第3心音に関する研究

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概要

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• The purpose of this papers is to present the results of both clinical and experimental studies on hemodynamic mechanism of third sound observed during heart failure as a component of early diastolic gallop sound. Part 1: Clinical observation. Subjects and Methods: Phonocardiogram obtained in the cardiopulmonary laboratory of the Mie University Hospital during the last five years on 163 cases of congenital heart disease, 244 cases of acquired heart disease and 242 cases of non-cardiac patients were analysed, 43 cases with mitral regurgitation were studied by right heart catheterization and the hemodynamic pathogenesis of the third heart sound was investigated. Results and Discussion: Higher incidence of third heart sound was occurred in 90% of MI cases and 76%of constrictive pericarditis cases. Positive correlation was observed between 2nd-3rd sound interval and preceding R-R interval in all cases of congenital, acquired heart disease and noncardiac cases. Additionally, excellent positive correlation was impressed between 2nd-3rd interval and preceding R-R interval in three cases of MI with atrial fibrillation. In MI cases, height of v-wave or Ry/v (Ry denotes descent of y wave in mmHg per sec.) of pulmonary arterial wedge pressure contour which are regarded as indicator of the severity of regurgiation, were compared with 2nd-3rd sound interval. Significant negative correlation was observed between 2nd-3rd sound interval and height of v wave (r = -0.57 0.001 <p<0.01). On the other hand, significant correlation was faild to be evidenced between 2nd- 3rd sound interval. 90% of MI cases with third sound, arithmetic average of v height and its mean pressure of pulmonary artery wedge pressure contour were 30.8 mmHg. and 18.4 mmHg., respectively. On the other hand, 10% of MI without third sound, arithmetic average of v height and its mean pressure were as low as 10.8 mmHg. and 6.2 mmHg., respectively, which indicates almost pressure gradient between LA and LV at the time of rapid filling period, and creates not enough blood flow or flow velocity through mitral ostium. MI without third sound, therefore is regarded as milder and in differentation from innocent apical systolic murmur, left ventriculography is needed.

• 社団法人日本循環器学会の論文
• 1971-11-20

著者

• 幸治 隆一

  三重県立大学第一内科学教室

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• 第3心音に関する研究

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