cute aortic dissection has a poor prognosis without therapy. Since 1955, DeBakey et al have reported surgical treatment for aortic dissection and classified aortic dissections as 3 types. 1,2 Thereafter, a simpler categorization, the Stanford classification, was proposed in 1970. 3 The most proximal type dissection was subjected to surgery and the peripheral type dissection without severe complications was treated medically. In addition to the site of the aortic dissection, we are also able to detect the state of the false lumen. The thrombosed false lumen was detected by angiography in 1966 4 and by computed tomography (CT) scan in 1981. 5 Several investigators have reported that aortic dissection with thrombosed false lumen has a better prognosis than with open false lumen. However, the method of treating dissecting aorta with open or thrombosed lumen has not yet been clearly determined. The purpose of the present study is to evaluate the long-term prognosis of each type of aortic dissection undergoing medical treatment and to determine the factors that would indicate the most suitable treatment.We have previously reported the results of dissecting aorta with medical treatment. 6 The present study has more patients than in our previous report, and we can determine the condition of false lumen for diagnosing aortic dissection with thrombosed false lumen. MethodsThe subjects in the present study are 263 patients with Japanese Circulation Journal Vol.65, May 2001 aortic dissection medically treated only. They were selected from 541 patients admitted to the Internal Medicine Departments of Chiba University Hospital and 14 affiliated hospitals between 1973 and 1998. Aortic dissection was diagnosed based on the detection of 2 aortic lumens with blood flow or thrombus by enhanced CT, transesophageal echocardiography or autopsy. Patients with high blood pressure were administered antihypertensive drugs, and for a shock state dopamine or dobutamine was used. Although most patients with Marfan's syndrome were operated, there were 9 patients treated only medically. Patients who were found to have an aortic dissection at the chronic phase were excluded from the study. ClassificationAortic dissections are classified according to the site of dissection and the state of false lumen. In the present study, patients were classified into 4 groups: (i) Stanford type A dissection with open false lumen (AO group); (ii) Stanford type B dissection with open false lumen (BO group); (iii) Stanford type A dissection with thrombosed false lumen (AT group); and (iv) Stanford type B dissection with thrombosed false lumen (BT group). At first, the survival rate with medical treatment only was analyzed in each group. Second, the event-free rate was analyzed. Event was defined as death-related with dissection or re-dissection. Third, gender, age, maximum diameter of dissected aorta, and the presence of shock at onset were examined as factors related to the event. StatisticsThe survival rate and event-free rate were analyzed by the Kaplan-M...

A 54-year-old man presented with dyspnea on effort. Echocardiogram revealed reduced apical wall motion of the left ventricle (LV) with extreme hypertrophy of the interventricular septum (IVS). Conventional coronary angiogram showed normal coronary arteries. Endomyocardialbiopsy specimens obtained from the IVS revealed extensive vacuolization of cardiac myocytes and mild fibrosis on light microscopy, and typical lysosomal inclusions with a concentric lamellar configuration were seen with electron microscopy ( Figure 1). With these findings and low plasma ␣-galactosidase activity, he was diagnosed as having Fabry disease. To evaluate the characteristics of the LV, ECG-gated enhanced multislice computed tomography (CT) (Light Speed Ultra, General Electric) was performed with a 1.25-mm slice thickness, helical pitch 3.25. After intravenous injection of 100 mL of iodinated contrast material (350 mgI/mL), CT scanning was performed with retrospective ECG-gated reconstruction at 30 seconds and 8 minutes after injection. In the axial source images, extreme hypertrophy of the IVS and the posterior wall of the LV compared with the apical and lateral walls of the LV could be observed (Figure 2). The apical and lateral portions of the LV revealed lower CT intensity than the IVS in the early phase (arrows), and in the late phase they were abnormally enhanced compared with the IVS, suggesting fibrotic changes in the apical and lateral myocardium. Therefore, we concluded that despite the IVS biopsy results, more fibrotic changes occurred in the apical and lateral portions of the LV rather than in the IVS.

As pulmonary vein (PV) isolation by catheter ablation for paroxysmal atrial fibrillation may cause PV luminal stenosis, digital subtraction angiography or magnetic resonance imaging have been used to evaluate the lumen of the PV. Electrocardiogram-gated multislice computed tomography can evaluate the lumen of the PV from any plane desired after acquisition with excellent spatial resolution. It can also evaluate hyperplasia of soft tissue around the lumen of the PV, which cannot be evaluated by digital subtraction angiography, and may thus serve as an indicator of complications or even the effectiveness of this treatment.

The study examined the association between aortic wall volume (AWV) detected by enhanced computed tomography and coronary artery atherosclerosis observed on angiography. In 180 cases, AWV was measured as the total wall volume of a 7-cm portion of the descending thoracic aorta distal from the tracheal bifurcation. Coronary artery atherosclerosis was angiographically quantified by both Gensini score, in terms of the severity of coronary artery stenosis, and Extent score, in terms of the severity of coronary artery involvement. Mean AWV values between the patients with significant coronary artery stenosis and those without significant stenosis were 9.83+/-4.04 cm3 and 8.09+/-2.39 cm3, respectively (p<0.001). AWV was a significantly independent variable for significant coronary artery disease (p=0.0097) and an Extent score > or = 60 (p=0.0092). Calcification of AWV, however, was not associated with coronary atherosclerosis. The quantification of aortic atherosclerosis was useful for diagnosing coronary artery disease.