Percutaneous coronary intervention (PCI) is the first choice for treating simple coronary artery lesions because of the progress of coronary stent techniques in recent years. However, cases involving multivessel coronary artery disease are generally treated with coronary artery bypass grafting (CABG). Several recent studies have demonstrated that the long-term outcomes of CABG are superior to those of PCI in patients with multivessel and/or left main disease 1 -. In Japanese guidelines on revascularization for stable coronary artery disease, which were revised in 2018, CABG is considered a class I recommendation for all types of stenosis location except for “one vessel disease without proximal LAD stenosis” . CABG remains the superior method for treating selected patient groups. Saphenous vein graft (SVG) is the most popular graft used in CABG. A survey of the Japanese Association for Coronary Artery Surgery demonstrated that SVG is used more than 40% inpatients undergoing CABG . However, SVG shows poor patency rates and does not improve long-term morbidity . Conversely, the left internal thoracic artery (ITA) has superior graft patency and excellent clinical results . Several trials reported a 10-year patency of the left ITA of 90%–95% compared with 50% in SVG 13, . The use of arterial conduits in CABG has been hypothesized to improve long-term results . Therefore, some arterial grafts have been used as bypass grafts including the right ITA , radial artery 17) and right gastroepiploic artery . Various combinations of these arterial grafts have been employed (Fig. 1) and many retrospective studies have supported their safety and effectiveness. These findings suggest that arterial grafts are better suited for coronary bypass grafts than venous grafts. Among the arterial grafts used for CABG, ITA has the greatest long-term patency rate. Many factors regarding resistance to the development of atherosclerosis in ITA have been indicated by numerous studies: structurally, its endothelial layer shows fewer fenestrations, lower intercellular junction permeability, greater antithrombotic molecules such as heparin sulfate and tissue plasminogen activator and higher endothelial nitric oxide production. These are some of the unique ways that make the ITA impervious to the transfer of lipoproteins, which are responsible for atherosclerosis development 19 -. In comparison, the radial artery has a relatively thick media and a tendency for distal intimal hyperplasia . Therefore, the use of bilateral ITA graft is theoretically reasonable for CABG in terms of long-term patency and survival. Numerous observational studies and metaanalyses have demonstrated the superiority of bilateral ITA in terms of survival compared with single ITA. Current guidelines therefore recommend bilateral ITA for CABG as class IIa 9, . In this review, the advantages and disadvantages of using bilateral ITA in CABG are discussed. Moreover, the only randomized trial comparing bilateral and
{"title":"Bilateral Internal Thoracic Artery Graft in Coronary Artery Bypass Grafting","authors":"T. Fukui","doi":"10.7793/JCAD.25.005","DOIUrl":"https://doi.org/10.7793/JCAD.25.005","url":null,"abstract":"Percutaneous coronary intervention (PCI) is the first choice for treating simple coronary artery lesions because of the progress of coronary stent techniques in recent years. However, cases involving multivessel coronary artery disease are generally treated with coronary artery bypass grafting (CABG). Several recent studies have demonstrated that the long-term outcomes of CABG are superior to those of PCI in patients with multivessel and/or left main disease 1 -. In Japanese guidelines on revascularization for stable coronary artery disease, which were revised in 2018, CABG is considered a class I recommendation for all types of stenosis location except for “one vessel disease without proximal LAD stenosis” . CABG remains the superior method for treating selected patient groups. Saphenous vein graft (SVG) is the most popular graft used in CABG. A survey of the Japanese Association for Coronary Artery Surgery demonstrated that SVG is used more than 40% inpatients undergoing CABG . However, SVG shows poor patency rates and does not improve long-term morbidity . Conversely, the left internal thoracic artery (ITA) has superior graft patency and excellent clinical results . Several trials reported a 10-year patency of the left ITA of 90%–95% compared with 50% in SVG 13, . The use of arterial conduits in CABG has been hypothesized to improve long-term results . Therefore, some arterial grafts have been used as bypass grafts including the right ITA , radial artery 17) and right gastroepiploic artery . Various combinations of these arterial grafts have been employed (Fig. 1) and many retrospective studies have supported their safety and effectiveness. These findings suggest that arterial grafts are better suited for coronary bypass grafts than venous grafts. Among the arterial grafts used for CABG, ITA has the greatest long-term patency rate. Many factors regarding resistance to the development of atherosclerosis in ITA have been indicated by numerous studies: structurally, its endothelial layer shows fewer fenestrations, lower intercellular junction permeability, greater antithrombotic molecules such as heparin sulfate and tissue plasminogen activator and higher endothelial nitric oxide production. These are some of the unique ways that make the ITA impervious to the transfer of lipoproteins, which are responsible for atherosclerosis development 19 -. In comparison, the radial artery has a relatively thick media and a tendency for distal intimal hyperplasia . Therefore, the use of bilateral ITA graft is theoretically reasonable for CABG in terms of long-term patency and survival. Numerous observational studies and metaanalyses have demonstrated the superiority of bilateral ITA in terms of survival compared with single ITA. Current guidelines therefore recommend bilateral ITA for CABG as class IIa 9, . In this review, the advantages and disadvantages of using bilateral ITA in CABG are discussed. Moreover, the only randomized trial comparing bilateral and","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.7793/JCAD.25.19-00001
