林 佳代, 土手 健司, 須永 恭司, 右馬 隆之, 大久保 直彦, 谷一 芳夫, 津田 信幸, 栗本 透, 稲田 満夫

Kayo HAYASHI, Kenji DOTE, Yasushi SUNAGA, Takayuki UBA, Naohiko OKUBO, Yoshio TANIICHI, Nobuyuki TSUDA, Tohru KURIMOTO, Mitsuo INADA

関西医科大学第2内科

The Second Department of Internal Medicine, Kansai Medical University

キーワード : Doppler echocardiography, VSD, Eisenmenger syndrome

An interesting shunt flow velocity pattern across the ventricular septal defect (VSD) was obtained by pulsed Doppler echocardiography in two patients with Eisenmenger VSD (24 ys. female and 25 ys. male). A rapid right-to-left shunt flow during isovolumic relaxation, a slow left-to-right shunt flow during rapid and slow filling phase, a slow right-to-left shunt flow during atrial contraction phase and a rapid left-to-right shunt flow during isovolumic contraction was obtained. These findings coincided with the pressure graident measured from bi-ventricular pressure curves, but there were no coincidence between pressure-shunt flow relation during ejection phase. The flow velocity pattern across the VSD indicated a rapid left-to-right shunt in early systole, while the flow direction abruptly reversed in midsystole and the right-to-left shunt gradually decreased in late systole. However, on the pressure pattern, left ventricular pressure was predominant than that of the right ventricle in the first case and left ventricular pressure was nearly equal to right ventriular pressure in the second case throughout the ejection phase. Pulmonary vascular resistance exceeded more than that of systemic in both cases.
It was suggested that the shunt flow velocity pattern in Eisenmenger VSD may be affected by the difference of bi-ventricular compliance, which defined by pulmonary vascular compliance, in addition to the pressure gradient.