大島 寛史¹, 桑子 賢司¹, 落合 正彦¹, 當間 三弘¹, 板岡 慶憲¹, 吉村 宏¹, 原 和弘¹, 樫田 光夫¹, 山口 徹¹, 戸出 浩之², 遠田 栄一²

Hiroshi OHSHIMA¹, Kenji KUWAKO¹, Masahiko OCHIAI¹, Mitsuhiro TOHMA¹, Yoshinori ITAOKA¹, Hiroshi YOSHIMURA¹, Kazuhiro HARA¹, Mitsuo KASHIDA¹, Tetsu YAMAGUCHI¹, Hiroyuki TOIDE², Eiichi TOHDA²

¹三井記念病院循環器センター内科, ²三井記念病院循環器センター中央検査部

¹Center for Cardiovascular Disease Mitsui Memorial Hospital, ²Central Clinical　Laboratory, Mitsui Memorial Hospital

キーワード : Permanent pacemaker, Tricuspid regurgitation, Doppler color flow mapping

To evaluate tricuspid regurgitation (TR) in patients with permanent pacemaker (PM), seventy- two patients and thirty-seven normal subjects were examined by Doppler color flow mapping (CFM) and continuous-wave Doppler echocardiography.
Since there existed an excellent correlation between the length and the area of TR signal on Doppler CFM, severity of TR were classified into three grades according to the length of Doppler TR signal; mild (less than 2.5 cm), moderate (between 2.5 and 5.0 cm) and severe (more than 5.0 cm). In twenty-four of 37 normal subjects (64%), TR was detected but its degree of TR was mild. On the other hand, TR was observed in seventy of 72 patients with PM (97%) and forty-three of them (61%) showed moderate or severe TR. Peak velocity and pressure gradients in moderate or severe TR patients were significantly greater than those in patients with mild TR and normal controls. The follow-up period after implantation of PM was also significantly longer in moderate or severe TR than in mild TR. TR was significantly greater in patients with atrial fibrillation than in those with sinus rhythm. There were, however, no significant difference in the grade of TR between atrioventricular block and sick sinus syndrome. In addition, five of 8 patients with severe TR showed symptoms and signs of right-sided heart failure.
In conclusion, TR was common in patients with PM and the major cause of TR was related to the implanted pacing lead and the duration of PM implantation. And Doppler CFM is a sensitive method to detect and evaluate TR in patients with PM.