S. Isoda, R. Izubuchi, I. Yamazaki, K. Uchida, Shotaro Kaneko, M. Goda, Yoshimi Yano, M. Masuda
Post-infarction ventricular septal defect (VSD) is a life-threatening complication of transmural acute myocardial infarction (AMI), with a poor survival rate despite medical therapy 1, . Untreated patients had a 24% mortality rate in a day and 80% within the first month 3, . Although surgical repair seems to provide better result than medical therapy, surgical results in 2014 in Japan showed 28.6% 30-day mortality rate and 33.5% in-hospital mortality rate 5, . The Society of Thoracic Surgeons database showed operative mortality rate of 54.1% when repair was attempted within 7 days after AMI . Although untreated post-infarction VSD in the ultra-acute phase has an extremely high mortality rate, surgeons are reluctant to perform emergent surgery due to fragility of the infarcted myocardium. Problems with the previous surgical techniques include residual leak, uncontrolled bleeding, and technical difficulty 2, -. To resolve these problems, we have developed a sandwich technique via a right ventricular (RV) approach -. This technique involves the placement of patches on both the left and right sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches via an RV approach (Fig. 1a). Since patients with post-infarction VSD tend to fall in severe lung edema or cardiac tamponade quickly and the condition sometimes become irreversible, necessitating postoperative cardiopulmonary support, we used our technique in the ultra-acute phase, with the Original Article
{"title":"“Sandwich Technique” via a Right Ventricular Incision for Ultra-acute Repair of Post-infarction Ventricular Septal Defects","authors":"S. Isoda, R. Izubuchi, I. Yamazaki, K. Uchida, Shotaro Kaneko, M. Goda, Yoshimi Yano, M. Masuda","doi":"10.7793/JCAD.25.19-00001","DOIUrl":"https://doi.org/10.7793/JCAD.25.19-00001","url":null,"abstract":"Post-infarction ventricular septal defect (VSD) is a life-threatening complication of transmural acute myocardial infarction (AMI), with a poor survival rate despite medical therapy 1, . Untreated patients had a 24% mortality rate in a day and 80% within the first month 3, . Although surgical repair seems to provide better result than medical therapy, surgical results in 2014 in Japan showed 28.6% 30-day mortality rate and 33.5% in-hospital mortality rate 5, . The Society of Thoracic Surgeons database showed operative mortality rate of 54.1% when repair was attempted within 7 days after AMI . Although untreated post-infarction VSD in the ultra-acute phase has an extremely high mortality rate, surgeons are reluctant to perform emergent surgery due to fragility of the infarcted myocardium. Problems with the previous surgical techniques include residual leak, uncontrolled bleeding, and technical difficulty 2, -. To resolve these problems, we have developed a sandwich technique via a right ventricular (RV) approach -. This technique involves the placement of patches on both the left and right sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches via an RV approach (Fig. 1a). Since patients with post-infarction VSD tend to fall in severe lung edema or cardiac tamponade quickly and the condition sometimes become irreversible, necessitating postoperative cardiopulmonary support, we used our technique in the ultra-acute phase, with the Original Article","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7793/JCAD.25.19-00001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.7793/jcad.25.19-00005
H. Tada, K. Sakata, M. Takamura, M. Kawashiri
Clinical usefulness of aggressive LDL-lowering therapies using statin, ezetimibe, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have been shown in primary as well as in secondary prevention settings. In addition, the idea that the lower, the better story in LDL appears to be true as low as ~30 mg/dl based on recent randomized controlled trials (RCT). Moreover, aggressive LDL-lowering therapies, for either of primary prevention setting, or secondary prevention setting has been shown to be quite effective in Japanese population as well. According to those facts, recent guidelines in Europe, and in Japan suggest to lower LDL cholesterol (LDL-C) level < 70 mg/dl for high-risk patients. However, the attainment rates of such “strict” goals seem to be quite low, probably because most cardiologists still have a feeling of anxiety of extremely low LDL-C level. In this review article, we provide the idea that LDL-C is one of the well-established causal factors for atherosclerotic cardiovascular disease (ASCVD) based on the findings from Mendelian randomization studies in addition to RCT. The beautiful consistency between RCT and Mendel randomization studies have reassured us that the lower, the better, as well as the earlier, the better appear to be true.
