A 64-year-old woman with an atrial septal defect (ASD) closure was referred to our hospital ; she presented with dyspnea at the time of admission. An echocardiogram showed mitral valve regurgitation, tricuspid valve regurgitation, and a residual ASD shunt. Coronary angiography revealed coronary-pulmonary artery fistulae originating from both the left anterior descending coronary artery and the right coronary artery (RCA). Closure of the coronary-pulmonary artery fistulae was performed in addition to mitral valve replacement, tricuspid valve plasty and ASD closure. The postoperative course was uneventful. Coronary angiography was performed, and some of the contrast medium remained in parts of the RCA fistulae. Ligation of the fistulae and direct closure of the intra-pulmonary openings during cardiopulmonary bypass had to be performed because of complete obstruction of the coronary-pulmonary artery fistulae.

The purpose of this study was to investigate the prognostic value of change in heart rate (HR) response to oxygen uptake (VO₂) during exercise in patients with coronary heart disease (CHD).We retrospectively studied 204 patients with CHD who were sent to our exercise testing laboratory between August 1983 and February 1985. The following equation was used to determine the relation between VO₂ and HR during a graded treadmill exercise test: HR= A・exp ^B･VO2, where the constant b was defined as the inclination of the exponential curve-fitting model for oxygen uptake and heart rate during graded treadmill exercise (I-ECOH). Data on mortality were determined in May 2006 by examining medical records from the outpatient clinic and/or conducting telephone interviews with the patients or their families. Among the 204 study subjects, there were 54 cardiac deaths during the entire 20-year follow-up period. Kaplan-Meier survival curves for 20 years of follow-up demonstrated a survival rate of 81.3% for patients with a lower I-ECOH (＜35) and 56.0% for those with a higher I-ECOH (≧35), showing a significant difference in survival (p＜0.001). Multivariate Cox proportional hazards analysis revealed left ventricular ejection fraction (LVEF), peak oxygen uptake (VO₂ peak) and I-ECOH as independent predictors of survival. In this analysis, the prognostic power of minutes ventilation/carbon dioxide output (VE/VCO₂)slope was insignificant. The patients were divided into two groups with (＜45%) and without (≧60%) LV dysfunction using LVEF for more detailed analysis. The VO₂ peak and VE/VCO₂ slope were significant independent predictors of survival in patients with LV dysfunction. However, the I-ECOH was a significant independent predictor of survival in patients with and without LV dysfunction. Our data indicate that I-ECOH provides independent prognostic information on CHD patients with and without LV dysfunction.

A study was conducted to clarify the validity and availability of inclination of exponential curve-fitting model for oxygen uptake (VO₂) and heart rate (HR) during incremental exercise (IECOH) as an index of cardio-pulmonary functional reserve in healthy subjects. A treadmill exercise test was used to measure the VO₂ (L/kg/min) and HR (beat /min) during incremental exercise of all subjects. The IECOH was derived from the following equation : HR=A⋅exp^B·VO₂. The constant “B” represents the IECOH. The following three identifications were made : 1) the relationship between maximal oxygen uptake (VO₂max) and IECOH in 82 healthy males ; 2) the relationship between IECOH and age in 428 healthy males and females ; 3) the effect of physical training in 8 healthy males.
There was inverse correlation between IECOH and VO₂max (r= -0.824) . And also, there were inverse correlations between IECOH detected from submaximal tests and VO₂max (above r=-0.6) . There were no differences in the IECOH detected from maximal and submaximal tests. In Bland-Altman plot method, accuracy of measurment in the IECOH detected from submaximal exercise test was precise. There was a significant relationship between IECOH and age in male and female subjects (r=0.499 and r=0.310, respectively) . Physical training increased VO₂max and decreased IECOH significantly. The VO₂max before and after physical training correlated inversely with the IECOH before and after physical training (r=-0.514) .
In conclusion, these results suggest that IECOH is adequate and useful as an index of cardio-pulmonary functional reserve which can be measured by the submaximal exercise test in healthy subjects.

Papillary fibroelastoma is a rare, benign heart tumor. We successfully treated a patient with multiple fibroelastomas derived from both the mitral valve and the chordae by surgical excision. A 59-year-old man was admitted to our hospital with a history of myocardial infarction three years before admission. Preoperative transthoracic and transesophageal echocardiograms showed multiple, mobile, rounded cardiac tumors in the left ventricular cavity and the mitral valve. Under cardiopulmonary bypass, we performed prosthetic mitral valve replacement after excising the valve with the tumor. The patient was discharged and remains asymptomatic. Histologic examination of 6 specimens of the excised tumor confirmed the diagnosis of papillary fibroelastoma. When papillary fibroelastoma is diagnosed, surgical treatment must be considered because of the high risk of embolization.

A study was performed to evaluate the physical exercise characteristics of 29 Japanese elite judo athletes by treadmill exercise test. Functional aerobic impairment (FAI), heart rate impairment (HRI) and peripheral circulatory impairment (PCI) in the judo athletes were not significantly different from those of normal sedentary subjects. However, myocardial aerobic impairment (MAI) was lower than in normal sedentary subjects. %VO₂max at the anaerobic threshold (AT) was 57.5±3.3% in male, and 57.0±4.3% in female judo athletes. %HRmax at AT was 72.4±3.8% in males, and 75.2±5.3% in females.
These findings suggest that functional aerobic capacity and peripheral circulatory function in Japanese elite judo athletes are not significantly different from those of normal sedentary subjects, but that judo athletes have high left ventricular function.
The blood biochemical profile and urinalysis date revealed that values of muscle injury enzymes, plasma uric acid and cholesterol were increased with relatively high freqency in elite judo athletes. Similar data were also obtained in individuals with suspected diabetic nephropathy and rhabdomyolysis.

