虚血性心筋症の内科治療と外科治療との比較検討

Ischemic cardiomyopathy: Medical versus surgical treatment

　冠状動脈病変に原因を有し，不可逆的な心筋障害を伴う難治性うっ血性心不全の病態を，Burchら^1）は虚血性心筋症ischemic cardiomyopathyと呼んだ。虚血性心疾患患者の多い欧米では，かかる病態の研究報告は多い。近年，本邦においても虚血性心疾患が激増し，こうした病態も多くみられるようになった。また，それに関する報告も散見される^2〜4）。我々も少数例を以前報告^5）した。しかし，その治療法については困難を覚えることが多く，論議の多いところである。本論文では，本疾患における内科的治療と外科的治療を比較し，心機能の推移および予後を検討した。

In view of the increased prevalence of so-called ischemic cardiomyopathy (Burch) in Japan, We attempted to compare the medical treatment with surgical one of this condition. Of the 25 cases with ischemic cardiomyopathy, 16 were managed medically and nine underwent A-C bypass opera-tion. In medical and surgical groups, ejection fraction, LVEDP, systolic pressure of pulmonary artery and cardiac index showed no deffereces before treatment.

Only two of the 16 medically treated patients showed the improvement in the NYHA functional class, six had death and the other eight showed no change. Whereas there was one death in surgical groups. All the other eight patients showed the remarkable improvement in the cardiac function. All these patients revealed a significant improvement of ejection fraction, LVEDP and cardio-thorax ratio after operation.

Our observations demonstrated that patients with ischemic cardiomyopathy may obtain a good symptomatic improvement by A-C bypass opera-tion.