フォントン手術後の単一左心室の収縮機能の回復の自然史とパターン
T Sluysmans1, S P Sanders, M van der Velde
1Department of Cardiology, Children's Hospital, Boston, MA 02115.
Circulation
|December 11, 1992
まとめ
単一心房患者のフォンタン型修復は,早期に行われた場合,左心房 (LV) の機能を改善します. しかし,手術時の年齢とともに回復能力は著しく低下する.
科学分野:
- ペディアトリック・カルディオロジー
- 生まれながらの心臓病 生まれながらの心臓病
- 心臓外科手術について
背景:
- 単一心室の生理学は,歴史的に,フォンタン手術の前に心不全と早期死亡をもたらしました.
- 静脈機能不全は,緩和治療にもかかわらず,これらの患者における重要な臨床的課題であり続けています.
研究 の 目的:
- 単心室患者における心室機能不全の原因を調査する.
- フォンタンのタイプの修復が左心室 (LV) 機能の悪化を逆転させることができるかどうかを判断する.
主な方法:
- エコーカルディオグラフィは,心室の寸法,体積,形状,壁のストレス,および静脈機能の評価のために84人の患者 (0.2-35歳) で使用されました.
- 緩和療法 (シャント,バンド) の前後に,そしてグレン・またはフォンタン手術の後に測定を行った.
- 分析は,年齢,大動脈の酸素飽和度,および外科的タイミングとLV機能を相関させた.
主要な成果:
- フォンタン以前は,心室の体積は正常の2〜3倍であり,異常な壁ストレスは2歳以降に発生した.
- LVの形状 (球形) の漸進的な変化と,壁のストレスの増加は,シストリック機能と収縮性の低下と相関する.
- 早期のフォンタン/グレン修復 (10歳未満) は,LV機能と収縮性を改善し,遅い修復は限られた回復を示した.
結論:
- 早期のフォンタン型修復は,単心室患者の年齢および体積負荷に関連する異常な収縮メカニズムを逆転させます.
- フォントン型手術後のLV機能の回復の可能性は,手術時の年齢とともに減少します.
関連する概念動画
01:16Heart Valves
The human heart is a complex organ with an intricate system of valves that regulate blood flow. There are two main types of valves: atrioventricular (AV) valves and semilunar valves.
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
01:26Imbalances in Cardiac Output
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
01:20Mitral Regurgitation I: Introduction
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
01:22Mitral Stenosis I: Introduction
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
01:30Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...