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人工ミトラ弁のが厚くなり,硬くなり,ミトラ弁の機能障害が生じます
Y Kobayashi1, S Nagata, F Ohmori
1Department of Internal Medicine, National Cardiovascular Center, Osaka, Japan.
Circulation
|November 1, 1996
まとめ
ミトラル弁の修復後に人工コルダが厚くなると,弁の機能が損なわれる可能性があり,特にポリテトラフルオロエチレン (PTFE) 縫い目と比較して,グルタルアルデヒドで光された異種心臓移植 (GTXP) により,弁の機能が損なわれます. これらの変化をモニタリングすることは,長期的な成果にとって極めて重要です.
科学分野:
- 心血管外科手術についてです.
- バイオマテリアル科学 バイオマテリアル科学
- エコーカルディオグラフィー エコーカルディオグラフィー
背景:
- ミトラル弁の修復に用いられる人工コルダの長期的な機能的変化に関するデータは限られている.
- 人工コルダの厚みや硬化は,時間の経過とともにミトラ弁の機能に潜在的に影響を与える可能性があります.
- 連続エコーカルディオグラフィは,これらの構造的および機能的変化を評価するための重要なツールです.
研究 の 目的:
- ミトラル弁の修復後の人工コルダの厚みと硬化を評価する.
- シリアルエコーカルディオグラフィを用いて,これらの変化がミトラバルブ機能に与える影響を評価する.
- 耐久性と機能的効果を比較するために,グルタルアルデヒドで焼された異種移植心臓 (GTXP) とポリテトラフルオロエチレン (PTFE) を比較します.
主な方法:
- GTXPまたはPTFE人工コーデでミトラ弁の修復を施した40人の患者の遡及的分析.
- 人工コルダの厚みや硬化 (分類グレード1-3) を評価するためのシリアルエコーカルディオグラフィック検査.
- 平均6.0年 (GTXP) と3.6年 (PTFE) の追跡期間におけるミトラル弁領域と小葉の運動の変化の評価.
主要な成果:
- グレード3の加厚と硬化 (パンフレット運動障害) は,4/7のGTXP患者と2/20のPTFE患者で発生しました.
- GTXP患者 (2.5〜2.1cm2) では,ミトラル弁の面積が著しく減ったが,PTFE患者 (2.1〜2.0cm2) ではそうではなかった.
- グレード3の変化は,PTFE chordae (P < .05) よりも,GTXPで早期に発達した.
結論:
- 人工コルデーを用いたミトラル弁の修復は,実行可能な選択肢です.
- 人工コルダ,特にGTXPの厚みや硬化は,ミトラル弁の機能障害につながる可能性があります.
- 人工コルダで修復した後のミトラル弁の機能を注意深くモニタリングすることは,有害な変化を検出するために不可欠です.
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