Fallot四徴の血行動態におよぼすisoproterenolとpropranololの効果 : 無酸素発作の発生および治療に関する考察

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The mechanism of the anoxic spells in the patient with tetralogy of Fallot is still uncertain, but beta adrenergic stimulation has been shown to accentuate cyanosis and occasionally to precipitate an anoxic spell. The purpose of the present study is to investigate the hemodynamic responses to isoproterenol (adrenergic beta stimulant) and propranolol (adrenergic beta blockade). Materials and Methods: Eleven children ranging in age from 3 to 14 years have been studied at cardiac catheterization (tetralogy of Fallot 7 cases, pulmonary stenosis with intact ventricular septum 2 cases, ventricular septal defect 1 case, patent ductus arteriosus 1 cases). All patients were sedated with hydroxyzine hydrochloride, secobarbital and pethidine HCl. The pressure pulses of pulmonary artery, right ventricle and femoral artery were obtained by the Siemens electro manometer. Determinations of oxygen satura-tions were obtained with the gas analyser (In-strumentation Laboratory) on arterial, pulmo- nary and mixed venous blood. Oxygen consumptions were measured by Fukuda Irika's respirometer. The phonocardiogram and the first derivative of right ventricular pressure pulse (dp/dt) were simultaneously recorded. Isoproterenol (0.1mg/20cc in 5% dextrose in water)was infused intravenously until the heart rate increased by 50 per cent. Then blood samples were obtained and pressure pulses were recorded. Thereafter, while the action of isoproterenol persisted, the infusion of propranolol in a dose of 5γ/kg (2mg/20cc in 5% dextrose in water) was administered, and the parameters were restudied. The angiocardiogram was obtained in one case before and after isoproterenol infusion. Results and Discussion: In tetralogy of Fallot the isoproterenol in-fusion resulted in an increase of right ventricular systolic pressure and a decrease of pulmonary systolic pressure. Pulmonary blood flow was decreased and systemic blood flow and right to left shunt were increased, so arterial oxygen saturation was markedly decreased. In angio-cardiogram the marked narrowing of the right ventricular outflow tract was demonstrated after isoproterenol infusion. In simultaneously recorded phonocardiogram the ejective systolic murmur due to pulmonary stenosis was decreased by isoproterenol infusion. In pulmonary stenosis with intact ventricular septum the pressure gradient of pulmonary artery and right ventricle was markedly increased, but arterial oxygen saturation was unchanged after isoproterenol infusion. Thereafter, while the action of isoproterenol persisted, a infusion of propranolol was administered. In tetralogy of Fallot the propranolol infusion resulted in an increase of arterial oxygen saturation. And the systolic pressure gradient of pulmonary artery and right ventricle was decreased. Pulmonary blood flow was increased and systemic blood flow and right to left shunt were decreased. So the patients were recovered from anoxic state. The mechanism of the anoxic spells in tetralogy of Fallot is still uncertain, but our study suggests that the increase of the contraction in the outflow tract of right ventricle makes the hypoxic condition. Relaxation of the outflow tract of right ventricle is seen after propranolol, and the patient is recovered from anoxic condition. In one case with tetralogy of Fallot in age of 9 months who had frequent cyanotic at-tacks we used propranolol orally 5 mg a day. After propranolol there has been no anoxic spell in this patient. So it may have been some practical usefulness in prevention and treatment of anoxic spells in tetralogy of Fallot.
社団法人日本循環器学会の論文
1968-01-15

Fallot四徴の血行動態におよぼすisoproterenolとpropranololの効果 : 無酸素発作の発生および治療に関する考察

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