{"title":"Encouragement of Super-aggressive LDL-lowering Therapies","authors":"H. Tada, K. Sakata, M. Takamura, M. Kawashiri","doi":"10.7793/jcad.25.19-00005","DOIUrl":"https://doi.org/10.7793/jcad.25.19-00005","url":null,"abstract":"Clinical usefulness of aggressive LDL-lowering therapies using statin, ezetimibe, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have been shown in primary as well as in secondary prevention settings. In addition, the idea that the lower, the better story in LDL appears to be true as low as ~30 mg/dl based on recent randomized controlled trials (RCT). Moreover, aggressive LDL-lowering therapies, for either of primary prevention setting, or secondary prevention setting has been shown to be quite effective in Japanese population as well. According to those facts, recent guidelines in Europe, and in Japan suggest to lower LDL cholesterol (LDL-C) level < 70 mg/dl for high-risk patients. However, the attainment rates of such “strict” goals seem to be quite low, probably because most cardiologists still have a feeling of anxiety of extremely low LDL-C level. In this review article, we provide the idea that LDL-C is one of the well-established causal factors for atherosclerotic cardiovascular disease (ASCVD) based on the findings from Mendelian randomization studies in addition to RCT. The beautiful consistency between RCT and Mendel randomization studies have reassured us that the lower, the better, as well as the earlier, the better appear to be true.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A myocardial bridge (MB) is an anatomical variant in which the myocardial muscle partially covers the epicardial coronary arteries -. Although MB can be detected in any coronary artery, most involve the left anterior descending coronary artery (LAD). This variant has historically been regarded as benign, because contraction of the bridged muscles alters blood flow within the underlying LAD during systole, whereas coronary flow in the LAD occurs predominantly during diastole. However, an MB can lead to significant clinical issues, such as arrhythmia, myocardial ischemia conduction disturbances 4, , myocardial infarction 6) and sudden death 7) in a subset of patients. II. Prevalence and diagnostic testing The prevalence of MB varies widely according to the detection methods applied. The reported MB rates among numerous necropsy series (Fig. 1) 8) range from 5% to 86% 9) and an average of ~25% of adults have MB. The reported rates of MB are higher according to pathological series including thin MB or even myocardial strands with minimal hemodynamic consequences, than those determined by coronary angiography, which typically detects systolic compression as a “milking effect” (Fig. 2) . Coronary angiography is the most popular means of diagnosing MB in the clinical setting, with detection rates ranging from 0.5% to 12% at rest and up to 40% upon provocation or after intracoronary nitroglycerin injection 2-4, -. Numerous factors have been presumed to account for the reported mismatch between the rates of “tunneled arteries” that run intramurally through the myocardium compared with angiographic findings. These include MB thickness and length, the reciprocal orientation of the coronary artery and myocardial fibers, loose connective or adipose tissue around the bridged segment, aortic outflow tract obstruction, in which the systolic tension that develops in the MB overcomes the intracoronary artery pressure, the intrinsic tone of the wall of the coronary artery, a proximal coronary fixed obstruction that causes a decrease in distal intracoronary pressure, and the status of myocardial contractility . Intravascular ultrasound (IVUS) can clearly visualize eccentric or concentric systolic compression in the tunneled segment of an artery that persists into diastole 4, 5, 8, -, accompanied by a highly specific echolucent “halfmoon” appearance throughout the cardiac cycle (Fig. 3) 5, 8, . Vessel compression can be detected by IVUS under coronary provocation even in the absence of angiographically significant milking. The prevalence of MB determined by IVUS, which is more sensitive than angiography for detecting minor compression, is 23%. Optical coherence tomography (OCT) can also detect MB with a homogeneous specific “band” appearance outside the adventitia (Fig. 4). Review Article
