GL改訂_松田班.indd
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1 PTMC Maze Procedure PTAC Circulation Journal Vol. 71, Suppl. IV,
2 ACCAmerican College of Cardiology AHAAmerican Heart Association ARaortic regurgitation ASaortic stenosis AVAaortic valve area AVRaortic valve replacement CABGcoronary artery bypass grafting CADcoronary artery disease CMCclosed mitral commissurotomy CTcomputerized tomography CVPcentral venous pressure Ddend-diastolic dimension Dsend-systolic dimension EFejection fraction FSfractional shortening LVleft ventricle MAPmitral annuloplasty MRmitral regurgitation MRImagnetic resonance imaging MSmitral stenosis MVAmitral valve area MVRmitral valve replacement NYHANew York Heart Association OMCopen mitral commissurotomy PTACpercutaneous transluminal aortic commissurotomy PTMCpercutaneous transvenous mitral commissurotomy TAPtricuspid annuloplasty TRtricuspid regurgitation TStricuspid stenosis TVRtricuspid valve replacement ACC/AHA ACC/ AHA 1 2 Circulation Journal Vol. 71, Suppl. IV, 2007
3 MS TR a b MS PTMC 3 4 a 1 < 5mmHg 510mmHg >10mmHg <30mmHg 3050mmHg >50mmHg >1.5 cm cm 2 <1.0 cm 2 5 1PTMC 2 3 b 1 1MS Circulation Journal Vol. 71, Suppl. IV,
4 6 straight back MarfanEhlers-Danlos MR MR MR LVEF LVEF LVEF MR MR 2MR 3MR 4 MR a 1 MR 1MR a cm % Vena contracta width 0.3cm cm 0.7cm /beat 30ml 3059ml 60ml 30% 3049% 50% 0.2cm cm 2 0.4cm 2 4 Circulation Journal Vol. 71, Suppl. IV, 2007
5 1MR MR 2 a 1 MR 1MR. MR MS MS MR MR Fick MS 1NIHAMS PTMC 250mmHg 60mmHg MS PTMC a 1NYHA MR PTMC b 1NIHA 1.5cm 2 MS 60mmHg 25mmHg 15mmHg 2 MS PTMC 1MS 2MR 1 10 mm 2 10 mm 3 PTMC 11 PTMC mm 2 2/3 58mm 3 1/3 58mm 4 PTMC Circulation Journal Vol. 71, Suppl. IV,
6 14 PTMC mmhg mmhg.. cm.. cm MR MR a 1 2AR TS TR 3 PTMC NYHA 12 anyha bc X MVA1.5cm 2 PAP60mmHg 15mmHg MVA1.5cm 2 PTMC OMC MVR PTMC MR34 X MVA1.5cm 2 Af MVA1.5cm 2 PAP60mmHg 15mmHg OMC MVR PTMC MR2 PTMC 6 Circulation Journal Vol. 71, Suppl. IV, 2007
7 OMC MVR1516Sellors 4MS Wilkins13 total echo score PTMC OMC MVR SellorsMVR 1NYHA MS MVA 1.5cm 2 1PTMC 2 2NYHA MS OMC MVR a 1NYHA MS MVA 1.5cm 2 1 PTMC mmHg 1 MS MS 1NYHA MS PTMCOMC 2NYHA MSMVA 1.0cm 2 50mmHg PTMC OMC MS OMC MVR MVR mmhg PTMCOMCMVR OMCMVR PTMC NYHA OMC.PTMC MVR. MR MR MR LVEF LVDs mm Circulation Journal Vol. 71, Suppl. IV,
8 MR EF>0.60 and Ds<40mm EF0.60 and/or Ds40mm EF>0.30 and/or Ds55mm EF<0.30 and/or Ds>55mm a a b a NYHA 6 1MR 2NYHA MR 3MR 4 MR a 1MR MR90% 2MR 3MR 4 NYHAMR b 1CRT NYHA MR 1MR 2MR LVEF LVDs LVEF %LVDs mm LVEF %LVDs mm LVEF %LVDs mm LVEF %LVDs mm mmhg mmhg CABG CABG 19 MVR 8 Circulation Journal Vol. 71, Suppl. IV, 2007
