心胸郭比100％の重症弁膜症に対する2手術例

Two cases of valve replacement for the patients with 100% cardiothoracic ratios

　強力な内科治療にもかかわらず手術時の心胸郭比（以下CTR）が100％と高度な心陰影の拡大，心臓悪液質を呈した2例の重症弁膜症（僧帽弁閉鎖不全症，僧帽弁閉鎖不全症兼三尖弁閉鎖不全症）に，僧帽弁置換術およびペースメーカー植込術，僧帽弁置換術および三尖弁輪縫縮術を施行し良好な結果を得たので報告する。うち一例には術前中心静脈栄養（以下IVH）を施行し心臓悪液質の改善を得た後に手術に臨んだ。CTRが100％を呈する重症弁膜症に対しても術前のIVHや術後IABPの使用によってより安全な手術が可能であった。また2例とも術後NYHA II度に回復し社会復帰している。

Two cases of cardiac cachexia with 100% cardio-thoracic ratios underwent successful valve re placement. Patients with cardiac cachexia have dis-function of many organs and are unable to absorb enough nutrition from the intestines. Preoperative cardiac function and general condition determine the result of surgery. Since 1983, we have performed intravenous hyperalimentation for the patients with cardiac cachexia before operating. The patients whose CTR were 100% had intravenous hyperalimen-tation for two months. Surgery was thus judged to be successful and both patients are presently leading normal lives.