{"title":"Myocardial Bridge","authors":"Ryotaro Yamada, S. Uemura","doi":"10.7793/jcad.25.012","DOIUrl":"https://doi.org/10.7793/jcad.25.012","url":null,"abstract":"A myocardial bridge (MB) is an anatomical variant in which the myocardial muscle partially covers the epicardial coronary arteries -. Although MB can be detected in any coronary artery, most involve the left anterior descending coronary artery (LAD). This variant has historically been regarded as benign, because contraction of the bridged muscles alters blood flow within the underlying LAD during systole, whereas coronary flow in the LAD occurs predominantly during diastole. However, an MB can lead to significant clinical issues, such as arrhythmia, myocardial ischemia conduction disturbances 4, , myocardial infarction 6) and sudden death 7) in a subset of patients. II. Prevalence and diagnostic testing The prevalence of MB varies widely according to the detection methods applied. The reported MB rates among numerous necropsy series (Fig. 1) 8) range from 5% to 86% 9) and an average of ~25% of adults have MB. The reported rates of MB are higher according to pathological series including thin MB or even myocardial strands with minimal hemodynamic consequences, than those determined by coronary angiography, which typically detects systolic compression as a “milking effect” (Fig. 2) . Coronary angiography is the most popular means of diagnosing MB in the clinical setting, with detection rates ranging from 0.5% to 12% at rest and up to 40% upon provocation or after intracoronary nitroglycerin injection 2-4, -. Numerous factors have been presumed to account for the reported mismatch between the rates of “tunneled arteries” that run intramurally through the myocardium compared with angiographic findings. These include MB thickness and length, the reciprocal orientation of the coronary artery and myocardial fibers, loose connective or adipose tissue around the bridged segment, aortic outflow tract obstruction, in which the systolic tension that develops in the MB overcomes the intracoronary artery pressure, the intrinsic tone of the wall of the coronary artery, a proximal coronary fixed obstruction that causes a decrease in distal intracoronary pressure, and the status of myocardial contractility . Intravascular ultrasound (IVUS) can clearly visualize eccentric or concentric systolic compression in the tunneled segment of an artery that persists into diastole 4, 5, 8, -, accompanied by a highly specific echolucent “halfmoon” appearance throughout the cardiac cycle (Fig. 3) 5, 8, . Vessel compression can be detected by IVUS under coronary provocation even in the absence of angiographically significant milking. The prevalence of MB determined by IVUS, which is more sensitive than angiography for detecting minor compression, is 23%. Optical coherence tomography (OCT) can also detect MB with a homogeneous specific “band” appearance outside the adventitia (Fig. 4). Review Article","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7793/jcad.25.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.7793/jcad.25.19-00010
Yasushi Watanabe, G. Kimura, Shinsuke Taguchi, Yoshiki Uehara, Y. Suematsu
The average age at the time of marriage is increasing in Japan. In addition, the percentages of people who have remained single or who are divorced are increasing . Consequently, the prevalence of single persons is expected to increase. Some studies have indicated that marital status is an important factor associated with mortality and cardiovascular diseases -. Thus, the status of Japan as a country with one of the greatest longevities in the world is at risk. However, few studies have investigated the relationship between the age of acute coronary syndrome (ACS) onset and marital status. We hypothesized that single men might have a greater risk of early-onset ACS and might have more coronary risk factors than married men. This study’s purpose is to reveal that marital status could be one of the coronary risk factors or not.
