重度の大動脈吐において,弁置換後の遅い時期に持続するダイアストリック機能障害.
Bruno Villari1, Samuel Sossalla, Quirino Ciampi
1Division of Cardiology, Fatebenefratelli Hospital of Benevento, Benevento, Italy.
Circulation
|November 26, 2009
まとめ
大動脈弁置換は,大動脈吐症の患者の左心室 (LV) 縮を正常化しますが,持続的な繊維縮と透析機能不全が持続し,LV機能に長期的に影響します.
科学分野:
- 心臓病学 心臓病学
- 心臓外科手術について
- 心血管研究 循環器科の研究
背景:
- 左心室 (LV) ハイパルトロフィーとダイアストリック機能障害は,慢性的な大動脈吐において一般的です.
- 以前の研究では,大動脈閉塞における大動脈弁置換術 (AVR) の後のLV高縮の回帰が示されました.
- 大動脈吐におけるLV機能と構造に対するAVRの影響については,さらなる評価が必要である.
研究 の 目的:
- 慢性大動脈吐症の患者におけるLV機能と構造に対するAVRの早期および後期的な効果を評価する.
主な方法:
- 重度の大動脈再発症の11人の患者は,AVR (21カ月と89カ月) の前後に,LV双平面血管図,圧力測定,心内膜バイオプシーを受けた.
- LVのシストリック機能 (エジェクション分数,ミッドウォールの分数縮小) とダイアストリック機能 (リラックス時間定数,ピークの充填率,硬度定数) を評価した.
- LV構造は,筋肉繊維の直径,インタースティシャル線維症,および繊維含有量によって評価されました.
主要な成果:
- AVRの後半のLV筋肉質は,AVRの後半に55%大幅に減少しました.
- AVR後,LVのリラクゼーションは遅くに正常化し,エジェクション分数は変化しませんでした.
- 静止硬さはAVR後も上昇し,インタースティシャル線維症は手術後遅くまで減少した.
結論:
- AVRは,大動脈リグルジテーション患者におけるマクロスコピックLV高縮の正常化につながります.
- しかし,持続的な繊維濃縮とダイアストリック機能不全は,AVR後の遅い時期に観察されます.
- これらの構造の変化は,被動弾性特性の変化と,持続的な下痢機能不全と相関する.
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