Evaluation by Contrast-Enhanced Electron Beam Computed Tomography of Myocardial Perfusion and Tissue Characteristics in Congenital Aortic Stenosis

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• The evaluation of myocardial perfusion and tissue characteristics gives useful information regarding the indication for surgery. In the present study, two-phase contrast enhanced electron beam computed tomography (EBT) was used to quantitatively examine myocardial perfusion and the tissue characteristics of the left ventricular (LV) myocardium in congenital aortic stenosis (AS). The AS group comprised 15 patients and the control group had 14 non-AS patients. Myocardial ischemia and tissue characteristics were evaluated by the ratio of the incremental CT number of the myocardium (M) and the lumen (L) of the LV (M/L) in, the early phase with and without dipyridamole (Dp) loading and in the late phase after enhancement (respectively). In a comparison betweenthe AS group and the controls, mean early M/Ls were significantly lower in the AS group than in the controls (20±5% vs 37±10%, p<0.01) and mean late M/Ls in the AS group were also significantly lower (47±11% vs 62±13%, p<0.01). In the AS patients, early M/Ls in the subendocardial and apical regions were especially lower than those of other segments, but the late M/Ls in these segments were inversely higher than those of other segments. These results suggest 2 things: (1) the existence of latent LV myocardial ischemia in AS patients, which is probably because of a hypertrophied LV wall, in turn caused by afterload, and (2) the presence of more myocardial ischemia and interstitial fibrosis in the subendocardial and apical regions of the AS heart. Using Dp loading for the AS patients increased the clarity of the contrast images. Contrast-enhanced EBT is useful for evaluating myocardial characteristics and perfusion in AS, and gives new insight into the LV wall characteristics in AS, as well as an indication for surgical correction of congenital AS. (Circ J2003; 67: 998-1002)

• 2003-11-20

著者

• 内藤 博昭

  国立循環器病センター 小児科

• Tsubata Shinichi

  Toyama Medical And Pharmaceutical University

• Kamiya Tetsuro

  Department of Pedeatrics

• Echigo Shigeyuki

  Department of Pediatrics, National Cardiovascular Center

• Naito Hiroaki

  Department Of Radiology National Cardiovascular Center

• Naito Hiroaki

  Department Of Radiology National Cardiovascular Center Osaka University Graduate School Of Medicine

• Sugiyama Hisashi

  Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center

• Tsukano Shinya

  Department of Pediatric Cardiology, National Cardiovascular Center

• Kamiya Tetusro

  Division Of Pediatrics National Cardiovascular Center

• Tsukano Shinya

  Department Of Pediatric Cardiology Division Of Cardiology National Cardiovascular Center

• YOSHIBAYASHI MUNEO

  Departments of Pediatrics, National Cardiovascular Center

• Echigo Shigeyuki

  The Japanese Society of Pediatric Cardiology and Cardiac Surgery Joint Working Groups

• Kamiya Testuro

  Department of Pediatrics National Cardiovascular Center

• Echigo Shigeyuki

  Department Of Pediatrics Nara Medical University

• Echigo Shigeyuki

  Department Of Pediatrics National Cardiovascular Center

• Echigo Shigeyuki

  Department Of Pediatric Cardiology National Cardiovascular Center

• Tsubata Shin-ichi

  Department Of Pediatrics National Cardiovascular Center

• Tsukano Shinya

  Department Of Pediatrics National Cardiovascular Center Osaka University Medical School

• KAMIYA TETSURO

  The Department of Pediatrics. National Heart Institute. Osaka

• Kamiya Tetsuro

  Department Of Radiology National Cardiovascular Center

• Kamiya Tetsuro

  Department Of Pediatrics National Cardiovascular Center

• 内藤 博昭

  Department Of Radiology National Cardiovascular Center Osaka University Graduate School Of Medicine

• Yoshibayashi Muneo

  Department Of Pediatrics National Cardiovascular Center

• Yoshibayashi Muneo

  Departments Of Radiology National Cardiovascular Center

• Naito Hiroaki

  Department Of Analytical Radiology Center Osaka University

• Noda Hiroyuki

  National Cardiovascular Center

• Kamiya Tetsuro

  Department Pediatrics National Cardiovascular Center

• Kamiya Tetsuro

  Department Of Pediatrics Kyoto University Faculty Of Medicine.

• Echigo Shigeyuki

  Department Of Pediatrics Cardiac Surgery National Cardiovascular Center Osaka.

• Kamiya Tetsuro

  Dept. Of Pediatrics Kyoto Univ.

• Kamiya Tetsuro

  National Cardiovascular Center. Dept. Of Pediatrics

• Sugiyama Hisashi

  Department Of Pediatrics National Cardiovascular Center

• Naitoh Hiroaki

  Department Of Radiology National Cardiovascular Center Osaka University Graduate School Of Medicine

• Sugiyama Hisashi

  Department Of Pediatric Cardiology National Cardiovascular Center

• Echigo Shigeyuki

  Pediatrics National Cardiovascular Center

• Kamiya Tetsuro

  Division Of Cardiac Surgery National Cardiovascular Center

• Naito Hiroaki

  Biomedical Center Osaka University

• Kamiya Testuro

  Departjnents Of Pediatrics And Cardiovascular Surgery Natlonal Cardlovascular Center

• KAMIYA Tetsuro

  Department of Cardiovascular Pediatrics, National Cardiovascular Center

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