{"title":"Single Men Have a Higher Morbidity Risk of Acute Coronary Syndrome at a Younger Age than Married Men","authors":"Yasushi Watanabe, G. Kimura, Shinsuke Taguchi, Yoshiki Uehara, Y. Suematsu","doi":"10.7793/jcad.25.19-00010","DOIUrl":"https://doi.org/10.7793/jcad.25.19-00010","url":null,"abstract":"The average age at the time of marriage is increasing in Japan. In addition, the percentages of people who have remained single or who are divorced are increasing . Consequently, the prevalence of single persons is expected to increase. Some studies have indicated that marital status is an important factor associated with mortality and cardiovascular diseases -. Thus, the status of Japan as a country with one of the greatest longevities in the world is at risk. However, few studies have investigated the relationship between the age of acute coronary syndrome (ACS) onset and marital status. We hypothesized that single men might have a greater risk of early-onset ACS and might have more coronary risk factors than married men. This study’s purpose is to reveal that marital status could be one of the coronary risk factors or not.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
contrast intravenous injection, microbubbles pass Myocardial contrast echocardiography (MCE) is an imaging modality to visualize myocardial perfusion using gas-filled microbubbles. Ultrasound contrast agents containing microbubbles are usually administered intravenously, and small microbubbles flow into left heart through pulmonary circulation. Number of microbubbles flowing into microcirculation would be very small, and image enhancing techniques such as intermittent power Doppler are required to detect weak signal from intramyocardial microbubbles. Fragile microbubbles are easily destroyed by incident ultrasound. When contrast agent is administered by continuous intravenous infusion, microbubbles are replenished into capillaries after microbubble destruction by ultrasound pulse. By analyzing the temporal recovery of myocardial contrast enhancement after microbubble destruction (a replenishment curve), myocardial blood flow could be determined. Such quantitative analysis can be performed using intermittent imaging technique or real-time MCE at low mechanical index (MI) ultrasound. MCE detects microvascular dysfunction (no-reflow phenomenon) in patients with acute myocardial infarction, which determines functional and clinical outcomes. MCE using stress testing could detect myocardial ischemia in patients with coronary artery disease (CAD). Theoretically, MCE could detect endocardial ischemia and diagnose CAD better than single-photon emission computed tomography (SPECT) because of higher spatial resolution. However, large-scale clinical studies failed to demonstrate superiority of MCE to SPECT for detecting CAD. No contrast agent is still approved for MCE, and further improvement of microbubbles and imaging techniques is required.
{"title":"Myocardial Contrast Echocardiography","authors":"K. Iwakura","doi":"10.7793/JCAD.25.006","DOIUrl":"https://doi.org/10.7793/JCAD.25.006","url":null,"abstract":"contrast intravenous injection, microbubbles pass Myocardial contrast echocardiography (MCE) is an imaging modality to visualize myocardial perfusion using gas-filled microbubbles. Ultrasound contrast agents containing microbubbles are usually administered intravenously, and small microbubbles flow into left heart through pulmonary circulation. Number of microbubbles flowing into microcirculation would be very small, and image enhancing techniques such as intermittent power Doppler are required to detect weak signal from intramyocardial microbubbles. Fragile microbubbles are easily destroyed by incident ultrasound. When contrast agent is administered by continuous intravenous infusion, microbubbles are replenished into capillaries after microbubble destruction by ultrasound pulse. By analyzing the temporal recovery of myocardial contrast enhancement after microbubble destruction (a replenishment curve), myocardial blood flow could be determined. Such quantitative analysis can be performed using intermittent imaging technique or real-time MCE at low mechanical index (MI) ultrasound. MCE detects microvascular dysfunction (no-reflow phenomenon) in patients with acute myocardial infarction, which determines functional and clinical outcomes. MCE using stress testing could detect myocardial ischemia in patients with coronary artery disease (CAD). Theoretically, MCE could detect endocardial ischemia and diagnose CAD better than single-photon emission computed tomography (SPECT) because of higher spatial resolution. However, large-scale clinical studies failed to demonstrate superiority of MCE to SPECT for detecting CAD. No contrast agent is still approved for MCE, and further improvement of microbubbles and imaging techniques is required.