4 左室形成術 : 特に小児の拡張型心筋症に対する経験から(シンポジウム心不全治療の最近のトピックス,第600回新潟医学会次第)

概要

論文の詳細を見る
The purpose of this study is to define the role and the indications of partial left ventriculectomy(PLV) in children with end-stage dilated cardiomyopathy(DCM). Clinical data were collected by retrospective chart review of children with DCM who were treated from 1997 to 2000. Four patients underwent PLV, two patients are well 48 and 65 months postoperatively, one infant survived 6 months and then successfully underwent heart transplantation, and the other child died of hemoptysis 2 weeks postoperatively. Factors affecting outcome were preoperative status, in particular whether surgery was performed emergently or electively. Based on our experience performing PLV in four patients, we identified several factors that determine the appropriateness of PLV in children with DCM. We feel most strongly that New York Heart Association class III or F, patients who are hospitalized for heart failure and require heroic doses of cathecholamines should undergo PLV before mechanical ventilation is needed. Less absolute criteria include a CTR≧70%, LVEDd(%)≧170%, EF≧20%, and BNP≧1000pg/mL. In conclusion, PLV is indicated for selected children with end-stage DCM, and is most appropriate when medical therapy is not effective and heart transplantation is unavailable.
新潟大学の論文
2005-02-10