後天性僧帽弁疾患における段階的高頻度ペーシングの血行動態に及ぼす影響

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概要

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• The effects of graded high rate pacing on hemodynamics in the mitral valvular diseases. Hemodynamic changes were studied by right atrial (RA) and right ventricular (RV) pacing to alter the rate in the valvular heart diseases (VHD), especially in the mitral valvular diseases (MVD) and clinical significance of pacing hemodynamics was assessed with the following results. 1) In the control subjects, the cardiac index (CI) was decreased with the elevated mean pulmonary capillary pressure (mPCP), mean pulmonary arterial pressure (mPAP) and increased total pulmonary vascular resistance (TPR), when the pacing rate exceeded 130/min. 2) In mitral stenosis (MS), regardless it's rhrthm, the author noted the decreased CI, the elevated mPCP and mPAP with the increased TPR at slightly increased rate by pacing and these changes were more apparrent after further increase in the pacing rate. 3) The effects of the increased rate on the hemodynamics were various according to the severity of MS and the extent of the elevated mPCP at the increased rate. 4) The MS with tricuspid regurgitation (MS + TR) revealed the slightly decreased mPCP and mPAP at the rate exceeding 130/min and accordingly pulmonary congestion in MS+ TR was less severe than in MS alone. However, the CI was remarkably decreased in the former. 5) In mitral regurgitation (MR), the CI was decreased and mPCP and mPAP were elevated with and the increased TPR, when then the rate exceeded 130/min, but the effects of the increased rate on the hemodynamics were obviously less manifestive in MR than in MS. It is concluded from these findings that the observation on the hemodynamic changes at the increased rate either by RA or RV pacing is quite valuable for evaluating the severity of VHD, especially in MVD and it would be able to provide the useful clinical informations about ipredicting prognosis and decision of therapeutical planning.

• 神戸大学の論文

著者

• 戸田 常紀

  神戸大学医学部内科学第一講座

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