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restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitationでは,左心室を逆向きに改造することで,
Jeroen J Bax1, Jerry Braun, Soeresh T Somer
1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. jbax@knoware.nl
Circulation
|September 15, 2004
まとめ
併用冠動脈バイパス移植と制限性アンヌロプラスティは,異動性心筋病を効果的に治療し,ミトラルを大幅に減らし,左心室の改造を改善します. この処置は,重度のミトラルリグルジテーションの患者にとって,長期的には優れた結果をもたらします.
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:
- 併合冠動脈バイパス移植 (CABG) と,不全性心筋疾患に対する制限性アンヌロプラスティクに関するデータは限られている.
- 左心室 (LV) の逆改造に対するこの併用アプローチの影響は,依然としてほとんど不明です.
研究 の 目的:
- 発血性心筋症および重度のミトラル吐症の患者におけるCABGと制限性アンヌロプラスティの併用療法の有効性を評価する.
- この組み合わせた外科的戦略がミトラルリグルジテーション,左心房の次元,およびLVの逆転リモデリングに与える影響を評価する.
主な方法:
- 発血性LV機能不全と重度のミトラル反発症の51人の患者は,CABGとミトラルアヌルスの縮小による制限性アンヌロプラスティを施しました.
- 連続エコーカルディオグラフィー研究では,ミトラル反吐,トランスミトラルグラデント,リーフレットコアプテーション,およびLV/左心房の寸法が評価されました.
- 臨床フォローアップでは,ニューヨーク心臓協会 (NYHA) のクラス,生存率,および2年後の有害事象が評価されました.
主要な成果:
- 併用した処置は,2年間の追跡調査ですべての患者で最小限の残留ミトラル吐 (グレード1+) を引き起こした.
- LVの終末シストリックと終末ダイアストリックの寸法において有意な改善が観察され,LVのリバースリモデリングを示した.
- 左心房の寸法も著しく減少し,NYHAクラスも3.4から1.3に改善した.
結論:
- 制限性アンヌロプラスティとCABGを併用すると,優れた臨床的およびエコーカルディオグラフィの結果が得られます.
- この処置は,ミトラル反吐を効果的に排除/最小限に抑え,重要なリバースLVリモデリングを促進します.
- この外科的アプローチは,高い生存率と機能的クラスの改善を含む,長期的な好ましい結果を示しています.
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