西上 和宏, 吉川 純一, 吉田 清, 皆越 真一, 赤阪 隆史, 赤土 正洋, 山浦 泰子, 松村 敬久

Kazuhiro NISHIGAMI, Junichi YOSHIKAWA, Kiyoshi YOSHIDA, Shinichi MINAGOE, Takashi AKASAKA, Masahiro SHAKUDO, Yasuko YAMAMURA, Yoshihisa MATSUMURA

神戸市立中央市民病院循環器センター

Department of Cardiology, Kobe City General Hospital

キーワード : Mitral regurgitant volume, Doppler color proximal, isovelocity surface area method, Preload, Afterload

Mitral regurgitant volume can be determined by a regurgitant orifice area, regurgitant velocity, and regurgitant period. We examined effects of preload augmentation using a legs raising maneuver and afterload augmentation by a cold pressor test on mitral regurgitant volume in 10 patients with mitral regurgitation using a Doppler color proximal isovelocity surface area (PISA) method. The regurgitant volume was calculated as PISA X isovelocity X regurgitant period. PISA was given by: 2/πr², where r was the mean systolic aliasing radius calculated from color overlayed M-mode (Q/M-mode) images. The regurgitant orifice area was calculated as regurgitant volume divided by the time velocity integral of the regurgitant jet measured by continuous wave Doppler. Regurgitant veolicty was obtained from continuous wave Doppler and the regurgitant period obtained from Q/M-mode. The leg raising maneuver resulted in a significant increase in mitral regurgitant volume and regurgitant orifice area, while regurgitant velocity and period were unchanged. The cold pressor test resulted in significant increases in mitral regurgitant volume, regurgitant orifice area, and regurgitant velocity, while regurgitant period was unchanged. Thus, preload augmentation induces an increase in mitral regurgitant volume due to an increase in regurgitant orifice area, while afterload augmentation induces an increase in mitral regurgitant volume due to an increase in both regurgitant orifice area and regurgitant velocity.