二尖瓣关闭不全に対する二心室圧容積面積比を用いた左室準備状態の評価二尖瓣关闭不全に対する二心室圧容積面積比を用いた左室準備状態の評価

Nikhil Thatte¹, Peter E Hammer², Gerald Marx¹

¹Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

JACC. Advances

|February 25, 2026

要旨

Background:

Assessing left ventricular (LV) preparedness in congenitally corrected transposition of the great arteries/intact ventricular septum for the double switch operation (DSO) remains challenging. Subpulmonary LV pressure-volume area (PVA)-a ventricular workload metric-compared to systemic right ventricular (RV) PVA, may be a good index of adequacy.

Objectives:

The objectives of the study were to determine if LV-PVA can be estimated (ePVA) from standard parameters and if the LV:RV ePVA ratio is associated with post-DSO outcomes.

Methods:

LV-PVA was measured using conductance catheters and compared to ePVA calculated with simple catheterization and volumetric variables. Agreement and bias were assessed using Pearson correlation and Bland-Altman analysis. In a retrospective cohort, associations between a composite outcome (≥moderate LV dysfunction, transplant, or death) and LV:RV ePVA ratio and clinical variables were evaluated using univariate Cox proportional hazards.

Results:

The ePVA showed high agreement and low bias with measured PVA (n = 20). In the retrospective cohort, 6/42 patients (14%, median age at DSO 2.9 years) experienced the composite outcome (median follow-up 1.65 [0.12, 4.58] years). Low LV:RV ePVA and pressure ratios were the only significant associations (HR: 3.9; 95% CI: 1.5-10.0 and HR: 2.4; 95% CI: 1.3-4.2, respectively), whereas LV mass indices were not. Among 8 patients with borderline pressure ratios, 5 with ePVA ratio <0.67 had adverse outcome, whereas 3 with ePVA ratio ≥0.67 did not.

Conclusions:

Estimation of subpulmonary LV-PVA using simple imaging and catheterization data was reliable compared to gold standards. LV:RV ePVA ratio ≥0.67 may serve as a good discriminator for LV preparedness for DSO for congenitally corrected transposition of the great arteries/intact ventricular septum.

キーワード:

先天性心臓手術先天性大血管転位症左室再トレーニング圧容積ループ

さらに関連する動画

08:21

Biventricular Assessment of Cardiac Function and Pressure-Volume Loops by Closed-Chest Catheterization in Mice

Published on: June 15, 2020

5.1K

07:56

Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model

Published on: May 18, 2021

4.3K

関連する概念動画

01:11

Cardiac Output and Stroke Volume

Cardiac output (CO) is an integral aspect of human physiology, reflecting the heart's efficiency and responsiveness to the body's needs. It represents the volume of blood that the left or right ventricle ejects into the aorta or pulmonary trunk each minute. The CO is calculated by multiplying the heart rate (HR)—the number of heartbeats per minute—by the stroke volume (SV)—the amount of blood pumped out with each heartbeat.
In an average resting adult male, the typical cardiac output averages...

01:24

Pressure Relationships in Thoracic Cavity

Breathing, otherwise known as pulmonary ventilation, is the process of air movement into and out of the lungs. The main mechanisms propelling pulmonary ventilation are atmospheric pressure (Patm), intra-pulmonary (Ppul ) or intra-alveolar pressure (Palv) within the alveoli, and intrapleural pressure (Pip) within the pleural cavity.
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs during...

01:22

Cardiac Output II: Effect of Stroke Volume on Cardiac Output

Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...