Combined Assessment with Myocardial Contractility and an Index Related to Ventricular Afterload in Patients with Isolated Severe Mitral Regurgitation Undergoing Valve Replacement. A Retrospective Study.:A Retrospective Study
スポンサーリンク
概要
- 論文の詳細を見る
The afterload to the left ventricle increases following valve replacement in chronic mitral regurgitation (MR), yet there has been no study taking into account left ventricular (LV) afterload. In 43 patients with isolated chronic MR undergoing mitral valve replacement (MVR), we calculated LV wall stress using preoperative LV end-diastolic dimensions and diastolic aortic pressure (predictive LV wall stress=pWS). This value would represent LV wall stress at the instant of aortic valve opening immediately after MVR, assuming that LV end-diastolic dimensions and the aortic pressure did not change after operation. We also calculated end-systolic wall stress/volume index (ESS/ESVI) ratio, an index of myocardial function. None of 15 patients with the ESS/ ESVI ratio>1.6 had postoperative mortality or morbidity, whereas among the 26 patients with the ESS/ESVI ratio<1.6, 12 patients had mortality (3 patients) and/or morbidity requiring intraaortic balloon pumping or prolonged catecholamine support. Three patients who died had pWS>200 kdynes/cm2. Including these 3, all 5 patients whose pWS>200 had mortality or severe morbidity immediately after surgery. In contrast, among the 38 patients with lower pWS, none died and only 7 patients (18%) had morbidity. Thus, patients who had a low contractility index and a high predictive afterload value had high mortality and morbidity. We conclude that the prediction of postoperative mortality and morbidity is improved by combined assessment of myocardial function and the hypothetical postoperative LV afterload.
- International Heart Journal刊行会の論文
著者
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Momma Kazuo
Department Of Pediatric Cardiology
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Seguchi Masashi
Department Of Cardiovascular Surgery And Department Of Pediatrics Seirei Hamamatsu General Hospital
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Yasukouchi Satoshi
Department Of Pediatric Cardiology Nagano Prefectural Children's Hospital
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Nakazawa Makoto
Department Of Pediatric Cardiology Heart Institute Of Japan Tokyo Women's Medical College
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Hosoda Saichi
Department Of Cardioangiology And Internal Medicine Jichi Medical School
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Oyama Kotaro
Department Of Pediatric Cardiology Iwate Medical University Memorial Heart Center
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OYAMA Kotaro
Departments of Pediatric Cardiology and Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College
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MOMMA Kazuo
Departments of Pediatric Cardiology and Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College
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SEGUCHI Masashi
Departments of Pediatric Cardiology and Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College
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YASUKOUCHI Satoshi
Departments of Pediatric Cardiology and Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College
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HOSODA Saichi
Departments of Pediatric Cardiology and Cardiology, the Heart Institute of Japan, Tokyo Women's Medical College
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