心臓手術後の右心機能不全に関する臨床的研究
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概要
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Postoperative hemodynamic study was carried out in 74 adult patients, who underwent open-heart surgery, with a special reference to the right ventricular function in the early postoperative low cardiac output state. Cardiac dysfunction was observed in 25 patients (34%) postoperatively and 15 patients of them developed right ventricular dysfunction (RVD) (Cardiac Index ≦2.2l/min/m^2 and central venous pressure ≦15mmHg). Presence of tricuspid regurgitation (TR) was diagnosed by palpating the regurgitant jet with surgeon's finger inserted through the right atrial appendage. TR was noticed in 18 patients and tricuspid annuloplasty (TAP) was performed in all of them. 7 patients (39%) of them developed RVD postoperatively and improvement of Cardiac Index was significantly poor compared with others. RVD was noticed three times as frequently in cases with TR as in cases without TR. TAP with single suture was performed in 11 patients and 6 (55%) of them developed RVD postoperatively. On the other hand, in 7 other patients in whom TAP was performed with two sutures or Carpentier's ring, no RVD was observed except for one patient suffering from postoperative myocardial infarction. It was concluded from these results that TAP for TR in the patients with mitral valve disease was preferably performed with two sutures or Carpentier's ring when the right ventricular end-diastolic pressure was elevated over 6mmHg. In case without TR, intraoperative or postoperative factors such as air embolism of the coronary arteries, insufficient myocardial protection, left ventricular overdistension during cardiopulmonary bypass, myocardial infarction, over tramfusion of blood and cardiac tamponade, are considered to be responsible for postoperative RVD.
- 神戸大学の論文