低左心機能大動脈弁狭窄症手術症例の検討
重症大動脈弁狭窄症(severe AS)のなかでも左室駆出率(EF)が低下し,かつ大動脈圧較差(PG)が低値を示す症例の手術適応については議論が多い.対象はASおよびAS優位の軽度閉鎖不全合併例(ASr)に対し大動脈弁置換術(AVR)を行った144例中,EFが35%以下の9例,心機能への影響を考慮し加療を要する冠状動脈疾患を合併した症例は除外した.平均年齢は70.0±9.3歳,男性4例,女性5例であった.左室拡張終期径(LVDd)57.3±5.8mm,左室収縮終期径(LVDs)49.3±5.7mm,心室中隔壁厚(IVSth)11.9±1.9mm,左室後壁厚(LVPWth)11.1±2.6mmと...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 35; no. 6; pp. 315 - 318 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.11.2006
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.35.315 |
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| Abstract | 重症大動脈弁狭窄症(severe AS)のなかでも左室駆出率(EF)が低下し,かつ大動脈圧較差(PG)が低値を示す症例の手術適応については議論が多い.対象はASおよびAS優位の軽度閉鎖不全合併例(ASr)に対し大動脈弁置換術(AVR)を行った144例中,EFが35%以下の9例,心機能への影響を考慮し加療を要する冠状動脈疾患を合併した症例は除外した.平均年齢は70.0±9.3歳,男性4例,女性5例であった.左室拡張終期径(LVDd)57.3±5.8mm,左室収縮終期径(LVDs)49.3±5.7mm,心室中隔壁厚(IVSth)11.9±1.9mm,左室後壁厚(LVPWth)11.1±2.6mmと左室の拡大を認める一方,左室心筋の肥厚はみられなかった.大動脈弁口面積(AVA)は平均0.58cm2と重症ASで,大動脈圧較差(peak PG)は65.2±32.7mmHgであった.全例でAVRを行い,術後遠隔期にEFは8例が改善,1例が不変で平均は56.9%であった.ASが進行しEFが低下した症例においても積極的な手術が予後を改善する可能性が示唆された. |
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| AbstractList | 重症大動脈弁狭窄症(severe AS)のなかでも左室駆出率(EF)が低下し,かつ大動脈圧較差(PG)が低値を示す症例の手術適応については議論が多い.対象はASおよびAS優位の軽度閉鎖不全合併例(ASr)に対し大動脈弁置換術(AVR)を行った144例中,EFが35%以下の9例,心機能への影響を考慮し加療を要する冠状動脈疾患を合併した症例は除外した.平均年齢は70.0±9.3歳,男性4例,女性5例であった.左室拡張終期径(LVDd)57.3±5.8mm,左室収縮終期径(LVDs)49.3±5.7mm,心室中隔壁厚(IVSth)11.9±1.9mm,左室後壁厚(LVPWth)11.1±2.6mmと左室の拡大を認める一方,左室心筋の肥厚はみられなかった.大動脈弁口面積(AVA)は平均0.58cm2と重症ASで,大動脈圧較差(peak PG)は65.2±32.7mmHgであった.全例でAVRを行い,術後遠隔期にEFは8例が改善,1例が不変で平均は56.9%であった.ASが進行しEFが低下した症例においても積極的な手術が予後を改善する可能性が示唆された. |
| Author | 上野, 正弘 上野, 隆幸 山本, 裕之 井畔, 能文 上野, 哲哉 坂田, 隆造 東, 昭弘 寺井, 弘 |
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| References_xml | – reference: 5) Connolly, H. M., Oh, J. K., Schaff, H. V. et al.: Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Circulation 101: 1940-1946, 2000. – reference: 3) Connolly, H. M., Oh, J. K., Orszulak, T. A. et al.: Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation 95: 2395-2400, 1997. – reference: 9) Sharony, R., Grossi, E. A., Saunders, P. C. et al.: Aortic valve replacement in patients with impaired ventricular function. Ann. Thorac. Surg. 75: 1808-1814, 2003. – reference: 1) Christakis, G. T., Weisel, R. D., Fremes, S. E. et al.: Can the results of contemporary aortic valve replacement be improved? J. Thorac. Cardiovasc. Surg. 92: 37-46, 1986. – reference: 10) Lund, O.: Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation 82: 124-139, 1990. – reference: 11) Mann, D. L. and Bristow, M. R.: Mechanisms and models in heart failure: The biomechanical model and beyond. Circulation 111: 2837-2849, 2005. – reference: 12) Sabbah, H. N., Sharov, V. G., Gupta, R. C. et al.: Reversal of chronic molecular and cellular abnormalities due to heart failure by passive mechanical ventricular containment. Circ. Res. 93: 1095-1101, 2003. – reference: 7) Pereira, J. J., Lauer, M. S., Bashir, M. et al.: Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction. J. Am. Coll. Cardiol. 39: 1356-1363, 2002. – reference: 8) Tarantini, G., Buja, P., Scognamiglio, R. et al.: Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery. Eur. J. Cardiothorac. Surg. 24: 879-885, 2003. – reference: 4) Powell, D. E., Tunick, P. A., Rosenzweig, B. P. et al. Aortic valve replacement in patients with aortic stenosis and severe left ventricular dysfunction. Arch. Intern. Med. 160: 1337-1341, 2000. – reference: 6) Rothenburger, M., Drebber, K., Tjan, T. et al.: Aortic valve replacement for aortic regurgitation and stenosis, in patients with severe left ventricular dysfunction. Eur. J. Cardio-thorac. Surg. 23: 703-709, 2003. – reference: 13) deFilippi, C. R., Willett, D. L., Brickner, M. E. et al.: Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. Am. J. Cardiol. 75: 191-194, 1995. – reference: 2) Carabello, B. A., Green, L. H., Grossman, W. et al. Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation 62: 42-48, 1980. |
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| Snippet | 重症大動脈弁狭窄症(severe AS)のなかでも左室駆出率(EF)が低下し,かつ大動脈圧較差(PG)が低値を示す症例の手術適応については議論が多い.対象はASおよびAS優位の軽度閉鎖... |
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| SubjectTerms | 低左心機能 重症大動脈弁狭窄症 |
| Title | 低左心機能大動脈弁狭窄症手術症例の検討 |
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