右心室流出管機能不全のための肺弁置換後の双心室応答:年齢は結果の予測要因ですか?
Alessandra Frigiola1, Victor Tsang, Catherine Bull
1Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. alessandra.frigiola@gmail.com
Circulation
|October 10, 2008
まとめ
肺弁置換 (PVR) は,先天性心疾患の患者の心臓機能と運動能力を改善します. 17.5歳以前にPVRを行うことは,特に右心室の体積と運動反応について,結果を最適化します.
科学分野:
- 心臓病学 心臓病学
- ペディアトリック・カルディオロジー
- 心臓外科手術について
背景:
- 生まれながらの心臓病における肺不全の肺弁置換 (PVR) のタイミングは困難です.
- 肺の再発は,心臓の機能と患者のアウトカムに大きな影響を及ぼします.
研究 の 目的:
- 肺のPVR後の改善の決定要因を評価する.
- 異なる患者年齢層における臨床結果の比較のための予測要因を特定する.
主な方法:
- 重度の肺吐を患った71人の患者がPVRを受けた.
- MRIとPVR前後の心肺運動テストを使用して評価された変化.
- 右心室と左心室の体積,心拍数,呼吸器応答を分析した.
主要な成果:
- PVRはニューヨーク・ハート協会の成績を向上させ,右心室の体積を大幅に減少させた.
- 左心室の終末ダイアストリック量は増加し,PVR後の効果的な心臓出力は上昇しました.
- 二酸化炭素に対する呼吸器応答の正常化は,17.5歳未満の患者でより頻繁に発生しました.
結論:
- 積極的なPVR戦略は,RVの体積を正常化し,二心房機能を改善し,運動能力を高めます.
- 17.5歳未満の手術は,呼吸器の反応が正常化し,LV機能が改善される.
- 早期PVRは,手術後の左心室の充填と静脈機能の改善と関連しています.
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