A study was conducted to clarify training ability in the recovery phase after coronary artery bypass graft surgery (CABG) . Thirty-one patients who underwent CABG were divided into four groups according to the degree of revascularization and graft patency: complete revascularization with graft patency (group A), complete revascularization without graft patency (group B), incomplete revascularization with graft patency (group C) and incomplete revascularization without graft patency (group D) . In all patients, exercise training was started one month after CABG and continued for one month. Treadmill exercise testing was performed at three points during the clinical course (one month before CABG, one month after CABG and at the end of exercise training) . Functional aerobic impairment (FAT), myocardial aerobic impairment (MAT), peripheral circulatory impairment (PCI) and electrocardiogram were measured at these points. The results obtained were as follows:
1) FAI was improved significantly after CABG as compared with before CABG in groups A and C, and was also improved significantly after exercise training as compared with before training in groups A and C. The degree of improvement in FAI in group A was larger than in group C.
2) Althought MAT was improved significantly after CABG as compared with before CABG in groups A and C, it was improved significantly after exercise training as compared with before training only in group A.
3) PCI remained unchanged before and after CABG in all groups. However, it was improved significantly after training as compared with before training in groups A and C.
4) The number of patients with a positive finding in the exercise test was reduced by CABG in all groups, and was decreased by training only in group A. However, CABG produced a significant decrease in groups A, B and C.
In conclusion, the present findings suggest that while graft patency is probably a major factor, the degree of revascularization may play only a subsidiary role in determining trainability soon after CABG.

A study was conducted to evaluate the effects of exercise training for cardiac rehabilitation. 69 patients with coronary artery disease were assigned to a low intensity exercise training program, which lasted for 3 months. The target heart rate for the exercise program was set at 50-60% of maximal heart rate. For comparison, the study patients were divided into 2 groups. 25 patients who had undergone CABG were assigned to group A and 42 patients who had not undergone CABG were assigned to group B. A symptom-limited treadmill exercise test was performed before and after the exercise training program in each patient. Oxygen uptake (VO₂), SBP, HR and PRP were measured at rest, submaximal workload and workload at the end point during the treadmill exercise test.
In addition, FAT, LVI and PCI were calculated. The parameters measured before and after exercise training were compared in order to assess the effects of the exercise training program. Our findings showed that exercise training was effective for improving exercise tolerance and submaximal exercise capacity in patients with coronary artery disease, particularly those who had undergone CABG.

This study examined the effects of physical training on exercise hyperpnea (EH) in patients on hemodialysis (HD) . In baseline, 17 (trained group) and 12 (control group) patients on HD performed symptom limited exercise test using a treadmill. Trained group, but not control group, exercised 2 to 3 times weekly on non-dialysis days under medical supervision. Exercise testing was repeated 20 weeks after the baseline. Ventilatory response to exercise was evaluated using the regression slope relating minute ventilation (VE) to carbon dioxide output (VCO₂ ) during incremental exercise (VE/VCO₂ slope) below the point of respiratory compensation. In trained group, VE, oxygen uptake ( VO₂) and VCO₂ at peak exercise increased and VE/VO₂ and VE/VCO₂ decreased after physical training, respectively. No change was observed in control group. VO₂ at the anaerobic threshold increased in trained group, but not in control group. The post training VE/VCO₂ slope (33.9±5.0) was significantly (p<0.05) lower than the pre-training slope (38.0± 4.8) and remained constant in control group. In trained group, changes in the VE/VCO₂ slope correlated with those in peak VO₂ (p<0.05) . These results suggest that physical training decreases EH in patients on HD and that it correlates with changes in exercise tolerance.

This study was conducted to clarify the validity and availability of inclination of exponential curve-fitting model for oxygen uptake (VO₂) and heart rate (HR) during incremental exercise (I-ECOH) as an index of cardio-pulmonary functional reserve in patients with ischemic heart disease (IHD). A treadmill exercise test was used to measure the VO₂(L/kg/min) and HR (beat/min) during incremental exercise of all subjects. I-ECOH was derived from the following equation : HR=A·exp^B·VO2. The constant "B" represents I-ECOH. The following two identifications were made : 1) the relation between peak oxygen uptake (VO₂peak) and I-ECOH in IHD patients with normal left ventricular function and with chronic heart failure (CHF); 2) the relation between I-ECOH and the New York Heart Association (NYHA) functional classification of IHD patients with CHF.There were significant differences among IHD patients with normal left ventricular function, CHF patients, normal controls and long distance runners in I-ECOH and VO2peak, respectively (p<0.001). There were inverse correlations between I-ECOH and VO2peak in IHD patients with normal left ventricular function (r=-0.64, p<0.001) and CHF (r=-0.63, p<0.001). I-ECOH could be used to discriminate effectively between NYHA functional classes (p<0.001).In conclusion, these results suggest that I-ECOH is adequate and useful as an index of cardio-pulmonary functional reserve in patients with ischemic heart disease.