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Kokyu to Junkan Volume 37, Issue 9 （September 1989）

呼吸と循環 37巻9号（1989年9月発行）

Japanese English

研究

ファロー四徴症根治術後の左室容積特性に関する検討—右室との相関関係について Left ventricular volume characteristics and its relationship with right ventricle after repair of tetralogy of Fallot 小林順二郎 ¹ , 中埜粛 ¹ , 松田暉 ¹ , 島崎靖久 ¹ , 徳庵喜久 ¹ , 川島康生 ¹ Junjiro Kobayashi ¹ , Susumu Nakano ¹ , Hikaru Matsuda ¹ , Yasuhisa Shimazaki ¹ , Yoshihisa Tokuan ¹ , Yasunaru Kawashima ¹ ¹大阪大学医学部第一外科 ¹First Department of Surgery, Osaka University Medical School pp.983-989

発行日 1989年9月15日 Published Date 1989/9/15

DOI https://doi.org/10.11477/mf.1404205544

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Abstract 文献概要
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　ファロー四徴症（TF）根治術後における心機能の研究は，右室流出路再建術後に発生する肺動脈弁閉鎖不全（PR），遺残する肺動脈狭窄（PS），右室切開の有無等に影響される右室を中心になされてきた_1〜4）。一方，左室についても検討が加えられるようになってきたが_5〜9），これらはいずれも左室単独の検討，あるいは遺残心室短絡手術時年齢の及ぼす影響に関する検討が中心であり，右室との相関についての研究は少ない。

　今回我々は，TF根治術後の左室機能を検討し右室の及ぼす影響について興味ある知見を得たので報告する。

In order to study the left ventricular volume characteristics and right ventricular influence on left ventricle, cardiac catheterization and biplane cine-angiography was performed in 61 patients after re-pair of tetralogy of Fallot. Preoperative left ven-tricular volume size was also measured in 25 patients.

Postoperative left ventricular end-diastolic volume index (LVEDVI) was 93±22 ml/m² (mean±standard deviation) and it was 140±20% of normal left ventricular volume. Left ventricular ejection frac-tion (LVEF) was 60±6 %. Left ventricular size significantly increased from 109±25% to 140±23% of normal by corrective surgery (p<0.001).

Left ventricular volume characteristics are corre-lated with right ventricle. LVEDVI increased with increasing right ventricular end-diastolic volume in-dex (RVEDVI) and decreased right ventricular ejec-tion fraction (RVEF). LVEDVI (ml/m²)= 60+0. 29 RVEDVI (ml/m²), r = 0. 52, p <0.001, LVEDVI (ml/m²) = 141-0.90 RVEF (%), r=-0. 30, p <0.02. LVEF decreased with increasing RVEDVI and decreased RVEF. LVEF (%)= 68-0.075 RVEDVI (ml/m²), r= -0. 51, p<0. 001, LVEF (% )= 43 + 0. 32 RVEF (%), r=0. 40, p <0. 001. On the contrary there was no relationship between right ventricular volume char-acteristics and right ventricular systolic pressure.

There were two cases whose LVEF was less than 50%. In one case right ventricular systolic pressure was as high as 98 mmHg. In the other patientRVEDVI was 299 ml/m² (453% of normal right ventricular volume) because of severe pulmonary regurgitation. In these cases interventricular septum was deviated to the left ventricle in the diastolic phase, and it moved paradoxically toward the right ventricle in the systolic phase.

This fact revealed that the right ventricle has an influence on the left ventricular pump function, possi-bly by way of the movement of the interventricular septum.