Fallot氏四徴症の心音圖學的研究
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The value of auscultation in the diagnosis of tetralogy of Fallot has not been sufficiently appreciated.This paper is concerned with the importance of auscultation in its close correlation to the hemodynamics and the morphological findings of tetralogy of Fallot.This study was carried out in 59 cases with central cyanosis of which 53 cases underwent cardiac surgery and 9 cases were necropsied.Phonocardiograph with high-pass frequency characteristics was used to obtain phonocardiograms in each case. Sound tracing was recorded simultaneously with electrocardiographic lead, carotid or jugular pulse tracing.Right ventricular, infundibular and pulmonary pressure tracing were recorded at the right heart catheterisation or by means of direct puncture at surgery.Results and Conclusions 1) Systolic murmurs of tetralogy of Fallot were classified into the 4 major types as follows : Type A : Systolic murmurs ceased before the sound of aortic semilunar closure (IIa), and peaks of the systolic murmurs were registered in earlier systole.……21/59 cases (35.6%)Type B : Systolic murmurs continued to the IIa, these maximal vibrations were nearby midsystole.……24/59 cases (40.7%)Type C : Systolic murmurs were crescendo in late systole.……11/59 cases (18.6%)Type D : Sytolic murmurs were faintly heard and did not show the definite ejection murmur.……3/59 cases (5.1%)2) These 4 types of systolic murmurs were explained on the basis of the hemodynamics and the morphological findings.In Type A, infundibular stenosis was severe and valvular stenosis was mild or absent. Infundbiular pressure raised at the isometric contraction or at the onset of ejection phase of right ventricular pressure, and then descended suddenly in midsystole. Pulmonary and infundibular systolic pressure were approximathly on the same level and both of the systolic pressure curves resembled with each other.In Typh B, somh cases had infundibular chamber, in addition to valvular stenosis, while other cases had infundibular stenosis alone.In Type C, infundibular stenosis was mild or absent, valvular stenosis was severe, infundibular pressure was slightly lower than right ventricular pressure, and pulmonary pressure was lower than the former.In Type D, infundibular and valvular stenosis were extremely severe. pulmonary pressure was very low and did not show apperent rise of pressure in systole.Clinicaly some of the Type A, and all of the Type D were extremely severe cases, while the Type C were mostly mild cases.3) Presence or site of the pulmonary component of the second heart sound must be determined by analysing both infundibular and pulmonary pressure curves.In Type A, the earlier descent of infundibular systolic pressure curves suggests the fact that outflow tract is closed at the infundibular region during systole. Accordingly, closure of pulmonary valve may occur earlier than that of the aortic valve.Phonocardiogiaphic registration revealed such low-frequency, low-piched vibrations before the aortic component of the 2nd heart sound in 9 cases out of 21 cases of Type A.In Type B and C, the infundibular isometric relaxation curves coincided with the right ventrivular isometric relaxation curves, and because of the fact that the pulmonary pressure was low, the pulmonary component of the 2nd heart sound delayed. Out of 24 cases of Type B, 2 cases had this component.5 cases out of 11 cases of Type C showed the pulmonary component following the aortic closure.4) Q-I interval was 0.04-0.08 sec.5) All 59 cases did not show the marked atrial systolic sound or any diastolic murmur.
- 社団法人日本循環器学会の論文
- 1959-06-20