先天性大動脈狭窄症における心肥大と手術時期による術後心機能回復への影響

概要

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Congenital aortic stenosis (cAS) in children is characterized by low left ventricular (LV) systolic wall stress (WS) allowing for supernormal ejection performance and immediate improvement of the cardiac function after operation. In contrast, the cardiac function of elder children seemed to have different. We evaluated the cardiac function of cAS before and after operation. Eleven patients (pts) who underwent Konno operation and cardiac cathetelization before and one month after the operation were studied. Six pts over 10 y.o. were assigned as the elder group (EG), and 5 pts under as the younger group (YG). Preoperative %Left ventricular mass (LVM) was significantly increased in YG and end-systolic wall stress (ESWS) was higher in EG. In both groups, LV ejection fraction was supernormal state and normalized after operation. %LVM decreased significantly in YG, whereas it showed only a slight decrease in EG after operation. ESWS increased in YG slightly after operation, whereas it remained high in EG. Chamber stiffness (Kc) showed improvement in YG, whereas it worsened in EG after operation. Inappropriate LV hypertrophy with high WS was noted in the EG which leaded to persistent high WS and increased Kc after operation. We conclude that appropriate timing of the operation of cAS may be less than 10 years of age wherefore myocardium shows good compensation with normal WS.
2000-12-25