not been reported. We present a case of peripartum cardiomyopathy with biventricular thrombi that was managed successfully using anticoagulant therapy. Case ReportA 23-year-old woman was admitted to hospital with palpitations, nocturnal dyspnea, and orthopnea 6 weeks after a normal first delivery of a healthy baby. Because her antenatal care had been uneventful, she was suspected to have peripartum cardiomyopathy and was referred to Tsukuba University Hospital for further evaluation. Chest radiography revealed cardiomegaly, with a cardiothoracic ratio of 61% and pulmonary venous congestion. Echocardiography showed left ventricular dilation with a left ventricular end-diastolic dimension of 55 mm and decreased systolic function with a left ventricular ejection fraction of 33%. She had a history of an atrial septal defect that had been treated by surgery at age 5. She had no history of excessive alcohol consumption.On examination, her pulse was 68 beats/min and blood Circulation Journal Vol.66, September 2002pressure was 98/68 mmHg. A third heart sound and a grade 2/6 pansystolic murmur was audible at the apex. Crepitations were not heard over the lung fields and edema was absent. Most laboratory findings, including cardiac enzymes, were within normal limits. Anticardiolipin 2-glycoprotein I complex antibody was absent, but D dimer, 2 plasmin inhibitor·plasmin complex, human atrial natriuretic peptide, and brain natriuretic peptide were all elevated ( Table 1). Titers of antiviral antibodies for 5 viruses (Coxsackie A-4, A-5, A-9, B-3, B-4) were measured on the day of admission and 3 weeks later, and no significant change was observed. The electrocardiogram revealed right axis deviation, negative T wave changes in leads I, aVL and V2-6, and QT prolongation (QTc 0.47 s). A repeat echocardiogram confirmed biventricular dilation, left atrial enlargement, marked generalized hypokinesis with a left ventricular enddiastolic dimension of 57 mm and a left ventricular ejection fraction of 18% (Fig 1A), grade 2 mitral and tricuspid regurgitation, and apical thrombi in both ventricles (Fig2A). The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile. There was no Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have bee...

These results indicate that the combination therapy with vitamin E is potentially a useful method to prevent the development of nitrate tolerance.