弁膜症の右心挙動—術前後の比較を中心とした検討

Right ventricular performance in patients with valvular heart disease following surgery

　弁膜症，特に僧帽弁膜症は左心負荷にとどまらず，肺循環を介して右心負荷をもたらしてくる。従って，左心に加えて右心の情報が心機能の把握および術後管理上に重要である。一方，心機能についてみると右心は左心と性質を異にしており，右心機能そのものを反映する指標は必ずしも明らかではない。

　著者らは先に，術前症例を中心に右室駆出率（RVEF）を中心とした弁膜症の右心挙動の考察を試みた^1）。今回，右室容積測定より得られる指標を用いて，術前後の変化に注目して比較検討を行い，右心挙動の解析を試みた。

Right ventricular performance of valvular heart disease has not been well documented. We showed the assessment of right ventricular performance with biplane cineangiography in pre-operative cases before.

This paper estimated the right ventricular performance change following surgery. And we also discussed the characteristics and the mech-anisms of right ventricular dilatation. RVEDVI is calculated with biplane cineangiography by area-length methods of Ferinz et al. We concluded the following results : 1) Normal value of RVEDVI was 89±8 ml/m², and RVEF was 59±9%. 2) Right ventricular volume was increased in Aortic Regurgitation groups, Mitral Regurgitation groups but not in Mitral Stenosis groups. The mechanisms of right ventricular dilatation in-cludes the influence of left ventricular dilatation through ventricular septum elongation in addition to pulmonary hypertension. 3) Post operative RVEF showed no significant change, although the relief of pulmonary hyper-tension and the decrease of RVEDVI were sig-nificant. RVEF should be adopted as an index of right ventricular performance with care. 4) RVEDVI correlated with RVedp (r=0.57, p<0.05).