Congenital pericardial defect: a case of right pericardial partial absence with normal parietal pleura [corrected].

Congenital pericardial defect (CPD) is a rare cardiovascular anomaly. A right-sided CPD is much rarer than left-sided defects. Usually both the pericardium and parietal pleura are absent. We report a rare case of a right partial CPD involving the right atrial appendage, suspected by computed tomography and cine magnetic resonance imaging, and confirmed by thoracoscopy, which also demonstrated a normal parietal pleura.

A case of right renal artery originating from the thoracic aorta.

The renal arteries normally originate from the abdominal aorta between the first and second lumbar vertebrae. The main renal artery arising from the thoracic aorta is an uncommon anomaly. Here we report a rare case of a right renal artery originating above the celiac axis. A 38-year-old male underwent computed tomographic angiography in preparation for being a renal donor, and two right renal arteries were observed. A main renal artery arose from the thoracic aorta at the 11th thoracic vertebral level, and an accessory renal artery originated from the abdominal aorta at the renal hilum.

A multicenter, open-label study of an intravenous short-acting ß1-adrenergic receptor antagonist landiolol hydrochloride for coronary computed tomography angiography by 16-slice multi-detector computed tomography in Japanese patients with suspected ischemic cardiac disease.

BACKGROUND: During coronary computed tomography (CT) angiography (CCTA), ß-blockers (ß-adrenergic receptor antagonists) have commonly been used to lower heart rate and improve image quality. OBJECTIVES: The aim of this study was to investigate the image quality-improving effect as well as the heart rate-lowering effect of landiolol hydrochloride (an intravenous short-acting ß1-adrenergic receptor antagonist) in CCTA by 16-slice multi-detector CT (MDCT). METHODS: A total of 39 subjects suspected of having ischemic cardiac disease and requiring CCTA received 0.125 mg/kg of landiolol hydrochloride to study the efficacy and safety of landiolol hydrochloride in a multicenter open-label clinical study. The endpoint was the diagnosable proportion (proportion of subjects whose coronary stenosis was diagnosable). RESULTS: The diagnosable proportions for the reconstruction images at mid-diastole were 56.0 %. The diagnosable proportions for the optimal reconstruction images were 65.4 %. The mean heart rate-lowering effect was observed soon after administration of landiolol hydrochloride; the peak of the effect was reached in 3-5 min, and the effect wore off in 30 min after completion of administration. The mean heart rate-lowering proportion at that time was -14.46 ± 8.4 %. CONCLUSIONS: Landiolol hydrochloride was confirmed to reduce heart rate significantly and rapidly after intravenous injection and this suggests that the study drug is a safe and useful agent for improving the image quality of CCTA by 16-slice MDCT.

A case of right double inferior vena cava with circumcaval ureter.

Congenital inferior vena cava (IVC) anomalies are silent and detected incidentally on imaging. Double IVC is the most common IVC anomaly and is usually characterized by the presence of an IVC on each side of the abdominal aorta. In contrast, right double IVC, which is defined as two post-renal IVCs positioned to the right of the abdominal aorta, is seldom recognized. We report a rare case of a complete right double IVC with a circumcaval ureter that was incidentally detected by CT and describe the embryological and clinical implications.

A randomized, double-blind, placebo-controlled, phase III study of the short-acting ß1-adrenergic receptor blocker landiolol hydrochloride for coronary computed tomography angiography in Japanese patients with suspected ischemic cardiac disease.

OBJECTIVES AND BACKGROUND: The objective of this study was to investigate the image quality-improving and heart rate-lowering effects of landiolol hydrochloride (a short-acting ß1-adrenergic receptor blocker) on coronary computed tomography angiography (CCTA). During CCTA, ß-adrenergic receptor blockers have been commonly used to lower heart rate and improve image quality. METHODS: A total of 258 subjects suspected of having ischemic cardiac disease and requiring CCTA were randomized to either a landiolol hydrochloride 0.125 mg/kg group or placebo group to study the efficacy and safety of landiolol hydrochloride in a multicenter, double-blind, randomized parallel study. The primary endpoint was the diagnosable proportion (proportion of subjects whose coronary stenosis was diagnosable). RESULTS: The diagnosable proportions about the reconstruction images at mid-diastole were 68.2 and 38.2 % in the landiolol hydrochloride and placebo group, respectively, indicating significant superiority of landiolol hydrochloride over placebo (p < 0.0001). The diagnosable proportions about the optimal reconstruction images were 81.4 and 54.2 % in the landiolol hydrochloride and placebo group, respectively, indicating significant superiority of landiolol hydrochloride over placebo (p < 0.0001). The mean heart rate-lowering effect was first observed soon after administration of landiolol hydrochloride, was most marked at 3-5 min, and disappeared 30 min after completion of administration. The mean heart rate-lowering proportion at that time was -19.1 ± 8.1 % and -5.9 ± 9.7 % in the landiolol hydrochloride and placebo groups, respectively, showing a significantly higher proportion in the landiolol hydrochloride group. CONCLUSIONS: Landiolol hydrochloride was confirmed to significantly and rapidly lower heart rate after intravenous injection, suggesting that it is a safe and useful agent for improving the image quality of CCTA.

