Combined Valvular Disease Research Articles

連合弁膜症における二次性三尖弁閉鎖不全の病態からみた外科治療の検討

連合弁膜症における二次性三尖弁閉鎖不全の病態からみた外科治療の検討

冠動脈病変を伴う弁膜疾患の外科治療

冠動脈病変を伴う弁膜疾患の外科治療

A case of ostcogensis impecfecta with combined valvular disease

A case of ostcogensis impecfecta with combined valvular disease

高度るい痩を呈した連合弁膜症に対する高流量体外循環の検討

高度るい痩を呈した連合弁膜症に対する高流量体外循環の検討

三弁疾患の外科治療 三弁疾患の外科治療成績と成績に影響する因子について

三弁疾患の外科治療 三弁疾患の外科治療成績と成績に影響する因子について

A 13-year follow-up study of rheumatic valvular diseases.

A 13-year follow-up study was performed in 301 patients with rheumatic heart disease (RHD). Of these patient, 223 cases, 78 men (average age 59.3 years) and 145 women (average age 60.4 years), survived. Seventy-eight cases including 38 men (mean age of death 72.5 years) and 40 women (mean age of death 64.8 years) died. RHD consisted of 51% mitral valvular diseases, 40% combined valvular diseases and 9% aortic valvular diseases. The mean mortality for all patients with RHD was 25.9%. Seventy percent of the deaths were due to severe, chronic heart failure, sudden death and cerebral emboli. Atrial fibrillation was observed in 50% of the patients. Cerebral emboli occurred frequently in patients with mitral stenosis (MS), mitral stenoregurgitation (MSR) and combined valvular disease (CVD), which were associated with atrial fibrillation. However, cerebral emboli were rarely found in cases with MSR, CVD and aortic valvular disease with sinus rhythm. The mortality of cardiac surgery was low, 13.3%.

CLINICAL STUDIES ON OPEN HEART SURGERY FOR ELDERLY PATIENTS

Thirty-three patients aged 60 or more undergoing open heart surgery were examined. Twenty-four patients had valvular disease with or without ischemic heart disease or congenital heart disease. Early mortality of the 24 patients was 12.5%, caused by left ventricular rupture, acute renal faulure and multiple organ failure associated with severe LOS. In the group of 24 patients, ageing was not associated with the period of ICU care, dose of catecholamine, furosemide administration, or recovery of cardiac index. Compared with 18 patients under 60 years ols with valvular disease in the period between June 1983 and July 1984, ten of 24 patients in the same period stayed in the ICU longer and were administered higher doses of drugs for circulatory management. The incidence of postoperative complication was 70% in ten patients aged 60 or more. The incidence of postoperative complications was associated with ageing, combined valvular disease and preoperative conditions.

連合弁膜症における大動脈弁閉鎖不全症の処置とその術後変化 ２‐Ｄ Ｄｏｐｐｌｅｒ心エコー図法による逆流評価

連合弁膜症における大動脈弁閉鎖不全症の処置とその術後変化 ２‐Ｄ Ｄｏｐｐｌｅｒ心エコー図法による逆流評価

Current diagnosis of infective endocarditis.

An analysis was made of 91 cases of infective endocarditis (IE) with regard to causative organisms and their sensitivities to various antibiotics, the clinical features of the disease, the laboratory test results and other items were important in establishing a diagnosis of IE. The number of cases of IE has shown a tendency to increase in recent years, particularly in the number of elderly patients, and the ratio of total cases consisting of prosthetic valve endocarditis (PVE) has shown a sharp increase. The most common causative organism is still Streptococcus viridans, but there has been an increase in the incidence of IE due to benzyl-penicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis and other fastidious organisms. The percentage of underlying diseases represented by combined valvular diseases has been increasing, while the primary known cause of the infection of IE was dental treatments. A positive value for CRP, an accelerated value for ESR, leukocytosis, anemia, a decrease in serum Fe, a positive value for RA-T, were all parameters which showed a high correlation with IE, and these should be useful in establishing the diagnosis of IE. The use of cardioechography to detect cardiac vegetation is important in relation to establishing the diagnosis and prognosis of IE, and the evaluation of the therapeutic results.

B-35 連合弁膜症-三弁疾患(大動脈弁,僧帽弁,三尖弁)-に対する外科治療の検討

B-35 連合弁膜症-三弁疾患(大動脈弁,僧帽弁,三尖弁)-に対する外科治療の検討

Nuclear techniques in ischemic heart disease

Until recently, it was necessary to measure parameters such as ventricular pressure to assess the effects of drugs on the force of myocardial contraction—the inotropic effect. Even simpler measurements such as cardiac output are not completely satisfactory, because they are determined not only by the contractile state but also by the diastolic volume of the ventricles, outflow impedance, and heart rate. Within the past few years, the use of radioactive tracer techniques has made it possible to measure the changes in ventricular volume that occur throughout the cardiac cycle. With these techniques, it is now possible to measure end-diastolic and end-systolic volumes, the rates of ventricular emptying and filling, stroke volume, and systolic and diastolic time intervals. In complicated diseases such as combined valvular and coronary artery disease the ventricular response to antiarrhythmic, vasodilator, and inotropic drugs can be assessed in individual patients.

