To determine the minimum duration of exercise for improving the aerobic capacity of patients with coronary heart disease (CHD), 23 female patients with CHD and/or hypertension, aged 52.8±8.7 years, were studied. After pre-testing, all the patients were conditioned for 4 months in order to elicit improvements in their aerobic capacity and other healthrelated factors. Duration and contents of daily activities were recorded by each patient. After 4 months, oxygen uptake at lactate threshold (VO_2LT) and VO_2peak were increased significantly from 12.9±2.6 to 16.0±3.4ml/kg/min and from 18.5±4.2 to 22.3±5.6ml/kg/min, respectively. Duration of exercise conditioning for the 4 months averaged 23.8±12.2min per day, ranging from 4.6 to 49.7min. Correlational analyses were applied in order to determine the extent to which the improvement in aerobic capacity was associated with the individual mean duration of exercise conditioning. As a result, changes in VO_2LT and VO_2peak correlated significantly with the exercise duration (Pearson's r=0.51, Spearman's rho=0.47 for VO_2LT; Spearman's rho=0.58 for VO_2peak) . Both VO_2LT and VO_2peak tended to improve markedly when daliy exercise duration was 20 min or longer. Furthermore, it was shown that the improvement in aerobic capacity remained almost the same within a range of exercise duration of 20 to 60min. We suggest that the minimum exercise duration for improving the aerobic capacity of cardiac patients is 20 to 30min per day or 140min or more per week.

To estimate how much physical activity is needed to improve overall health status in female patients with ischemic heart disease (IHD), the dose-response relationship between the duration of daily aerobic exercise and change in vital age (VA) was assessed for 4 months of exercise training. VA was considered as an index of physical health status and was computed from various coronary risk facotrs and physical fitness elements. Eighteen female patients with IHD, aged 54.3±9.1 yrs, continued the supervised exercise training 1-2 d/wk and the self-controlled exercise training 1-5 d/wk for 4 months. The intensity of exercise was set at individually determined lactate threshold. Daily duration of aerobic type exercise calculated for each patient averaged 21.1±11.0min/d, rang ing from 4.6 to 46.7 min/d. After the 4-month exercise training, VA decreased from 59.6±12.1 yrs to 54.2±11.8 yrs (P<0.05) . Significant correlation was found between daily duration of exercise and the change in VA (Spearman's rho=-0.60 ; Pearson's r=-0.62) . In this relationship, 10 min/d of exercise induced the decrease in VA and no further decrease in VA was found over the 30 min/d of exercise. In the 11 variables which constitute the equation of VA, oxygen uptake at lactate threshold (Spearman's rho=0.65; Pearson's r=0.64) and balancing on one leg with eyes closed (Spearman's rho=0.48; Pearson's r=0.51) significantly correlated with daily duration of aerobic exercise. From these results, it is suggested that the amount of moderate intensity exercise required to improve physical health status in female patients with IHD may be 10-30 minutes per day.

A 44-year-old woman with Marfan's syndrome presented complaining of severe back pain. Angiography revealed annulo aortic ectasia, aortic regurgitation, acute aoric dissection (DeBakey IIIb) and distal aortic arch aneurysm. One month after admission, she underwent cardiopulmonary bypass was established through the femoral artery, the superior and inferior vena cava. The heart was arrested by aortic cross clamping and retrograde cold (20°C) cardioplegia. At first, a modified Bentall's procedure was done in addition to a Carrel patch procedure. After this procedure, the heart was perfused continuously (300ml/min) with warm (37°C) blood until the end of the cardiopulmonary bypass. The heart recovered a sinus rhythm spontaneously. Subsequently, aortic arch replacement and the elephant trunk method was done with the aid of deep hypothermia and circulatory arrest. The patients is well 1 year after the operation. This technique is useful for patients who require prolonged aortic cross clamping time.

