Kokyu to junkan. Respiration & circulation最新文献

A 66 year-old woman underwent coronary artery bypass grafting for postinfarction angina. A left internal mammary artery graft was joined to the left anterior descending artery. Coronary and graft angiography revealed a 90% stenosis in the anastomotic site of the left internal mammary artery. During PTCA with a 2.0 mm balloon catheter, acute occlusion of the graft body occurred. Intragraft injection of isosorbide dinitrate failed to dilate the graft. Thus, careful consideration should be given to several complications such as acute occlusion of the graft when PTCA for anastomotic site of the graft is performed.

The aim of this report is to investigate the factors which influence mean left atrial pressure (LAP) after percutaneous transvenous mitral commissurotomy (PTMC) and the characteristics of patients in whom PTMC is most effective. Fifty one patients with symptomatic mitral stenosis underwent PTMC. The patients included 8 males and 43 females, aged 26-66 years (mean age of 46). These patients were classified into two groups according to LAP after PTMC: 31 cases with LAP after PTMC of 12 mmHg or less (group A) and 20 cases with LAP after PTMC greater than 12 mmHg (group B). The patients of group A were younger (44 +/- 6 vs 48 +/- 6 years, p < 0.05), and had atrial fibrillation (af) less frequently (35 vs 65%, p < 0.05), and had mitral valve calcification less frequently (29 vs 65%, p < 0.01). Before PTMC, LAP (19 +/- 6 vs 23 +/- 5 mmHg, p < 0.01) was lower and mitral valve area (MVA) (0.95 +/- 0.24 vs 0.81 +/- 0.15 cm2, p < 0.05) larger in group A. Symptoms graded according to the New York Heart Association functional classification system were similar in both groups before PTMC. After the procedure, final MVA (1.79 +/- 0.69 vs 1.40 +/- 0.50 cm2, p < 0.05) was larger and systolic pulmonary artery pressure (32 +/- 9 vs 39 +/- 7 mmHg, p < 0.01) lower in group A. Mitral regurgitation > or = 3-grade tended to complicate more frequently (3 vs 20%, NS) in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of sick sinus syndrome with mirror-image dextrocardia which was associated with bilateral superior vena cava and an absent inferior vena cava with azygos continuation is reported. A 45-year-old woman was referred to our hospital with the chief complaints of dizziness and palpitation. The electrocardiogram showed a atrial fibrillation with a 4-second period of asystole. A permanent endocardial bipolar demand pacemaker was inserted through the left superior vena cava. Since anomaly of venous system is commonly associated with mirror-image dextrocardia, the angiogram is necessary prior to permanent pacemaker implantation.

A 22-year-old man was admitted to the department of plastic surgery in our university with diagnosis of ankylosis and microgeniea. His complaints were snoring and somnolence in the daytime, so we performed a Respigraph (Chest) that showed obstructive apnea during sleep. We diagnosed obstructive sleep apnea syndrome. So we observed pulmonary circulation and measured lung water using the double indicator dilution method (Nihon Koden, MTV-1100) during sleep. During the period of apnea, arterial oxygen pressure and mixed venous saturation decreased, reversely, mean pulmonary arterial pressure rose, lung water (ETV) and central blood volume increased. We considered that the increase of lung water during sleep apnea is caused by hemodynamic change due to hypoxia and increase of venous return. After operation, the value of blood gas assay and apnea index were improved.

We encountered a case that was observed on coronary angiography (CAG) during coronary dissection after coronary angioplasty (PTCA) in which the dissected cavity disappeared on CAG but thrombolytic obstruction in the dissected cavity could be observed by intravascular echocardiography (IVUS). A 67-year-old woman was admitted with a diagnosis of acute myocardial infarction with ST elevation when experiencing chest pain. PTCR was performed for obstruction of the left circumflex artery (LCX) and the stenosis was improved to 90 percent. One month later PTCA was performed on an obstruction lesion in LCX and the feature of the dissected section at the same site was observed by CAG after PTCA. CAG showed that the dissected cavity had disappeared a year and a half later, but IVUS indicated thrombolytic obstruction in the dissected cavity.

We have put forward a hypothesis that the pleural fluid is filtered at the arterial ends of the pleural blood capillaries and is absorbed mainly at the venous ends, partly at the lymphatic channels, as it is in the other tissues. Then we have calculated the pleural liquid pressure following the Starling equation applying the ordinary value of factors. The result is that the calculated pleural liquid pressure is low enough to expand the lung.

The purpose of the study was to investigate the effect of continuous IV administration of midazolam and ketamine on respiratory pattern in six adult volunteers. Midazolam 0.05 mg/kg and ketamine 0.5 mg/kg were given, and then 0.1 mg/kg/hr for midazolam and 1 mg/kg/hr for ketamine were administered continuously. We measured MV, RR and TV (OMR86036), and calculated duty ratio and mean inspiratory flow at the level of 0 and 5 cmH2O CPAP during spontaneous respiration of air with and without 5% CO2. Each parameter was obtained before and 1 hr after the start of IV administration of the drugs. With 5% CO2, MV decreased significantly from 15.5 +/- 1.5 l/min to 11.7 +/- 0.8 l/min at 0 cmH2O CPAP level and from 15.8 +/- 1.8 l/min to 12.6 +/- 1.5 l/min at 5 cmH2O CPAP level, and also mean inspiratory flow decreased significantly from 590 +/- 2 ml/sec to 421 +/- 30 ml/sec at 0 cmH2O CPAP level and from 606 +/- 53 ml/sec to 477 +/- 48 ml/sec at 5 cmH2O CPAP level. TV decreased significantly during sedation at both CPAP levels with or without 5% CO2, while RR and duty ratio tended to increase. It was thought that, when the respiration was stimulated with 5% CO2, the decrease in mean inspiratory flow greatly contributed to the fall in MV during administration of midazolam and ketamine.