Japanese
Title肺高血圧を合併した僧帽弁弁膜症の人工弁置換後の肺循環動態(特に人工弁置換術後も高肺血管抵抗値を持続した二症例)
Subtitle症例
Authors井上健治*, 須磨幸蔵**, 大江容子***, 古谷幸雄***
Authors(kana)
Organization*国立山口病院放射線科, **東京女子医大第2病院心臓血管外科, ***東京女子医大第2病院麻酔科
Journal循環制御
Volume12
Number2
Page339-343
Year/Month1991/
Article報告
Publisher日本循環制御医学会
Abstract「要旨」僧帽弁弁膜症に合併した肺高血圧は, 僧帽弁人工弁置換術直後に大多数の症例で, 肺動脈圧は下降すると考えられている. しかし我々は, 術後48時間経過しても高肺血管抵抗が持続する症例を経験した. 症例1は52才女性. 術前診断は僧帽弁狭窄症兼閉鎖不全症. 症例2は48才男性. 術前診断は僧帽弁狭窄症. これら2症例とも, 僧帽弁人工弁置換術後48時間後の肺血管抵値は, 依然として高値を維持しており, 症例1で9.8PRU/m2, 症例2で8.4PRU/m2であった. 最近, 肺高血圧を合併した症例の手術成績が以前と比べて向上したとは言え, まだ100%の救命率ではない. かくの如き重症例では, まずPercutaneous mitralvalvuloplastyを施行し, 少しでも肺血管床の抵抗を下げてやり, しかる後に開心術を施行すれば, 少しでも手術のリスクを減少さす可能性がある. 「はじめに」心臓病に合併する肺高血圧症は, 先天性心疾患であれ, 後天性心疾患であれ, 手術予後に関して急性期はもちろん遠隔期にも, 重要な影響を与えると考えられている. ところがこれらの疾患に外科的処置を加えたあとの, 特に急性期の肺循環動態に関する報告は少ない. 後天性心疾患のうち肺高血圧症を合併した僧帽弁弁膜症に関していえば, 術後の肺動脈圧の時間的推移についてまだいつ下降するのか, 不明なのが現状である.
Practice基礎医学・関連科学
Keywordspulmonary hypertension, mitral valve surgery, mitral valve replacement, pulmonary vascular resistance
English
TitlePulmonary vascular resistance after mitral valve replacement complicated with pulmonary hypertension
Subtitle
AuthorsK.Inoue*, K.Suma**, Y.Ohoe***, Y.Furuya***
Authors(kana)
Organization*Dept. of radiology Yamaguti national hospital, **Dept. of cardiovascular surgery Tokyo women's medical college daini hospital, ***Dept. of anesthesiology Tokyo women's medical college daini hospital
JournalCirculation Control
Volume12
Number2
Page339-343
Year/Month1991/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractIn most of the cases of mitral valve disease complicated with pulmonary hypertension, pulmonary artery pressure is supposed to be reduced immediately after replacement of mitral valve with proshesis. We experienced the following two cases whose pulmonary vascular resistances were maintained at high levels for over 48 hours postoperatively. The first case (52-year-old female) was preoperatively diagnosed as mitral stenosis with regurgitation and the second case (48-year-old male) as mitral stenosis. Their pulmonary vascular resistances 48 hours after replacement of mitral valve with prosthesis still showed high levels, to be recorded as 9.8 PRU/m2 in Case 1 and 8.4 PRU/m2 in Case 2 respectively. Although the recent operation results in the cases of mitral valve disease complicated with pulmonary hypertension are improved, we have to admit that the percentage of success has not attained to 100%. In these high risk cases, the recommended technique is as follows：percutaneous mitral valvuloplasty to reduce pulmonary vascular resistance prior to subsequent radical open heart surgery. This treatment is likey to decrease the risk of operation.
PracticeBasic medicine
Keywordspulmonary hypertension, mitral valve surgery, mitral valve replacement, pulmonary vascular resistance

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