前帯状切断は,左心室の局部機能だけでなく,右心室の局部機能も,ミトラル反吐で損なう
T Le Tourneau1, D Grandmougin, C Foucher
1Service d'Explorations Fonctionnelles Cardio-vasculaires, Services de Chirurgie Cardio-vasculaire, Hôpital Cardiologique, Lille, France.
Circulation
|September 25, 2001
まとめ
mitra valve replacement for mitral regurgitation (ミトラ弁置換) 中の前弦切断は,左心室と右心室の両方の機能を損なう. この外科的アプローチは,心臓の健康に対する潜在的なリスクを強調し,地域の心室の性能に悪影響を及ぼします.
科学分野:
- 心血管外科手術についてです.
- 心臓機能評価について
- ミトラルバルブ病の症状について
背景:
- chordae tendineae経由で無骨動脈の連続性を維持することは,左心室 (LV) の機能を維持し,手術後の結果を改善するために不可欠です.
- ミトラル逆流 (MR) は,心臓機能全体への影響を考慮する介入を必要とします.
研究 の 目的:
- MR患者における全局的および地域的LVおよび右心室 (RV) 機能に対する前帯切断の影響を将来的に評価する.
- ミトラル弁 (MV) 修復の機能的アウトカムと,前弦切断によるMV置換を比較する.
主な方法:
- 重度のMRを患った65人の患者は,手術前および手術後の放射性核素血管撮影を受けた.
- 患者は,MV修復 (42) または前弦切断 (23) によるMV置換のグループに分けられました.
- 両心室のグローバルおよび地域放出分数 (EF) を分析し,心室ごとに9つの領域を評価した.
主要な成果:
- 前弦切断によるミトラル弁の置換は,LVエジェクション分数 (LVEF) の有意な減少と,RVエジェクション分数 (RVEF) の変化をもたらさなかった.
- ミトラル弁の修復は,LVEFの有意な変化を示さなかったが,RVEFの改善を示した.
- 地域分析では,前頭 papillary 筋肉の挿入領域での LVEF 障害と,コード切断による MV 置換後の apicoseptal 領域での RV 機能の障害が明らかになりました.
結論:
- MRのMV置換の際に前弦切断は,地域のLV機能に悪影響を及ぼします.
- この外科的手法は,地域的なRV機能の有意な障害にもつながります.
- この発見は,中枢弁手術後の最適な心房機能を維持するために,帯の整合性を維持することが重要であることを示唆しています.
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