Percutaneous coronary intervention for left main trunk ostial stenosis in a patient with Takayasu's arteritis.

Takayasu's arteritis with coronary artery involvement is a rare event especially in men. We will report on a male case of Takayasu's arteritis undergoing stent implantation for left main trunk (LMT) ostial stenosis. The case was that of a 25-year-old man who had been diagnosed with Takayasu's arteritis but there was no significant large vessel involvement. He presented with effort angina and a multidetector computed tomography (MDCT) revealed severe ostial stenosis in the LMT. A coronary angiography confirmed this finding and a virtual histology intravascular ultrasound (VH-IVUS) showed fibrous thickening of the intima and media with little necrotic lipid core and calcification. We performed a bare metal stent implantation for this lesion. No restenosis was found in the MDCT at the 6 month follow-up. Our experience suggests that the VH-IVUS is useful for examining the gross structure and component of the coronary vascular wall and for determining the choice of treatment in patients with Takayasu's arteritis.

Efficacy of intracoronary administration of a short-acting ß-blocker landiolol during reperfusion in pigs.

BACKGROUND: Although ß-blockers are used to prevent myocardial ischemia/reperfusion injury, the risk of heart failure has limited ß-blocker therapy in patients with acute myocardial infarction. This study evaluated efficacy of intracoronary administration of the short-acting ß-blocker, landiolol, during reperfusion in pigs with acute myocardial ischemia. METHODS AND RESULTS: In the non-ischemic model landiolol administered into the left anterior descending coronary artery (LAD) inhibited in a dose-dependent fashion segmental wall thickening (SWT) in the anterior LV wall without altering SWT in the posterior LV wall and without prolonged depression of global LV function except for the highest dose. In the ischemic model with 60 min LAD occlusion followed by reperfusion the medium dose landiolol administered into the LAD 1 min before and for 10 min during reperfusion inhibited initial recovery of SWT in the anterior LV wall but improved SWT in this region and global LV function late after reperfusion. Ultrastructural studies showed inhibition of sub-sarcolemmal bleb formation by treatment with landiolol 10 min after reperfusion associated with the inhibition of CK-MB release and the reduction of infarct size. There was no significant difference in CK-MB release and infarct size between landiolol treatment for 10 min and 180 min during reperfusion. CONCLUSIONS: Selective and brief intracoronary administration of landiolol during reperfusion enhances myocardial salvage without causing deterioration of global LV function.

Three-dimensional echocardiographic assessment of left ventricular function in takotsubo cardiomyopathy.

We evaluated left ventricular (LV) function by three-dimensional echocardiography (3DE) in a patient with takotsubo cardiomyopathy (TC). An 82-year-old man was admitted to our hospital with a suspicion of acute myocardial infarction but was diagnosed as TC by coronary angiography and left ventriculography (LVG). Three-dimensional echocardiography showed circular asynergy from the midventricle to the apex associated with hyperkinesis of the base and volumetric data very close to those obtained by LVG. Thus, 3DE is a useful tool in evaluating regional wall motion abnormalities and LV volume in patients with TC.