人工弁移植術後血行動態の心音図による研究

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Introduction: There has been world wide popularity of prosthetic replacement for the severely destroyed cardiac valve with malfunction. Total number of 289 cases of 336 of prostheses have been replaced for them until end of March, 1968. Among them, author made phonocardiographic analysis postoperatively. It is believed that this method display the considerable accuracy of hemodynamic statement or function of the cardiac valve without painstaking to the patient. With this method of analysis, hemodynamic improvement had been compared with various prostheses replaced, including new type of prosthesis, Wada hingeless valve. Method: Total number of 105 cases were selected for the phonocardiographic analysis. They were all followed up more than 3 months after surgery. Fifty-five cases of them were mitral and rest were aortic replacement. These were 2 to 51 year-old in age. Fifty of them were male and 55 female. In mitral replacements, there are 36 of Starr-Edwards, 10 of Wada hingeless, 6 of SmeloffCutter and 3 of Kay-Shiley valve. In aortic, these are 38 of Starr-Edwards, 8 of SmeloffCutter and 4 of Wada hingeless valve. Cardiac sound was recorded using crystal micro-phone and traced photographically. At the same time, apexcardiogram and carotid pulse wave were traced in selected cases. These data were compared in each other and normal person. Result. At mitral position of ball or disc valve, there noted clear and high pitched opening and closing sound both in auscultation and phonocardiogram. However, in cases of the replacement with Wada hingeless valve, there noted opening sound in 50% phonocardiographically and no opening sound in auscultation. There are mild prolongation of Q-Mitral Closing Valve Sound interval (Q-MCVS) when compared with Q-1 interval of normal heart. There are prolongation of II-Mitral Opening Valve Sound interval (Q-MOVS) than preoperative value of II-OS interval in cases of mitral stenosis. II-MOVS proportionally decrease with the rate of cardiac beat. When atrial fibrillation exists, there showed prolongation of Q-MCVS and shortening of II-MOVS than that of sinus rhythm. Three of them showed that Q-MCVS and II-MOVS changed proportionally increase and decrease respectively with the preceding R-R interval. There recorded sometimes extra-sound (Rotating Ball Sound, RBS and Rebounding Leaflet Sound, RLS) which some due to prosthetic valve itself. Upon the analysis of the cases who regurgitation and malfunction of prosthesis postoperatively, it noted appearance of the murmur and changes of II-MOVS phonocardiographically. These phonocardiographic changes are important clue which decides reoperation for the malfunctioned valve in time. At aortic replacements, there noted systolic murmur of ejection type in all cases. Wada hingeless valve recorded the least prosthetic opening sound. It was observed that Q-M_1 interval prolonged slightly than normal in the group of sinus rhythm and more in the group of atrial fibriffa-tion. There are almost normal value in M_1-Aortic Opening Valve Sound (M_1-AOVS) and Aortic Opening Valve Sound-Aortic Closing Valve Sound interval (AOVS-ACVS). There recorded extra sounds (RBSRLS) in 42 % of aortic replacement. It was considered to be non-specific hemodynamically . In analysis of carotid pulse wave, it indicated the lateral flow obstruction and stenosis of valvular orifice in some cases. Unlike to the cases of mitral replacement, there obtained no qualitative results phonocardiographically to the grade of regurgitation developed postoperatively. Conclusion: In summary, after the prosthetic replacement of the cardiac valves it revealed prosthetic opening sound and systolic murmur of ejection type at aortic replacements. Otherwise, it showed approximately normal value in each intervals phonocardiographically. In general, it showed that the currently available prosthetic valves indicated satisfactory valvular function in their positions. However, these are all showing mild stenosis of t
社団法人日本循環器学会の論文
1969-07-20

人工弁移植術後血行動態の心音図による研究

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