冠動脈バイパス移植だけでは,中等度の不全性ミトラル吐を矯正するのでしょうか?
L Aklog1, F Filsoufi, K Q Flores
1Divisions of Cardiac Surgery and Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. laklog@partners.org
Circulation
|September 25, 2001
まとめ
中等度の不全性ミトラル反吐 (MR) の単独の冠動脈バイパス移植 (CABG) は,しばしば中等度または重度の持続的なMRにつながります. 同時にミトラルアンヌロプラスティは,これらの患者にとってより良い選択肢かもしれません.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- 心血管画像検査についてです.
背景:
- 適度な不全性ミトラル反発 (MR) の最適な管理は議論されています.
- 手術の選択肢には,隔離冠動脈バイパス移植 (CABG) または,ミトラアヌロプラスティによるCABGが含まれます.
研究 の 目的:
- 中度性不全性MRに単離されたCABGの早期の影響を評価する.
- 隔離されたCABGが中度性不全性MRに十分かどうかを判断する.
主な方法:
- 隔離されたCABGを受けていた中度性不全性MRの136人の患者の遡及的分析.
- 術内トランスエゾファゲアルエコーカルディオグラフィ (TEE) と術後のトランストラシックエコーカルディオグラフィ (TTE) を用いて,MRの重症度を評価した.
主要な成果:
- 30日間の手術後の死亡率は2.9%でした.
- 術内TEEは89%の症例でMRの重症度を過小評価した.
- 術後のTTEは,患者の40%が依然として中等度または重度のMR,51%が軽度のMR,9%がMRが解消したことを示しました.
結論:
- 中度性の不血性MRに対して単独で分離されたCABGは,多くの場合,有意な残留リグルジテーションを残します.
- 術内TEEは,MRの重症度を過小評価する可能性があります.
- 中程度のMRの術前診断は,同時にミトラアヌロプラスティの必要性を示す可能性があります.
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