9 1 2 a 1 2 b 1 2MR 3MR cut & sewmaze. 1 2NYHA 3 4 5MVR vs. Maze Procedure Maze Procedureclass Circulation Journal Vol. 71, Suppl. IV,
10 AS 20AS ACC/AHA. cm. cm /m. cm Mayo ClinicManual. cm. cm AS ACC/AHA. 21 m/s mmhg < cm cm 2 /m 2 < X a 1 b 1 2SPECT 3DSA 22 AR Marfan Reiter AR AR AR AR AR AR AR AR 10 Circulation Journal Vol. 71, Suppl. IV, 2007
11 23 1AR and or 6.0%pt-yr 3.5%pt-yr 0.2%pt-yr 2AR 25% pt-yr 3AR 10% pt-yr AR CT AR AR LVEF CTMRI AR X 3 a 1 2 b 1 2SPECT 3 4CT 5MRI AS AR AR AS AS AR AS AR AR AS AR Fick 25 b 1AVR AVR PTAC 2 PTAC 1AVR Circulation Journal Vol. 71, Suppl. IV,
12 26 1AS 2CABG AS 3AS 4AS EF 50 a 1CABG AS b 1AS 2 AS 3 AS CABG 40.6cm 2 60mmHg 5.0m/sec 1Classab AS AVR AS 27 1AVR 5% % 2CABG 5 10% % 528 AR 1LVEF25% 2 3 AR 4 LVEF 2549% a 1LVEF 2549% 2LVEF50% 3LVEF50% b 1LVEF50% 2LVEF25% 1 AR AR AVR Ross 12 Circulation Journal Vol. 71, Suppl. IV, 2007
13 AR 1 AVR EF EF50% EF EF EF50% 2 4 LVDs55 mm LVDd75 mm LVDs45mm LVDd60 mm LVDs45-50mm LVDd60-70 mm LVDs50-55mm LVDd70-75mm # # EFCTMRI # # LVDd= LVDs= FS27% LVDs5055mm 2527mmm 2 LVDd7075mm 3538mmm 2 RTh3.8 X SBPRTh l minm 2 12 mmhg 50% mlm mlm 2 3 NYHA EF RI45% Circulation Journal Vol. 71, Suppl. IV,
14 TS TR TR 1TR a 1TR 2TR 3TR 4TR b 1TR 2TR 1 60mmHgTR No Yes 1 1Kay 93.6%10 2De Vega96.7%10 3Carpentier-Edwards ring97.5% %1062.7% %1075.0% Circulation Journal Vol. 71, Suppl. IV, 2007
15 MR AS MR AS TR MS AS AS MS MS AS MS MS PTMC AS AS AS/MR AS/ MVPAS MR MR AS MR AS AS MS AR AR AR MS pressure half-time AR AR MR AR AR MR MR AR MR Circulation Journal Vol. 71, Suppl. IV,
16 32. ARMR Sellers AS mmhg MS.cm a AR AS MR SellersMR AS MR MR MR MR MR 1NYHA a 1 2NYHA 3 1 MS b MRMS AR SellersAS mmhg AVR MVR. mmhg..pt-yr actuarialsurvival rate IE. 16 Circulation Journal Vol. 71, Suppl. IV, 2007
17 1acute IE 2AR MR acute IE 3IE 4Valsalva IE a 1 IE b 110mm IE 1PVE 2PVE 3 PVE 4PVE 5PVE a 1 PVE 2PVE 1 PVE. CABG. CAD CAD. 34 CAD AS MR AS CAD MR AVR CABG 1 70% AVR CABG a 1AVRCABG AVR CABG CABGAVR 1 AS CABG AVR a 1AS2540mmHg 34m/secCABG AVR b 1AS25mmHg 3m/sec CABGAVR CAD CAD MR MVR CABG MVR CABG 34 AR Marfan annuloaortic ectasiaaae sinotubularjunctionar Circulation Journal Vol. 71, Suppl. IV,
18 ASAR Bentall 35 cm AR cm.. cm 15cm 2 4.5cm a 1AR 4.0cm / 38 shower emboli 1 23mm CTMRIMRA 2 3 4CT mm 39 chronicobstructive pulmonary diseasecopd Spirometry 1 % 50% 2 PO 2 70mmHg PCO 2 50mmHg Circulation Journal Vol. 71, Suppl. IV, 2007
