河野 和弘, 福田 信夫, 恵美 滋文, 苛原 恵子, 富永 俊彦, 奥本 哲生, 大木 崇, 森 博愛

Kazuhiro KAWANO, Nobuo FUKUDA, Shigefumi EMI, Keiko IRAHARA, Toshihiko TOMINAGA, Tetsuo OKUMOTO, Takashi OKI, Hiroyoshi MORI

徳島大学医学部第二内科

The 2nd Department of Internal Medicine, Faculty of Medicine, University of Tokushima

キーワード : Pulmonary hypertension, Pulmonary ejection murmur, Blood flow pattern in the right ventricular outflow tract, Phonocardiogram, Pulsed Doppler echocardiogram

The pulmonary ejection murmur was analysed in 14 patients with pulmonary hypertension (PH) and in 13 with normal pulmonary arterial pressure (non-PH), in comparison with the blood now pattern at the right ventricular outflow tract just proximal to the pulmonary valve obtained by the pulsed Doppler technique. In PH group, the blood flow pattern in systole showed a rapid acceleration and deceleration with a sharp peak in early systole ("V" shaped pattern). In contrast, that of non-PH group showed a gradual acceleration and deceleration with a dome-like contour, the peak of which was observed in mid-systole ("U" shaped pattern). Both the duration and the time interval from the beginning to the peak of ejection murmur were significantly shorter in PH group than in non-PH group, and showed significant negative correlations with mean pulmonary artery pressure (r=-0.69, pThese results suggest that the change in configuration of the pulmonary ejection murmur in PH is mainly due to that of the blood flow pattern at the right ventricular outflow tract, and that the acceleration and deceleration of right ventricular ejection flow are the important determinant factor on the generation of the ejection murmur.