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はじめに
僧帽弁狭窄症は常に右室に後負荷をかけている疾患と考えられるが,右室機能についての研究は未だ少ない1〜3)。本症の左室機能は正常よりも低下しているといわれているが4,5),右室機能については低下していないという報告3),必ずしもそうではないという報告2)があり一定の評価を得ていない。著者らは左室機能と右室機能を同一症例で検討し,血行動態諸成績との関連を追求した。すなわち,本症の低心拍出量は第一に僧帽弁の弁口面積が小さいことによるものと考えられているが6),これに抗って血液を拍出するのは右心室の働きであり,この右室の機能低下が低心拍出量状態を来たすものと考えられる。本症の左室および,右室容積を求めることによって左室,右室機能を検索し,血行動態と比較検討した。
Right and left ventricular functions were evaluated by quantitative biplane cineangiocardio-graphy in 17 patients with mitral stenosis. Right ventricular enddiastolic volume index (RVEDVI) ranged from 69 to 130 (99±18) ml/m2(mean±SDM), and right ventricular ejection fraction (RVEF) ranged from 0.33 to 0.69 (0.51±0.08). There was an inverse relationship between the RVEDVI and RVEF (r=-0.52, p<0.05). Left ventricular enddiastolic volume index (LVEDVI) ranged from 65 to 112 (91±12) ml/m2, and left ventricular ejection fraction (LVEF) ranged from 0.32 to 0.60 (0.52±0.08).
Cardiac index ranged from 1.61 to 4.40 (2.56±0.72) 1/min/m2, and correlated well with the RVEF (r=0.78, p<0.001) and with the LVEF (r=0.60, p<0.05).
All patients were divided into two groups. Group 1 contained of 9 patients with a cardiac index of over 2.50 1/min/m2 and group 2 of 8 patients with a cardiac index of less than 2.50. The RVEF averaged 0.55±0.07 in group 1 and 0.47±0.08 in group 2 (p<0.05), and the LVEF averaged 0.56±0.04 in group 1 and 0.49±0.09 in group 2 (p<0.05).
Tricuspid regurgitation was evident in 11 patients. The RVEDVI averaged 108±14 ml/m2 in 11 patiens with TR and 81±13 ml/m2 in those without incompetence (p<0.05). The RVEF averaged 0.49±0.10 in patients with TR and 0.56 ±0.04 in those without regurgitation. There were 7 patients who had had a closed mitral commissurotomy. Cardiac index averaged 2.11±0.43 and 2.88±0.72 1/min/m2 in 7 patients with recurrence and in 10 without a previous surgery, respectively (p<0.05). The RVEF averaged 0.46±0.08 and 0.55±0.07 in patients with a recurrence and in a non-recurrent patients (p<0.05).
These results indicate that the right ventricular enddiastolic volume was increased and ejection fraction was depressed in patients with mitral stenosis and a low cardiac output.
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