Background— Although type B aortic dissection has been treated with β blockers to lower the arterial blood pressure (BP), there has been little evidences about reduction in heart rate (HR). We assessed whether tight HR control improved the outcome of medical treatment in patients with aortic dissection. Methods and Results— From 1997 to 2005, 171 patients with acute aortic dissection medically treated and controlled to lower BP under 120 mm Hg were enrolled. Based on the average HR at 3, 5, and 7 days after the onset, patients were divided into tight HR (<60 beat per minute) control group (32 patients; mean HR of 56.6±3.1 beat per minute) and conventional HR (≥60 beat per minute) control group (139 patients; mean HR of 71.7±8.2 beat per minute). We compared the frequency of aortic events including late organ or limb ischemia, aortic rupture, recurrent dissection, and aortic expansion of >5 mm, and surgical requirement between two groups. During a median follow-up of 27.0 months, late organ or limb ischemia, aortic rupture, recurrent dissection, pathological aortic expansion, and aortic surgery occurred in 0, 8, 14, 39, and 26 patients, respectively. Reduction in aortic events was observed in tight HR control group (12.5%) compared to conventional HR control group (36.0%), (Odds ratio: 0.25, C.I.: 0.08 to 0.77, P <0.01). Conclusions— The present study demonstrated that tight heart rate control improved the outcome of medical treatment in patients with aortic dissection.

The Multi-Institutional IABP Balloon Study Group in Japan (14 institutions) conducted a retrospective nonrandomized study to elucidate the incidence and type of IABP balloon-related complications relative to design and durability of five different clinically available balloons: TMP (n = 960), Kontron (n = 943). Datascope (n = 485), Mansfield (n = 226), and Aries (n = 189) balloons. A total of 2,803 patients (1,973 males, 830 females, mean age 62.1 years) spent a total of 243,856 h on the pump. Forty-nine balloons (1.7%) ruptured as recognized by the appearance of blood in the catheter (39 cases) or console alarm (4 cases). Ten patients required surgical removal of the balloon due to entrapment. Other IABP balloon-related complications requiring surgical intervention or with a lethal outcome occurred in 89 patients (3.2%). They included lower limb ischemia (61 cases), hematoma (11 cases), extensive dissection (6 cases), perforation (5 cases), entrapment without balloon rupture (3 cases), and mesenteric infarction (3 cases). The incidence of rupture, other major complications, and total complications, respectively, for each balloon was 0, 2.7, and 2.7 for TMP, 1.6, 4.3, and 5.9% for Kontron, 4.1, 1.9, and 6.0% for Datascope, 1.3, 2.7, and 4.0% for Mansfield, and 5.8, 3.7, and 9.5% for Aries. In conclusion, the TMP balloon demonstrates a significantly lower rate of rupture while the incidence of other complications for the 5 balloons is not significantly different.

Background Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads. Methods and ResultsIn 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103±44 mmHg. The pressure gradient decreased significantly to 8±16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68±25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1±2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516±286 and 143±34 pg/ml at baseline, decreased significantly to 230±151 and 93±44 pg/ml 3 months after implantation (p=0.027 and 0.028). Conclusion RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM. (Circ J 2005; 69: 536 -542)

rimary malignant lesions of the aorta occur rarely and are associated with a very low survival rate. Common presentations are distal embolic phenomena, 1 aortic dissection, 2 or even occlusion of the aortic lumen. 3 This case report describes a patient with a primary malignant fibrous histiocytoma (MFH) of the thoracic aorta associated with ulcer-like projection (ULP). The aortic mural tumor invaded into the surrounding tissue, not into the aortic lumen, and the radiological appearance mimicked ULP with aortic pseudoaneurysm formation. To our knowledge, a primary aortic tumor with ULP has not been previously reported and knowledge of the characteristic imaging findings is clinically important. Case ReportA 57-year-old woman with a 1-month history of heartburn and who suffered from progressive back pain was admitted to hospital. Her past medical history was rheumatoid arthritis. Physical examination revealed: blood pressure, 130/ 90 mmHg; pulse, 96 beats/min; respiration, 16 breaths/min; and body temperature, 36.8°C. Lung and cardiac sounds were normal. Blood count revealed slight anemia (hemoglobin level: 10.5 g/dl). Other laboratory data, including blood chemistry, coagulation studies, and cardiac enzymes, were not abnormal. Precontrast and contrast-enhanced dynamic computed tomographic (CT) imaging was performed using a 64-row multislice scanner (Aquilion-64, Toshiba). Contrast agent (100 ml) at an iodine concentration of 300 mg/ml (Iomeron, Eisai) was injected at a rate of 4 ml/s, and arterial phase imaging was performed 30 s later. The delay time was 3 min for delayed phase imaging. CT images in the arterial phase showed a 6.5×4.3×6.7 cm aortic Circulation Journal Vol.71, October 2007 lesion with ULP in the thoracic descending aorta (Fig 1).The attenuation values (in Hounsfield units (HU)) were measured at regions of interest (ROIs) in the aortic lesion in each phase. Attenuation of each ROI was 53 HU, 59 HU, and 62 HU on the precontrast CT, arterial-phase, and delayed-phase CT images, respectively. Because the case was initially diagnosed as a pseudoaneurysm with ULP and possible impending rupture, emergency endovascular stentgraft placement was selected as the treatment, using a tailored 100-mm stent-graft device (Gianturco Z-stent with UBE woven Dacron graft material). The immediate post interventional result showed complete exclusion and thrombosis of the ULP (Fig 2). One month after the stent -graft treatment, the ULP was completely excluded but the aortic mass lesion showed no regression in size on CT imaging. Two months later, the aortic mass lesion had increased in size and there was distinct enhancement on contrastenhanced CT imaging (Fig 3). The patient was referred for surgery during which it was found that a tumor of the thoracic aorta had solidly invaded the pulmonary hilus and was considered to be nonresectable. Surgical biopsy was performed. On histological examination, the tumor comprised a haphazardly arranged mixture of pleomorphic spindle and giant cells with frequent mitosis. Immunohis...

A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.