Effect of the Great East Japan Earthquake on cardiovascular diseases--report from the 10 hospitals in the disaster area.

BACKGROUND: We reported an increased occurrence of cardiovascular diseases (CVDs) after the Great East Japan Earthquake by examining ambulance records, but it had to be confirmed by cardiologists. METHODS AND RESULTS: We enrolled patients admitted to the cardiology department of the 10 hospitals in the disaster area from 4 weeks prior to 15 weeks after March 11 in the years 2008-2011 (n=14,078). The weekly occurrence of several CVDs, including heart failure (HF), pulmonary thromboembolism (PTE) and infectious endocarditis (IE), was sharply and significantly increased after the Earthquake. CONCLUSIONS: The Disaster caused significantly increases in the occurrence of HF, PTE and IE.

Effectiveness of right or left radial approach for coronary angiography.

The transradial approach for catheterization is becoming increasingly more popular. At present, the choice of the right or left radial artery depends on the operator's preference. We examined how the laterality influenced the effectiveness of the approach. Employing Judkins-type catheters, we performed coronary angiography in 232 patients with the left approach and in 205 patients with the right approach. Although access time did not differ between the two groups of patients, the duration of catheter manipulation was shorter in the left- than in the right-approach group (11.7 +/- 5.9 vs. 9.8 +/- 4.4 min; P < 0.001). Because of the shorter duration of catheter manipulation, the total procedural duration was shorter in the left-approach group (13.7 +/- 6.4 vs. 11.4 +/- 4.8 min; P < 0.001). The fluoroscopy time was shorter in the left- than in the right-approach group (3.7 +/- 2.5 vs. 5.0 +/- 3.3 min; P < 0.001). The amount of contrast material did not differ between the groups (79 +/- 27 vs. 83 +/- 25 ml). The rate of guidewire usage to engage the coronary ostium was higher in the right- than in the left-approach group because of the severe tortuosity of the right subclavian artery (20/205 vs. 0/232; P < 0.001). Thus, for operators with significant experience, the left radial approach may provide increased procedural efficacy for coronary angiography compared to the right radial approach.

A new miniature catheter with side-holes for percutaneous transradial or transbrachial coronary angiography.

The percutaneous arm approach through the radial or brachial artery for diagnostic cardiac catheterization has advantages, such as a lower incidence of access-site complications and decreased patient discomfort, particularly when smaller diameter catheters are employed. However, the pressure produced by high-flow jets of contrast material exiting from an end-hole against the vascular wall can cause coronary dissection or myocardial blushing. To avoid this type of complication, we designed and developed a new miniature (4 French) catheter with two side-holes for coronary angiography. Under conditions similar to those of a clinical situation, we obtained the relationship between the pressure produced by the jets exiting from an end-hole and the force with which the tip of the catheter was pushed against the vascular wall. The presence of the side-holes substantially decreased the pressure at forces ranging between 0 and 15 gf, and at all injection rates (2.0 3.5 ml/second), but their location did not affect the pressure. In a preliminary clinical study, the new catheters with side-holes were feasible and effective for coronary angiography through the radial artery. Furthermore, the distribution of contrast material decreased the incidence of dislodgement of the catheter from the coronary ostia and enabled good visualization of the coronary ostia and proximal branches.