| Japanese |
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| Title | 左室拡大による逆流代償機転を指標とした慢性大動脈弁閉鎖不全症の手術適応 |
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| Subtitle | 原著 |
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| Authors | 木原信一郎 |
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| Authors(kana) | |
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| Organization | 東京女子医科大学附属日本心臓血圧研究所循環器外科 |
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| Journal | 循環制御 |
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| Volume | 21 |
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| Number | 1 |
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| Page | 41-46 |
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| Year/Month | 2000/ |
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| Article | 原著 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 無症候性の大動脈弁閉鎖不全症(AR)の至適手術時期を診断することは困難であり, 現在のところ, 的確に判定する指標はない. 今回はARの左室拡大による逆流代償機転の新しい指標として大動脈弁逆流率・左室拡張末期容積比(RF/LVEDV)を設定し, これを指標とした軽度, 中等度(LVESVI＜150ml/m2)ARの手術適応を検討した. 術後の左室拡張末期径(LVDd)非正常化例では, RF/LVEDVは有意に低値であったがLVEDPの上昇を認めた. 左室拡大による逆流代償機転が充分機能しているにもかかわらず, 重症度が高いと考えられた. 軽症, 中等症の無症候性ARでRF/LVEDVが0.150ml-1以下を示す例では術後の心機能回復が遷延する可能性があり, 早期に外科治療を行うことが好ましいことが示唆された. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Aortic valve insufficiency, Hemodynamics, Left ventricular function, Heart valve prosthesis |
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| English |
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| Title | Regurgitant Fraction to End-diastolic Volume Ratio for Optimum Timing of Surgery in Patients with Chronic Aortic Regurgitation |
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| Subtitle | |
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| Authors | Shin'ichiro KIHARA |
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| Authors(kana) | |
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| Organization | Department of Cardiovascular Surgery,The Heart Institute of Japan,Tokyo Women's Medical University |
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| Journal | Circulation Control |
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| Volume | 21 |
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| Number | 1 |
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| Page | 41-46 |
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| Year/Month | 2000/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | 「Background:」 The optimum timing of aortic valve replacement (AVR) in symptomatic patients with aortic valve disease is well established. However, timing in asymptomatic and minimally symptomatic patients with chronic aortic regurgitation (AR) is still controversial. Many indicators of preoperative left ventricular function in AR have been introduced, and a new determinant, regurgitant fraction to end-diastolic volume ratio (RF/LVEDV), concerning diastolic ventricular function, was developed to evaluate postoperative functional recovery. 「Methods:」 In one hundred AVR patients, catheterization and echocardiographic evaluations were performed before and after surgery. LVESVI, LVEDVI, LVDd, LVDs, LVEF, LVEDP, LVEDP/LVEDV and RF/LVEDV were determined, and patients with residual ventricular dilatation after AVR and patients with normalized ventricular size after AVR were compared. 「Results:」 There was a positive correlation between preoperative RF/LVEDV and postoperative left ventricular diastolic dimension. From the equation, the limit of normalization in functional recovery was 0.150ml-1. In chronic AR, increased LVEDP with low preoperative RF/LVEDV indicated diastolic dysfunction and delayed recovery of diastolic dimension. 「Conclusion:」 RF/LVEDV is a useful predictor of functional recovery after AVR. Minimally symptomatic chronic AR patients with RF/LVEDV under 0.150ml-1 should undergo early surgical intervention to obtain better postoperative functional recovery. |
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| Practice | Basic medicine |
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| Keywords | Aortic valve insufficiency, Hemodynamics, Left ventricular function, Heart valve prosthesis |
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