Dose-finding study of landiolol hydrochloride: a short-acting ß1-blocker for controlling heart rate during coronary computed-tomography angiography in Japan.

INTRODUCTION: Coronary computed-tomography angiography (CCTA) has high diagnostic performance, but it sometimes does not allow evaluation because of artifacts. Currently, the use of a ß-blocker is recommended to prevent motion artifacts, but the ß-blocker (metoprolol, propranolol, etc.) commonly used has a slow onset and long duration of action. Landiolol hydrochloride is an intravenous ß1-blocker with a very short half-life. We investigated the efficacy and optimal dose of this drug for reduction of heart rate in patients undergoing CCTA. METHODS: Eighty-seven subjects with ischemic heart disease were divided into three groups to receive landiolol hydrochloride at a dose of 0.125 (Group L), 0.25 (Group M), or 0.5 mg/kg (Group H). CCTA was performed at 3-7 min after administration, and heart rate, blood pressure, and image quality were assessed. RESULTS: Heart rate decreased rapidly after completion of landiolol hydrochloride administration in all groups, with a heart rate reduction of 15.55 ± 6.56% in Group L, 16.48 ± 7.80% in Group M, and 21.49 ± 6.13% in Group H (Group L vs Group H, P = 0.0008; Group M vs Group H, P = 0.0109). Since there was no significant difference in heart rate during imaging among the three groups, although there was a significant difference between groups L and H and groups M and H in terms of percent change in heart rate, coronary stenosis was diagnosable in all groups with no significant difference. CONCLUSION: Landiolol hydrochloride showed a rapid onset and short ß-blocking effect, and was most effective at a dose of 0.5 mg/kg. However, the diagnosable proportion had no significant differences among the three groups in CCTA. Therefore, the clinically recommended dose was 0.125 mg/kg or less, considering the heart rate of patients with suspected coronary stenosis during CCTA.

A randomized, double-blind, placebo-controlled, phase II dose-finding study of the short acting ß1-blocker, landiolol hydrochloride, in patients with suspected ischemic cardiac disease.

The purpose of this study was to compare the safety and efficacy of the short-acting ß1-receptor blocker, landiolol hydrochloride (0.06 and 0.125-mg/kg), to placebo during coronary computed tomography angiography (CTA) in a phase 2 dose-finding study. A total of 183 patients suspected of having ischemic cardiac disease and scheduled to undergo an invasive coronary angiography were randomized to groups treated with landiolol hydrochloride (0.06 or 0.125-mg/kg) or placebo. The heart rate, safety, and the performance of coronary diagnosis using landiolol hydrochloride were evaluated in a multicenter, double-blind, randomized, parallel study. The patients' heart rates during the coronary CTA were 67.6 ± 8.7 and 62.6 ± 7.8 beats/min in the 0.06 and 0.125-mg/kg landiolol hydrochloride groups, respectively, both of which were significantly lower than the heat rate of 73.7 ± 11.8 beats/min in the placebo group (P = 0.003 and P < 0.001, respectively). No adverse events or reactions occurred at an incidence of 5 % or greater, confirming the safety of landiolol hydrochloride. The proportion of correctly classified patients was significantly higher in the 0.125-mg/kg landiolol hydrochloride group than in the placebo group (73.6 vs. 50.0 %). Landiolol hydrochloride at doses of 0.06 and 0.125-mg/kg significantly decreased the heart rate compared with a placebo. The present findings suggest that landiolol hydrochloride is safe and useful at a dose of 0.125-mg/kg to improve coronary diagnostic performance during coronary CTA.

Major venous anomalies are frequently associated with horseshoe kidneys.

BACKGROUND: Several cases of horseshoe kidney with anomalous inferior vena cava (IVC) have been described, but there have been no reports of the incidence and variation of anomalous IVC in patients with horseshoe kidneys detected using multidetector row computed tomography (MDCT). METHODS AND RESULTS: 105 patients with horseshoe kidneys were evaluated with MDCT and a variety of venous anomalies were identified in 30 patients (28.6%). Anatomical variations of the renal vein were identified in 24 patients (22.9%), which was no higher than the reported incidence in the general population. However, variations of the IVC were identified in 6 patients (5.7%), which was a higher incidence than expected to be found in the general population: 1 pre-isthmic IVC with retrocaval ureter, 2 double IVCs posterior to the horseshoe kidney, 2 left IVCs posterior to the horseshoe kidney, and 1 azygos continuation of the IVC. CONCLUSIONS: Horseshoe kidneys are frequently found in patients with other venous, and particularly IVC, anomalies, which should be evaluated using MDCT as part of treatment planning.

