Effects of Balloon Pulmonary Valvuloplasty on Atrial Shunting : A Patient With Pulmonary Valve Stenosis and A Large Secundum Atrial Septal Defect
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概要
- 論文の詳細を見る
Percutaneous balloon valvuloplasty has been established as an effective treatment for pulmonary valve stenosis (PS) in children and adults. However, there are few reports of the use of this technique in patients with other cardiac anomalies. We report the performance of balloon pulmonary valvuloplasty in a 72-year-old woman with a large atrial septal defect (ASD). This patient had a PS with a right ventricular pressure of 108/18 mmHg and a pulmonary arterial pressure of 42/21 mmHg, corresponding to a 66 mmHg pressure gradient. The ASD measured 32×27 mm. Balloon pulmonary valvuloplasty reduced the pressure gradient to 5 mmHg immediately after the procedure and to 2 mmHg 40 days after the procedure. The left-to-right shunt ratio was reduced from 17% before to 12% immediately after and to 36% 40 days after the procedure. In contrast, the right-to-left shunt ratio showed a transient increase from 16% before to 28% immediately after the procedure before decreasing to 11% 40 days after the procedure. The arterial blood oxygen tension was 53 Torr before, 46 Torr immediately after and 55 Torr 40 days after the procedure. The grade of heart failure decreased from New York Heart Association class IV before to class II in the chronic stage. These findings indicated that balloon pulmonary valvuloplasty in a patient with ASD transiently increased the right-to-left shunting associated with a decrease in oxygen tension, but that the change in the chronic stage was slight. In our patient with ASD valvuloplasty was useful in relieving the symptoms associated with elevated right ventricular pressure but could not reduce the hypoxemia caused by right-to-left shunting. In conclusion, valvuloplasty in patients with ASD should be considered as a preoperative treatment with the aim of reducing the risk of surgery and to treat symptoms in patients who refuse to undergo surgery.
- 社団法人日本循環器学会の論文
- 1997-01-20
著者
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Okada Seiji
Matsue Municipal Hospital 2nd Department Of Internal Medicine
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Tamita Kouichi
神戸市立中央市民病院
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Tanabe Kazuaki
神戸市立医療センター中央市民病院 循環器内科
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Tanabe Kazuaki
Division Of Cardiology Kobe General Hospital
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Shimada Toshio
Fourth Department of Internal Medicine, Shimane Medical University
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SANO Kazuya
Cardiovascular Division, Department of Internal Medicine, Shimane Medical University
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MORIOKA Shigefumi
Cardiovascular Division, Kobe General Hospital
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Okada Seiji
Fourth Department of Internal Medicine, Shimane Medical University
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Shimada Toshio
Division Of Cardiobascular Medicine Shimane University Faculty Of Medicine
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Morioka Shigefumi
Fourth Department Of Internal Medicine Shimane Medical University
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Ishibashi Yutaka
Fourth Department of Internal Medicine, Shimane Medical University
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Sano Kazuya
Fourth Department of Internal Medicine, Shimane Medical University
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TANABE Kazuaki
Fourth Department of Internal Medicine, Shimane Medical University
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Kin Hakutetsu
Fourth Department of Internal Medicine, Shimane Medical University
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Nakamura Kou
Fourth Department of Internal Medicine, Shimane Medical University
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Matsumoto Hiroshi
Fourth Department of Internal Medicine, Shimane Medical University
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Okada Seiji
Department Of 2nd. Internal Medicine Matsue City Hospital
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Sano Kazuya
Cardiovascular Division Department Of Internal Medicine Shimane Medical University
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Nakamura Kou
Fourth Department Of Internal Medicine Shimane Medical University
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Kin Hakutetsu
Fourth Department Of Internal Medicine Shimane Medical University
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Morioka Shigefumi
Cardiovascular Division Kobe General Hospital
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Ishibashi Yutaka
Division Of Cardiobascular Medicine Shimane University Faculty Of Medicine
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Okada Seiji
The 2nd Department Of Internal Medicine Matsue City Hospital
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Ishibashi Yutaka
Fourth Department Of Internal Medicine Shimane Medical University
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Shimada Toshio
Fourth Department Of Internal Medicine Shimane Medical University
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Matsumoto Hiroshi
Fourth Department Of Internal Medicine Shimane Medical University
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