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7793/JCAD.25.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ischemic mitral regurgitation (MR) is defined as functional MR caused by myocardial ischemia including myocardial infarction and ischemic cardiomyoplasty that results in disturbed left ventricular (LV) geometry. It does not usually coexist with rheumatic heart valve disease, degenerative disease, or congenital defect of the mitral valve (MV) 1) and is associated with excess mortality independently of baseline characteristics and the severity of ventricular dysfunction . The mechanism of regurgitation is independently multifactorial, including LV dilation, LV sphericity, apical and posterior displacement of the papillary muscle, and LV function. Apical and posterior displacement, referred to as tethering, positively correlates with maximal regurgitation area 1, . II. Moderate mitral regurgitation at coronary artery bypass surgery
{"title":"Ischemic Mitral Regurgitation","authors":"H. Takemura","doi":"10.7793/JCAD.25.003","DOIUrl":"https://doi.org/10.7793/JCAD.25.003","url":null,"abstract":"Ischemic mitral regurgitation (MR) is defined as functional MR caused by myocardial ischemia including myocardial infarction and ischemic cardiomyoplasty that results in disturbed left ventricular (LV) geometry. It does not usually coexist with rheumatic heart valve disease, degenerative disease, or congenital defect of the mitral valve (MV) 1) and is associated with excess mortality independently of baseline characteristics and the severity of ventricular dysfunction . The mechanism of regurgitation is independently multifactorial, including LV dilation, LV sphericity, apical and posterior displacement of the papillary muscle, and LV function. Apical and posterior displacement, referred to as tethering, positively correlates with maximal regurgitation area 1, . II. Moderate mitral regurgitation at coronary artery bypass surgery","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Before the introduction of reperfusion therapies, VSR occurred in 1 to 3 percent of AMI cases 1 -. In the era of reperfusion therapy, Crenshaw et al. reported the VSR incidence in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries trial (GUSTO-I) at 0.2 percent, which indicated a reduction of the incidence of VSR since the introduction of reperfusion therapies . In spite of this reported reduction the real-world incidence may not have continued to improve as much as one might hope. Moreyra et al. found from the MIDAS database that the rate of VSR had not changed from 1990 to 2007, and that mortality had remained high and relatively constant . Annual reports from The Japanese Association for Thoracic Surgery, including data from almost all the centers nationwide demonstrated fairly consistent numbers of VSR repairs, ranging from 275 to 296 cases annually from 2010 to 2017 -. VSR is more probable after anterior myocardial infarction than after inferior infarction 6, . Risk factors for VSR in the pre-reperfusion era included hypertension 15, , advanced age (60 to 69 years) , female sex 15, , and no history of angina or myocardial infarction 1, 2, -. Angina or myocardial infarction may stimulate the growth of coronary collaterals, which may reduce the development of rupture . In the reperfusion era, advanced age, female sex, and the absence of smoking are often associated with an increased risk of developing VSR , but the absence of previous angina has not been associated with an increased risk .
在引入再灌注治疗之前，1 - 3%的AMI病例发生VSR。在再灌注治疗时代，Crenshaw等人在Global Utilization of Streptokinase and TPA for Occluded冠脉试验(GUSTO-I)中报道了VSR的发生率为0.2%，这表明自引入再灌注治疗以来VSR的发生率有所降低。尽管报告的发病率有所下降，但现实世界的发病率可能没有像人们希望的那样继续改善。Moreyra等人从MIDAS数据库中发现，从1990年到2007年，VSR率没有变化，死亡率保持较高且相对稳定。日本胸外科协会的年度报告，包括来自全国几乎所有中心的数据，显示了相当一致的VSR修复数量，从2010年到2017年，每年的数量从275例到296例不等。前路心肌梗死比下路心肌梗死更容易发生VSR 6，。再灌注前发生VSR的危险因素包括高血压15、高龄(60 ~ 69岁)、女性15、无心绞痛或心肌梗死史1,2，-。心绞痛或心肌梗塞可刺激冠状动脉侧枝的生长，从而减少破裂的发生。在再灌注时代，高龄、女性和不吸烟通常与VSR发生风险增加相关，但既往无心绞痛与VSR发生风险增加无关。
{"title":"An Update Review on Postinfarction Ventricular Septal Rupture","authors":"T. Asai","doi":"10.7793/JCAD.25.004","DOIUrl":"https://doi.org/10.7793/JCAD.25.004","url":null,"abstract":"Before the introduction of reperfusion therapies, VSR occurred in 1 to 3 percent of AMI cases 1 -. In the era of reperfusion therapy, Crenshaw et al. reported the VSR incidence in the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries trial (GUSTO-I) at 0.2 percent, which indicated a reduction of the incidence of VSR since the introduction of reperfusion therapies . In spite of this reported reduction the real-world incidence may not have continued to improve as much as one might hope. Moreyra et al. found from the MIDAS database that the rate of VSR