| Japanese |
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| Title | 僧帽弁血流速度パターンにより術中心筋虚血を診断できた一症例 |
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| Subtitle | 症例 |
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| Authors | 舩津直彦, 河田竜一, 大下修造, 坂部武史 |
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| Organization | 山口大学医学部麻酔・蘇生学教室 |
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| Journal | 循環制御 |
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| Volume | 16 |
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| Number | 2 |
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| Page | 237-240 |
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| Year/Month | 1995/ |
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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」左室機能が軽度低下した虚血性心疾患患者の非心臓手術中に経食道心エコー図を用いた循環管理中, 麻酔導入2時間30分後に, 僧帽弁血流速度パターンは拡張早期最大流入速度が低下し, 拡張後期最大流入速度との比が1.13から0.74, さらに3時間30分後には比が0.64と低下した. このとき, 血圧や心拍数は変化はなく, 心電図は3時間30分後にSTの低下がみられた. この術中の僧帽弁血流速度パターンの変化は, 虚血による早期心筋障害と考え, ただちに亜硝酸薬の投与をおこない, 心筋障害の拡大を防止できたと思われる. 虚血性心疾患患者の術中モニターとして, 経食道心エコー図による僧帽弁血流速度パターンの連続観察は, 左室短軸像の観察と同時に有用と考えられる. 「はじめに」僧帽弁血流速度パターンは, 左室拡張能の指標とされる1,2). われわれは, 虚血性心疾患患者の非心臓手術で, 経食道心エコー図を用いた循環管理中, 心電図変化がおこる前に, 心筋虚血が原因と思われる僧帽弁血流速度パターンの変化を検出した症例を経験した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | TEE, Mitral flow, Perioperative myocardial ischemia |
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| English |
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| Title | Detection of Perioperative Myocardial Infarction by Mitral Flow Velocity Curves；A Case Report |
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| Authors | Naohiko Funatsu, Ryuichi Kawata, Shuzo Oshita, Takefumi Sakabe |
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| Organization | Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 16 |
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| Number | 2 |
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| Page | 237-240 |
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| Year/Month | 1995/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Mitral flow velocity curves may be a good index of left ventricular diastolic function. We describe a case of perioperative myocardial ischemia that was detected by mitral flow velocity curves using transesophageal echocardiography (TEE). A 62-year-old woman was scheduled for repair of a femoral neck fracture. Preoperative cardiac catheterization revealed three vessel coronary disease. Anesthesia was induced with thiopental and maintained with fentanyl, sevoflurane, and vecuronium. Mitral flow velocity curves were monitored via TEE. At induction, the mitral flow velocity pattern was normal with 1.13 of early/late diastolic peak flow ratio (E/A ratio), but gradually changed to a pattern consistent with myocardial ischemia. E/A ratio decreased to 0.63 at 3hr. 30 min. after induction concomitant with marked ST segment depression. Continuous intravenous administration of isosorbite improved the myocardial ischemia. The patient was no complication after the operation. We conclude that mitral flow velocity via TEE was useful in the detection of early intraoperative myocardial ischemia during anesthesia. |
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| Practice | Basic medicine |
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| Keywords | TEE, Mitral flow, Perioperative myocardial ischemia |
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