特異な三尖弁血流を示した高度肺動脈弁弁下部狭窄症の1手術治験例

A surgical case report of severe infundibular PS:especially transtricuspid flow by pulsed Doppler cardiography

　肺動脈弁狭窄症は他に合併奇形が伴わない限り無症状であることが多いが，加齢，圧較差の増大などにより心不全に陥る場合がある。

　著者らは肺動脈弁弁下部狭窄で著明な右心不全およびうっ血肝をきたした症例で，pulsed Doppler法上，特異な三尖弁血流を示した症例を経験したので，その手術前後の三尖弁血流を中心に若干の文献的考察を加え，自験例を報告する。

A 48-year-old female with severe infundibular PS was admitted on the purpose of operation. Catheteri-zation data and RVgraphy showed PS, especially in infundibular position. Transtricuspid flow, using pulsed Doppler, revealed that there was almost no rapid inflow (R wave) to RV in diastolic phase but A wave was very prominent in end-diastolic phase. So it was very important to maintain sinus rhythm in ECG in order to keep transtricuspid flow in end-diastolic phase.

Operation was as follows, under cardiopulmonary bypass. At first RVtomy in outflow was performed, and then abnormal muscle bundle was incised, finally RV outflow was reconstructed by dacron patch.

Postoperative hemodynamics was in satisfactory condition, and pulsed Doppler showed that R wave in transtricuspid flow was apparently accepted, on the contrary A wave was less prominent than before.