Valvular Heart Disease

This readable and well-edited book from the faculty of the University of Massachusetts Medical School provides an excellent review of the current knowledge of common valvular disorders exclusive of complex congenital lesions. The two chief authors are acknowledged experts in the field, and they have wisely used their experience in compiling chapters provided by their fellow faculty members. The book is divided into 13 chapters; nine deal with the clinical and pathophysiological aspects of isolated valvular lesions (mitral, aortic, tricuspid, and pulmonic valve disorders), one with combined valvular disease, and three with pathogenesis, antimicrobial prophylaxis of infective endocarditis, and anticoagulant therapy. The material in each chapter is organized by etiology; clinical and laboratory findings, including echocardiographic and catheterization studies; differential diagnosis; and therapy. Excellent tables provide succinct summaries of the text. The figures, which are derived from the authors' own experience and from the cardiology literature, are generally of good

A histopathological study on the alteration on the pulmonary arterioles in the acquired valvular heart diseases (author's transl)

The vasculature in the pulmonary circulation is known to have specific anatomic architecture and in this view point that alteration of the arterioles in pulmonary circulation attracts much attention of the physiologists, thoracic surgeons and pulmonary pathologists. Extensive pathological surveys of the hypertensive pulmonary vasculature have been hitherto reported, however, the vigorous studies of the pulmonary arterioles in acquired heart diseases should await further clarification. In this connection, the author has investigated the changes of the pulmonary arterioles in acqu'red heart diseases by the light microscope and electron microscope as well. The specimens were available either autopsy or surgical biopsy.For clarification of the alteration of the connective tissue involving the collagen fibrils and elastic fibers, the periodic acid methenarnine silver (PAM) stain and tannic acid stain (Mizuhira et al.) have been applied. The studied cases are as follows: Forty-three cases of autopsy; Aortic valvular disease (AVD) 15 cases, Mitral valvular disease (MVD) 20 cases, Combined valvular disease (CVD) 8 cases. Ten cases of surgical biopsy ; AVD 3 cases, MVD 3 cases, CVD 4 cases.Based on the criteria of Heath & Edwards, the relatively slight cases reveal swelling of the endothelial cells, medial fibrosis and edema, however, in cases which involved moderate or advanced pathological changes reveal intensive proliferation of PAM positive collagen fibrils of irregular configuration and increase of elastic fibers in media and adventitia. The latter is selectively demonstrated with tannic acid stain. The changes are frequently observed in rather in the mitral valvular disease than the aortic valvular disease. More detailed investigation reveals the sclerotic changes particularly involving the media and adventitia. These changes are also observed in cases of Grade 1 (Heath & Edwards) not only the severe cases which may be classified as Grade 3. The initial sclerotic changes involving the arterioles. eventually give the persisting derangement of the circulatory disturbance and finally may cause the sclerotic changes of the arteries at higher level.

Histopathological studies on the myocardial fibrosis and vascular lesion of rheumatic valvular disease.

To clarify the types and frequency of myocardial fibrosis and vascular lesions caused by different types of the rheumatic valvular disease, 41 autopsied hearts with rheumatic valvular lesions were examined and the following results were obtained. As to myocardial fibrosis, 1) perivascular fibrosis, caused mainly by perivascular inflammation and partly by myocardial strain, varied in grade according to the types of the valvular disease, i.e., most severe in mitral regurgitation (MR) and combined valvular disease (CVD) and least in mitral stenosis (MS); 2) Aschoff's nodes: 3 typical and 8 atypical cases were found; 3) perimycial fibrosis due to myocardial strain: most severe in MR and CVD and least in MS; and 4) irregular patchy fibrosis, caused mainly by myocarditis and partly by ischemia, was noticed in all types of the valvular disease. As to vascular lesion, 1) angitis was found in 7 cases and most frequently in MR; and 2) thickening of the intima and media was found in all types of valvular disease. Thus, myocardial fibrosis and vascular lesion varied according to the types of valvular disease, and not only hemodynamic changes but also myocardial fibrosis and vascular lesions might determine the prognosis of the valvular disease.

心臓弁膜症における刺激伝導系およびその灌流動脈の病理組織学的研究

The atrial fibrillation is the arrhythmia which is frequently encountered in the valvular disease of the heart. The authors have investigated the conduction system and its supplying arteries by light microscopical study on serial section. The cases subjected for investigation were as follows; Aortic valvular disease (AVD) 4, Mitral valvular disease (MVD) 4, and Combined valvular disease (CVD) 5 cases. A special attention has been paid for the correlation of the ECG findings with histo-pathological observations of conduction system and of its supplying arteries. The histo-pathological study revealed that the extensive loss of conduction cells as well as the sclerotic involvement of the central artery was noted in the cases having atrial fibrillation of the long term duration. Concerning to the Sino-Atrial node, injury to the S-A node and its supplying artery was much more striking in the cases of MVD & CVD rather than ADV. The chages of A-V node and His Bundle were more remarkable in the cases of AVD & CVD compared with MVD. The authors incline to attribute the genesis for these pathological changes of conduction system and of its supplying arteries to the circulatory disturbance involved in the heart valvular disease. The persisting derangement of the circulation in the supplying arteries of these region would result in their sclerotic shanges and in loss of conduction cells. These changes were much more pronounced than those of age matched controls.

主題III-14 連合弁膜症,とくに3弁(A.M.T.)疾患に対する外科治療

主題III-14 連合弁膜症,とくに3弁(A.M.T.)疾患に対する外科治療

主題III-21 連合弁膜症における開心術術後低心拍出量症候群について

主題III-21 連合弁膜症における開心術術後低心拍出量症候群について

主題III-19 連合弁膜症の外科治療

主題III-19 連合弁膜症の外科治療

主題III-16 連合弁膜症の手術治療における大動脈弁形成術の意義と成績

主題III-16 連合弁膜症の手術治療における大動脈弁形成術の意義と成績

主題III-10 連合弁膜症に対する弁置換術とその血行動態・弁機能の検討

主題III-10 連合弁膜症に対する弁置換術とその血行動態・弁機能の検討