One-year follow-up and convalescence evaluated by nuclear medicine studies and 24-hour holter electrocardiogram in 11 patients with myocardial injury due to a blunt chest trauma.

BACKGROUND: There are few reports on long-term convalescence with regard to cardiac injury caused by blunt chest trauma. Nuclear medicine study of the heart (NMSH) in the early stages of injury is reportedly superior to detect the correlation between injury and fatal arrhythmia. Therefore, we prospectively performed NMSH and Holter electrocardiogram (ECG) in the early and chronic stages for a cardiac injury patient, and we longitudinally examined the recovery process and the occurrence of fatal arrhythmia. METHODS AND RESULTS: A total of 202 patients with blunt chest trauma were admitted to our hospital between April 2006 and January 2007. Of 65 patients who were diagnosed with cardiac injury by ECG, a myocardial enzyme, or cardiac ultrasonography, 11 were enrolled in this study because they agreed to outpatient visiting for regular examinations for 1 year. NMSH showed positive findings in 6 of the 11 patients in the acute period of <1 month. Twelve months later, five patients improved but still exhibited protracted cardiac damage without complete recovery. Among the six patients in whom NMSH showed positive findings, Holter ECG indicated an abnormal finding in two patients in the acute period and in four patients in the chronic period, and detected one patient with a nonsustained ventricular tachycardia in the chronic period. CONCLUSION: Cardiac injuries may exacerbate cardiac functions and lead to fatal arrhythmia during the chronic period. Therefore, evaluating recovery for at least 12 months after myocardial damage is necessary to prevent sudden cardiac death.

Time course of reversed cardiac remodeling after pulmonary endarterectomy in patients with chronic pulmonary thromboembolism.

To evaluate the time course of reversed remodeling after pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension(CTPEH), we studied 22 patients (age: 60 +/- 13 years) with MRI immediately before, 1 month, 3 months, and 6 months after PEA. MRI included assessment of biventricular function, aortic and pulmonary artery(PA) flow, and right ventricular (RV) overload using the ratio of RV-to-biventricular diameter. Except in one patient, who died 2 months post-surgery, clinical improvement occurred early after PEA (NYHA class: 3.3 +/- 0.6 to 1.5 +/- 0.8, p < 0.0001) with a decrease of systolic pulmonary artery pressures (79 +/- 14 to 44 +/- 14 mmHg, p < 0.0001). At 1 month post PEA, RV end-diastolic volumes decreased (198 +/- 72 to 137 +/- 59 ml, p < 0.0001), and the RV ejection fraction (EF) improved (31 +/- 9 to 47 +/- 10%, p < 0.0001). No further significant improvement in pulmonary pressures or RV function occurred at 3 months or 6 months. Although no significant change was found in LV volumes or function, aortic flow increased early after surgery. PEA had only a beneficial effect on right PA flow. RV overload decreased early after PEA (ratio RV-to-biventricular diameter: before: 0.67 +/- 0.04, after: 0.54 +/- 0.06, p < 0.0001), showing a good correlation with the improvement in RVEF (r = 0.7, P < 0.0001). In conclusion, reversed cardiac remodeling occurs early after PEA, to slow down after 1 month. At 6 months, cardiac remodeling is incomplete as witnessed by low-normal RV function and residually elevated PA pressures.

Sensitivity and specificity of CT in the diagnosis of inflammatory abdominal aortic aneurysms.

PURPOSE: The purpose of this study is to assess the diagnostic ability (sensitivity and specificity) of CT in the diagnosis of inflammatory abdominal aortic aneurysm (IAAA) and to quantitatively evaluate its features. METHOD: A retrospective survey of 355 consecutive patients with abdominal aortic aneurysm and iliac artery aneurysm who underwent CT examination and surgical repair yielded 18 patients with operatively confirmed IAAA. The sensitivity, specificity, and diagnostic accuracy of CT were evaluated in this review. Eighteen IAAAs were then analyzed in terms of distribution and degree of perianeurysmal fibrosis as well as time-dependent change of CT values of the aneurysmal wall on contrast-enhanced CT. Complications related to IAAA were also determined. RESULTS: Fifteen of the 18 cases of IAAA could be easily diagnosed on CT prior to surgical repair. Three false-negative and one false-positive case were found. This gives a sensitivity rate of 83.3% for this imaging technique, with specificity and accuracy rates of 99.7 and 93.7%, respectively. Thickening of the aortic wall was noticed mostly in the anterolateral wall of the aneurysm as compared with the posterior wall. The thickness of the perianeurysmal fibrosis correlated neither with the size of aneurysm nor with the inflammatory reaction such as erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count. CT indicated the complications in 7 of 18 patients with IAAA. These included hydronephrosis, aortoenteric fistula, and infected iliac aneurysm. CONCLUSION: CT scan with contrast enhancement was a highly reliable imaging modality for the diagnosis of IAAA.