ALTERATION OF PULMONARY BLOOD FLOW DISTRIBUTION IN PATIENTS WITH CONGENITAL LEFT TO RIGHT CARDIAC SHUNT : Pre-and Postoperative Study with Macroaggregates of ^99m<Tc>-labeled Human Serum Albumin
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概要
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The pulmonary blood flow in 84 patients with left to right cardiac shunts was preoperatively and postoperatively examined by scintigram with macroaggregates of ^&l;t99m>Tc-labeled human serum albumin. Lung biopsy was also performed in 28 patients. The regional pulmonary blood flow distribution curves obtained from perpendicular scintillation to the long axis of the right lung in the supine position were classified into 4 patterns (normal and types I to 3). The normal pattern displayed uniform distribution, however type I demonstrated a lack of upper corner in the curve. Type 2 showed 2 peaks (a lower peak in the upper and a higher peak in the lower part of the lung) with a dip between them. Finally only I peak in the lower part of the lung was manifest in type 3. The right Upper/Lower lung count ratio, R(U/L), expressed as the mean±standard deviation in each curve type was 0.82±0.12 (n=23), 0.71±0.11 (n=28), 0.6±0.08 (n=17) and 0.58±0.18 (n=16), respectively. The count ratios from the 3 abnormal types were statistically significant compared to the normal curve type (p<0.01). In addition, the type I and 2 curves were significant compared to type 3 (p<0.05-0.01). In patients under 3 years of age, lower R (U/L) count ratio expressed more severe pulmonary hypertension. Negative correlations were observed with the peak pulmonary/peak systemic pressure ratio, Pp/Ps, (r=-0.66, p<0.01) and with the pulmonary vascular resistance index, PVRI, (r=-0.45, p<0.01). However, these correlations disappeared in patients above age 3. The postoperative alteration of the curve type depended on the preoperative severity and was considered useful for follow-up. Seventy-five percent of type I patients changed to normal after I year. However, the more severe type 2 and 3 patients only demonstrated recovery to normal in 43% and 10% of the cases, respectively.
- 社団法人日本循環器学会の論文
- 1993-04-20
著者
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Kurosawa Hiromi
Department Of Cardiovascular Surgery Jikei University School Of Medicine
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Arai Tatsuta
Jikei University School Of Medicine The Department Of Cardiac Surgery
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Arai Tatsuta
Jikei University School Of Medicine Department Of Cardiovascular Surgery
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Nakamura Yuzuru
Department Of Cardiovascular Surgery Jikei University School Of Medicine
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Matsui Michihiko
Jikei University School of medicine, The Department of Cardiac Surgery
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HASHIMOTO KAZUHIRO
Jikei University School of Medicine, Department of Cardiovascular Surgery
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NAKAMURA YUZURU
Saitama Children's Hospital, Department of Cardiovascular Surgery
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SUZUKI KAZUHIKO
Jikei University School of Medicine, Department of Cardiovascular Surgery
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KUROSAWA HIROMI
Jikei University School of Medicine, Department of Cardiovascular Surgery
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Matsui Michihiko
Jikei University School Of Medicine Department Of Cardiovascular Surgery
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Hashimoto Kazuhiro
Department Of Cardiovascular Surgery Jikei University School Of Medicine
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Suzuki Kazuhiko
Jikei University School Of Medicine Department Of Cardiovascular Surgery
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