The purpose of this study was to clarify the validity of 12-min submaximal treadmill walk (TMW) and run (TMR) tests, as indirect measures of cardiorespiratory endurance, and to develop estimation equations of cardiorespiratory endurance using TMW or TMR performance and some other useful items correlating with cardiorespiratory endurance. Fifty-one young adult men, aged 20 -r34 years (22.8±3.6), walked or ran for 12 minutes on the treadmill at the intensity corresponding to the level 13 on the Borg's ratings of perceived exertion (RPE 13), and performed a maximal incremental exercise test. Mean (± SD) of oxygen uptake corresponding to anaerobic threshold (VO₂AT) and maximal oxygen uptake (VO₂max) were 42.0 ± 9.0 ml/kg/min and 55.9 ± 7.4 ml/kg/min, respectively, and mean (± SD) of 12-min walk and run distances were 1221 ± 103 m and 2108 ± 269 m, respectively. Cardiorespiratory endurance indices (VO_2AT and VO₂max) significantly correlated with TMW (r=0.49 and 0.48, respectively) and with TMR (r=0.69 and 0.68, respectively) . A stepwise multiple regression analysis was applied to determine the estimation equations of the cardiorespiratory endurance using VO_2AT or VO₂max as a dependent variable, and TMW or TMR distance, age, resting heart rate (HRrest), and exercise frequency in a week as independent variables. The multiple regression equations of VO_2AT and VO₂max were developed as follows : When TMW distance entered as an independent variable, VO_2AT = 20.781 X₁ + 2.298 X₃ - 0.29 X₄ + 31.855 (r = 0.83, SEE = 5.33 ml/kg/min) : VO₂max =19.941 X₁ + 1.127 X₃ - 0.208 X₄ - 0.656 X₅ - 0.853 X₆ + 77.884 (r = 0.88, SEE = 3.96 ml/kg/min), and when TMR distance entered as an independent variable, VO₂AT =15.443 X₂ + 2.158 X₃- 0.157 X₄ + 14.234 (r = 0.90, SEE = 4.18 ml/kg/min) ; VO₂max =10.817 X₂ + 1.274 X₃ - 0.1946 X4 - 0.504 X₅ + 55.234 (r = 0.89, SEE = 3.79 ml/kg/min), where X₁ : TMW distance (m), X₂: TMR distance (m), X₃ : exercise frequency in a week (d/wk), X₄: HRrest (b/min), X₅: age (yr) and X₆: BMI. It is concluded that cardiorespiratory endurance could be better estimated by a combination of submaximal exercise performance and some easily measurable items correlating with cardiorespiratory endurance such as exercise frequency, circulatory function, chronological age and body composition.

The purpose of this study was to examine the validity of physical performance tests (test battery) for assessing functional fitness required for activities of daily life in older persons with chronic disease. This test battery consisted of 4 items: arm curl, walking around two cones, moving beans with chopsticks, and functional reach. Seventy-one persons (aged 66.7±7.8 yr) with either hemiplegia, Parkinson's disease (PD), or chronic obstructive pulmonary disease (COPD) served as subjects. There were significant differences among standard test scores in each rate of progression of the disease in all hemiplegia groups (Stages III, IV, V), and COPD groups (Stages 1, 2, 3) (Kruskal-Wallis'H=22.3 and 7.3, respectively) . In PD groups, there was no significant difference between standard scores in Stages II and III (Mann-Whitney's U=4.0) . However, the rank order correlation coefficient between the ranking in standard test score and the ranking in physical independence assessed by a medical doctor and a public health nurse was significant (ρ=0.57, P<0.05) . All tests were safely applied for all subjects. These results suggest that our test battery may be applicable to a majority of older persons with various chronic diseases. Furthermore, the variability of standard test scores was greater than the clinical subjective ratings by Stage, which suggests that such a classification may provide a better description of disease progress/functional fitness.

