Developmental Aspects of Pulmonary Circulation : Clinical Implications of Postnatal Maturation of Right Heart System
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概要
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The postnatal maturation of pulmonary vasculature which occurs early neonatal stage brings a decrease of pulmonary artery pressure and of pulmonary vascular resistance as shown in our study on the normal subjects. The presence of small ventricular septal defect (VSD) did not affect the normal maturation pattern. In some severe congenital heart diseases the maturation also occurs but is modified to some extent. The maturation occurred in a case of large VSD causes transient increase of pulmonary blood flow as seen in our data and the latter may act as a precipitating factor for the onset of congestive heart failure. However, we showed that there are a number of cases which have heart failure prior to the increase of pulmonary blood flow. The traditional concept of maturation cannot be applicable, for such cases to explain the development of heart failure. We proposed a broader concept of the maturation of the right heart containing the maturation of right ventricular musculature, and showed that it is effectively applicable for the explanation of the hemodynamic transition and the onset of heart failure in large VSD, transposition of great vessels (TGA) and pure pulmonary stenosis (PPS). A transient postnatal decrease of right ventricular pressure in TGA and a discrepancy existing between the hemodynamic severity and the grade of ECG findings in young children with PPS were found and discussed. The pathologic physiology of maturation containing the re-activity of pulmonary vasculature, the right ventricular function and the heart failure was discussed on the ground of the above mentioned data and the added cases of primary pulmonary hypertension and cor pulmonale.
- 社団法人日本循環器学会の論文
- 1974-11-20
著者
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Kato Hirohisa
Associate Professor Of Pediatrics School Of Medicine Kurume University
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Oda Teiichi
Associate Professor Of Pediatrics Faculty Of Medicine Kyushu University