| Japanese |
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| Title | 肥大型閉塞性心筋症の心筋切除術と僧帽弁置換術の麻酔経験 |
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| Subtitle | 症例 |
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| Authors | 長沢千奈美, 野村実, 小高桂子, 加藤真弓, 近藤泉, 白井希明, 鈴木英弘 |
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| Organization | 東京女子医科大学麻酔科学教室 |
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| Journal | 循環制御 |
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| Volume | 15 |
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| Number | 4 |
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| Page | 613-617 |
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| Year/Month | 1994/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」肥大型閉塞性心筋症の患者に対する心筋切除術と僧帽弁置換術の麻酔管理を経験した. 麻酔は循環動態の変動が少なく十分な麻酔深度を得られるという点から大量フェンタニール麻酔にイソフルランを併用した. 体外循環離脱には難渋し, 一時的補助循環を行い, 経食道心エコー図(TEE)で左室収縮能および左室容量の判定を行いながら体外循環を離脱した. 肥大型閉塞性心筋症患者においては, 術前投与されたβブロッカーによるかまたは, 心筋肥厚のための体外循環時の不十分な心筋保護による心機能不全, また左室流出路圧較差が残存する可能性もあり, 体外循環の離脱に際し, TEEで左室収縮能や適切な前負荷を確認することが重要である. 「はじめに」肥大型閉塞性心筋症(以下HOCM)は心筋肥大による左室腔狭小化, 左室拡張期コンプライアンスの低下, 及び左室流出路の閉塞を来たす疾患である. 今回我々は, HOCMに対する治療のため僧帽弁置換術(MVR)及び, 心筋切除術を同時に施行し, 体外循環離脱に難渋した症例を経験した. 体外循環離脱時の心機能, 前負荷, 左室流出路圧較差の確認および体外循環離脱後の麻酔薬, 血管作動薬選択など, 経食道心エコー図(TEE)の有効性について述べる. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Hypertrophic obstructive cardiomyopathy, Trans-aortic myectomy, Mitral valve replacement, Transesophageal echocardiography. |
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| English |
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| Title | Usefulness of TEE for Management of Trans-aortic Myectomy and Mitral Valve Replacement for Hypertrophic Obstructive Cardiomyopathy |
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| Authors | Chinami Nagasawa, Minoru Nomura, Keiko Kodaka, Mayumi Kato, Izumi Kondo, Kimei Shirai, Hidehiro Suzuki |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology, Tokyo Women's Medical College |
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| Journal | Circulation Control |
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| Volume | 15 |
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| Number | 4 |
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| Page | 613-617 |
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| Year/Month | 1994/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We reported an anesthetie management using TEE on a case of a 59-year-old man who had underwent trans-aortic myectomy and mitral valve replacement for hypertrophic obstructive cardiomyopathy (HOCM). A preoperative echocardiography revealed systolic anterior movement of the mitral leaflets, severe left ventricular hypertrophy, and asymmetric septal hypertrophy. Cardiac catheterization uncovered a left ventricular outflow tract pressure gradient of more than 100mmHg, a left ventricular ejection fraction of 67% and moderate mitral regurgitation. Anesthesia was maintained with high-dose fentanyl and supplemented isoflurane inhalation. The patient's hemodynamic profile was stable throughout the pre-cariopulmonary bypass (CPB) period. After 99min of the aortic cross clamp, weaning from the CPB was difficult. TEE revealed global hypoakinesis of the left ventricle, so a partial CPB was established for 30min and the doses of dopamine and dobutamine were increased. After improvement of left ventrjcular function was confirmed by TEE, the patient was successfully weand from CPB. The reasons of difficulty in the first attempt to wean the patient from CPB in this case are suspected as follows：insufficient ventricular pre-load, the myocardial depressant effect of the oral β blocker preoperatively administered, and insufficient myocardial protection by cardioplesia during CPB. TEE was found to be useful for the anaesthetic management of the surgical correction for HOCM. |
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| Practice | Basic medicine |
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| Keywords | Hypertrophic obstructive cardiomyopathy, Trans-aortic myectomy, Mitral valve replacement, Transesophageal echocardiography. |
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