Pulmonary rehabilitation is a common therapy for improving both exercise tolerance and quality of life (QoL) in patients with chronic obstructive pulmonary disease (COPD) . Although exercise is an important rehabilitation strategy, walking, treadmill use, bicycling and respiratory muscle training can be monotonous. A comprehensive exercise program that includes recreational activities may be a more effective means to decrease the occurrence of dyspnea during daily activities and improve QoL in patients with COPD. The purpose of this study was to investigate the effects of our exercise therapy, including recreational activities and respiratory muscle training, on dyspnea and health related QoL (HRQL) in COPD patients. Thirty-eight male patients with COPD were randomly assigned to a control (C) (70.1±6.4yr) (n=12) . pulmonary rehabilitation (PR) (70.3±8.3yr) (n= 16), or exercise (EX) (68.7±4.6yr) (n=10) group. The following evaluations were performed at baseline and at 8 weeks: (1) cycle ergometer test ; (2) 6-min walking distance : (3) physical fitness (4) pulmonary function ; (5) dyspnea : and (6) HRQoL (SF-36) . The C group showed no significant changes in physical fitness, pulmonary function, dyspnea, and HRQoL scores throughout the observation period. There was a significant (P<0.05) improvement in 6-min walking distance. physical fit-ness, maximum rnspiratory pressure (MIP), and HRQoL for the PR group. The EX group demons-trated a significant (P<0.05) improvement in physical fitness, maximum expiratory pressure (MEP), dyspnea, and HRQoL. Moreover, the degree of improvement in each variable was greater for EX than for PR. There were significant (P<0.05) correlations between MIP and FEV_1.0 (r=0.65), and between MEP and FEV_1.0 (r=0.43) . Based on these results, it appears that our comprehensive exercise program, including recreational activities and respiratory muscle training, improves physical fitness, pulmonary function, dyspnea, and quality of life in COPD patients.

Ischemic mitral regurgitation (IMR) is a serious and increasingly common clinical disorder, but at present, the relationship between left ventricular shape and IMR is not completely understood. Thirty patients with moderate or severe IMR who underwent mitral valve surgery combined with coronary artery bypass grafting were studied retrospectively. Left ventricular shape, left ventricular regional wall motion, hemodynamic index, condition of the coronary artery, severity of IMR and long term results were assessed using ventriculography and angiography. Left ventricular shape at end diastole and end systole were quantified based upon the ratio of the major-to-minor axis and the sphericity index. Hospital mortality rate was 13.3%, 5 years survival rates were 10.5%, and 5-year rate of freedom from congestive heart failure (CHF) were 7.8%. Significant difference between cardiac deaths (n=11) and survivors (n=19) included requiring intensive care admission, requiring intra-aortic balloon pumping, recurrent myocardial infarction, the ratio of the major-minor axis at end diastole, the sphericity index at diastole, and the sphericity index at end systole. Multivariable regression analyses were performed with the Cox proportional hazards model. Significant determinants of survival were the sphericity index at end systole and LV regional wall motion at the site of the anterobasal segment or apex. These findings indicate that the shape of the LV and LV regional wall motion in IMR may be important determinants of prognosis and suggest that surgical attention to shape may be helpful for mitral valve surgery.

We report two cases the first was a 74-year-old woman who had received coronary artery bypass grafting [SVG-to-LAD, SVG-to-Cx, SVG-to-RCA, the left internal thoracic artery (LITA) was mobilized but was unsuitable for the graft] two years previously. Postoperative angiography revealed graft occlusion. Since repeated catheter intervention was not successful, reoperation was performed. A MIDCAB procedure with radial artery graft and proximal anastomosis was performed on the left axillary artery. The operation was successful and there were no complications. Two weeks after the operation, the graft patency was confirmed and she was discharged. The second case was a 64-year-old man who received coronary artery grafting (LITA-to-LAD, SVG-to-Cx and SVG-to-RCA). Two months after the operation, recurrent chest pain was caused by severe stenosis of the LITA anastomotic site. Percutaneous transluminal coronary angioplasty was performed but was unsuccessful. He received redo CABG in the same manner using the saphenous vein. The postoperative course was uneventful and he was discharged 6 days after the operation. This procedure is useful for the patients whose left internal thoracic artery has been used on a previous operation. Good early results were obtained in both patients.

A 62-year-old man was transferred to our institution with ventricular fibrillation. Percutaneous cardiopulmonary support (PCPS) was established and he underwent successful percutaneous transluminal coronary angioplasty. Since his left ventricular function did not recover, he was placed on a left ventricular assist system (LVAS). Under general anesthesia, a 10-cm longitudinal incision was made on the right parasternum. The third and fourth cartilages were completely resected. The pericardium was incised longitudinally. At first, an inflow cannula was insected to the right side of the left atrium. The ascending aorta was then partially excluded and an outflow cannula with a 10mm Gore-Tex prosthesis was anastomosed end-to-side to the aorta with a continuous Gore-Tex suture. After the pump was established, PCPS was gradually discontinued. During 9 days of support, his left ventricular function recovered and subsequently he was weaned from LVAS. Unfortunately, he died two days after LVAS removal. We think this procedure is useful because it is easy to perform, reduces the bleeding, shortens the operating time.