高田 博之¹, 澤田 準¹, 高尾 信廣¹, 岡部 昭文¹, 相澤 忠範¹, 藤井 諄一², 加藤 和三¹

Hiroyuki TAKATA¹, Hitoshi SAWADA¹, Nobuhiro TAKAO¹, Akifumi OKABE¹, Tadanori AIZAWA¹, Junichi FUJII², Kazuzo KATO¹

¹心臓血管研究所, ²故人

¹The Cardiovascular Institute, ²the deceased

キーワード : Real-time two-dimensional color Doppler echocardiography, Ischemic heart disease, Left ventricular blood flow, Valvular regurgitation

Intracardiac blood flow in ischemic heart disease was assessed by real-time two-dimensional color Doppler echocardiography in 64 patients with ischemic heart disease (40 with old myocardial infarction, 24 with angina pectoris). There were some abnormal intracardiac blood flow patterns which were not observed in normal subjects.
(1) Mitral regurgitation was observed in 35 patients (55%). In these cases, excluding 3 patients with mitral valve prolapse, wall motion was impaired around the papillary muscles and/or the mitral ring was dilated. Tricuspid regurgitation was observed in 6 patients (9%). In these cases significant lesion was observed in the coronary artery which perfuses the right ventricle. There was no specific relation between the presence of aortic regurgitation and the changes due to ischemic heart disease.
(2) Two types of abnormal systolic blood flow in the left ventricle were observed. Twenty two patients showed disappearance of blood flow at the apex. Twenty of these cases had ventricular aneurysm of the apex. In 30 patients, blood flow toward the apex in the inflow tract and that toward the aorta in the outflow tract could be recorded simultaneously even in mid-systole. In these cases, left ventricular contraction was widely impaired and ejection fraction was less than that of other patients with ischemic heart disease (42.7±11.9% vs. 58.6±11.6%, p(3) Diastolic blood flow in the left ventricle showed four types of abnormal blood flow. Twenty two patients showed no blood flow at the apex in either diastole or in systole. In 23 patients, blood flow toward the aorta was recorded in the outflow tract in early rapid filling phase. These cases showed lower ejection fraction (39.7±10.2% vs. 57.1±12.3%, pAbnormal intracardiac blood flow in ischemic heart disease could be classified qualitatively by real-time two-dimensional color Doppler echocardiography. The abnormal blood flow patterns seemed to reflect the hemodynamic changes in ischemic heart disease.