機能的三尖弁閉鎖不全症の病態に関する研究 : 三尖弁弁輪拡大と右室容積および右室機能との関連について
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The presnt study was undertaken to clarify the mechanism inducing functional tricuspid regurgitation using the technic of selective right ventricular angiography. Materials chosen for this study were 38 patients with rheumatic heart disease (RHD) who underwent open heart surgery and certified the valvular changes, 20 patients with atrial septal defect (ASD) 8 patients with valvular pulmonary stenosis (PS) and 9 cases without heart disease (NHD). Right ventriculography was performed with large film changers at speed of 6/sec. for 3-4 sec. as biplane. Tricuspid annular area (TAA) was calculated using the angiogram in frontal plane and right ventricular volume was obtained using modified Dodges area-length method. TAA was compared with those of right ventricular volume, right ventricular ejection fraction and systolic right ventricular pressure. Results were as follows. 1) All Patients whose TAA at the endsystole exceeded 13cm^2/m^2 developed tricuspid regurgitation. 2) Between TAA and right ventricular end diastolic volume (RVEDV), a significant correlation was found. RHD induced more pronounced enlargement of TAA than ASD despite RVEDV of both disease were almost same. 3) In PS, pressure overload to the right ventricle did not cause an increase in RVEDV and also did not induce the enlargement of TAA. 4) In RHD with tricuspid regurgitation (TR) and ASD, a significant negative correlation was observed between RVEDV and right ventricular ejection fraction (RVEF). RVEF in RHD with TR was compared with that in ASD under the condition that RVEDV was almost the same. From these result, it was revealed that the measurement of TAA was highly evaluated for making diagnosis of functional tracuspid regurgitation. In addition, it was suggested that the myocardial factor in rheumatic heart disease might play a role in the divelopment of functional tricuspid regurgitation.
- 神戸大学の論文
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