had not changed from 1990 to 2007, and that mortality had remained high and relatively constant . Annual reports from The Japanese Association for Thoracic Surgery, including data from almost all the centers nationwide demonstrated fairly consistent numbers of VSR repairs, ranging from 275 to 296 cases annually from 2010 to 2017 -. VSR is more probable after anterior myocardial infarction than after inferior infarction 6, . Risk factors for VSR in the pre-reperfusion era included hypertension 15, , advanced age (60 to 69 years) , female sex 15, , and no history of angina or myocardial infarction 1, 2, -. Angina or myocardial infarction may stimulate the growth of coronary collaterals, which may reduce the development of rupture . In the reperfusion era, advanced age, female sex, and the absence of smoking are often associated with an increased risk of developing VSR , but the absence of previous angina has not been associated with an increased risk .","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7793/JCAD.25.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71173962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Ultimate Goals of Surgical Ventricular Reconstruction","authors":"S. Yamazaki, S. Numata, H. Yaku","doi":"10.7793/JCAD.25.007","DOIUrl":"https://doi.org/10.7793/JCAD.25.007","url":null,"abstract":"","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ob-struction and cause ischemic cardiac events. Anomalous aortic origin of a coronary artery is a congenital anomaly that carries a risk of a life-threatening cardiovascular event, such as sudden cardiac death or myocardial infarction. Some therapeutic guidelines have been proposed, but specific indications and treatment procedures remain controversial. In general, all patients with anomalous aortic origin of the left coronary artery are indicated for surgical repair, whereas surgical indications for anomalous aortic origin of the right coronary artery have not been established. Various surgical therapies (e.g., coronary artery bypass graft, unroofing, reimplantation, and pulmonary artery translocation) have been reported. The unroofing procedure is presumably a reasonable and safe approach for revascularization in patients with anomalous aortic origin of a coronary artery with a long intramural course, despite the risk of aortic insufficiency or recurrent sudden cardiac arrest. Among surgical procedures, reimplantation is conceivably the most physiologically appropriate and durable procedure. However, the procedure is technically demanding procedure because of the requirement for extensive dissection and vessel mobilization. Currently, optical surgical intervention is proposed based on coronary anatomy. With increasing numbers of treated patients and improved diagnostic tools, based on both anatomy and function, this anomaly may be definitely resolved in the near future.
{"title":"Surgical Therapy for Anomalous Aortic Origin of a Coronary Artery","authors":"K. Furukawa, A. Shiose","doi":"10.7793/jcad.25.011","DOIUrl":"https://doi.org/10.7793/jcad.25.011","url":null,"abstract":"ob-struction and cause ischemic cardiac events. Anomalous aortic origin of a coronary artery is a congenital anomaly that carries a risk of a life-threatening cardiovascular event, such as sudden cardiac death or myocardial infarction. Some therapeutic guidelines have been proposed, but specific indications and treatment procedures remain controversial. In general, all patients with anomalous aortic origin of the left coronary artery are indicated for surgical repair, whereas surgical indications for anomalous aortic origin of the right coronary artery have not been established. Various surgical therapies (e.g., coronary artery bypass graft, unroofing, reimplantation, and pulmonary artery translocation) have been reported. The unroofing procedure is presumably a reasonable and safe approach for revascularization in patients with anomalous aortic origin of a coronary artery with a long intramural course, despite the risk of aortic insufficiency or recurrent sudden cardiac arrest. Among surgical procedures, reimplantation is conceivably the most physiologically appropriate and durable procedure. However, the procedure is technically demanding procedure because of the requirement for extensive dissection and vessel mobilization. Currently, optical surgical intervention is proposed based on coronary anatomy. With increasing numbers of treated patients and improved diagnostic tools, based on both anatomy and function, this anomaly may be definitely resolved in the near future.","PeriodicalId":73692,"journal":{"name":"Journal of coronary artery disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71174328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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