人工弁置換が行われた後天性弁膜症の死因に関する臨床的考察
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概要
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One hundred and forty-two cases of valve replacement have been performed in our clinic on patients with acquired valvular disease from 1966 to 1977. Forty seven death cases were investigated clinically especially from the viewpoint of causes of death. 1. Twenty-nine cases out of 47 were early death and 18 were late death. Among all the 142 cases, 13 cases needed re-operation: three cases of which died at early postreoperative period and 2 ended in late death. 2. Among 29 cases of early death, 13 showed mainly mitral stenosis while 6 showed mitral regurgitation. Compared with the MR group tended to have much longer patient years, low cardiac index, marked S-T ischemic depression in chest lead and high R p/Rs. The causes of death in the MS group were mainly due to LOS or hepato-renal failure induced LOS, whilst in the MR group other factors such as arrhythmia or thrombo-embolism were considered to be the cause of death. 3. Based on the retrospective review of these death cases, a certain score was given to the several preoperative factors which are thought to be contributory to the cause of death. All the patients with score 5 or more died developing LOS. The lower the score, the less mortality rate and less LOS occuring rate were observed. 4. Among the late death cases, the most frequent cause of death was thrombo-embolism which was found in approximately a half of all the cases in this group. Therefore, it would be very important to put the emphasis on preventing this complication in further practice. 5. Determination of indication and surgical technique are difficult for re-operation. The cause of death in this group should be evaluated or considered separately from the primary operation group.
- 神戸大学の論文