19 LOS 11.5mg dl 230ml TR a bc 1ICG1525% 2Child BC 32000IU L 4 2mgdl 49% St.Jude MedicalCarboMedicsSorin Bicarbon ATS On-X. CEP Structural valvular deterioration 2Nonstructural dysfunction 3Valve thrombosis 4Embolism 5Bleeding event 6Prosthetic valve endocarditis Author Valve type No. of pts mean FU yrs Embolism Bleeding % pt-yr% pt-yr Thrombosis % pt-yr Endocarditis % pt-yr Paravalvularleak% pt-yr AVR Aoyagi 1994 SJM Nakano 1994 SJM Copeland 1995 CM Borman 1998 BC Butchart 2001 MH Khan 2001 SJM MVR Aoyagi 1994 SJM Nakano 1994 SJM Copeland 1995 CM Borman 1998 BC Butchart 2001 MH Khan 2001 SJM * SJMSt. Jude Medical CMCarboMedids BCBicarbon MHMedtronic-Hall Circulation Journal Vol. 71, Suppl. IV,
20 Author Valve type No. pts Mean FU yrs Embolism Bleeding % pt-yr% pt-yr Thrombosis % pt-yr Endocarditis % pt-yr Paravalvularleak% pt-yr Kinsley 1986 SJM Armenti 1987 SJM Burchhardt 1988 SJM Arom 1989 SJM Czer 1990 SJM Smith 1993 SJM De Luca 1993 CM Nakano 1994 SJM Ibrahim 1995 SJM Baucet 1995 SJM Copeland 1995 CM Borman 1998 BC Butchart 2001 MH SJMSt. Jude MedicalCMCarboMedidsBCBicarbonMHMedtronic-Hall 1 2 AVR INR AVR AVR INR MVR INR b 1 INR PT-INR PT-INR mg a mg INR2.0 aptt INR1.5 INR2.0 b 1 72 INR2.0 INR1.5 INR g50mgkg PO 1 2 2g50mgkg IV or IM mg20mgkg PO 1 2g50mgkg PO 1 2g50mgkg PO 1 500mg 15mgkg PO mg20mgkg IV 30 1g25mgkg IV or IM 30 POIVIM 20 Circulation Journal Vol. 71, Suppl. IV, 2007
21 1 1 2g IM or IV 1.5mg kg120mg30 61g IMor IV1g PO 2 50mg kg IM or IV 2g 1.5mg kg mg kg IM or IV25mg kg 2 11g IV mg kg 120mg IM or IV mg kg IV12 1.5mg kg 120mgIM or IV30 POIVIM AVR 65 a AVR AVR 4TVR b 1MVR AVR 465. Circulation Journal Vol. 71, Suppl. IV,
22 AVR MVR AVR MVR Burr,et al Carpentier-Edwards standard Carpentier-Edwards supraannular Pelletier, et al Carpentier-Edwards standard Carpentier-Edwards supraannular Burdon, et al Hancock Hancock MO Khan et al AVR Hancock 7.3MVR Hancock MO Jamieson et al Carpentier-Edwards standard Marchand et al Carpentier-Edwards Banbury et al Carpentier-Edwards David et al AVR Hancock 6.9MVR Jamieson et al Medtronic Intact ACC/AHA 22 Circulation Journal Vol. 71, Suppl. IV, 2007
2004 12 16 2 1 3 2 5 2.1............... 5 2.2........... 14 2.3........................... 17 3 22 3.1.................. 22 3.2......................... 22 3.3........................ 25 3.4........................
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GL改訂_松田班.indd
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