河野 智彦, 大木 崇, 井内 新, 小川 聡, 藤本 卓, 清重 浩一, 田畑 智継, 影治 好美, 真鍋 和代, 福田 信夫, 伊東 進

Tomohiko KAWANO, Takashi OKI, Arata IUCHI, Satoru OGAWA, Takashi FUJIMOTO, Koichi KIYOSHIGE, Tomotsugu TABATA, Yoshimi KAGEJI, Kazuyo MANABE, Nobuo FUKUDA, Susumu ITO

徳島大学医学部第二内科

The Second Department of Internal Medicine, School of Medicine, Tokushima University

キーワード : Transesophageal echocardiography, Pulmonary venous flow velocity pattern, Mitral valve disease

Pulmonary venous flow velocity pattern(PVF) was recorded in 13 patients with mitral stenosis and sinus rhythm(MS-SR), 20 patients with MS and atrial fibrillation(MS-Af), eight patients after open mitral commissurotomy(OMC), 10 patients with mild to moderate mitral regurgitation(MR), 10 patients with severe MR, eight patients with lone Af and 20 normal controls(N). We measured the peak velocity of systolic(S), diastolic(D) and atrial contraction(A) waves of PVF, and compared the results with the various parameters, such as 1)total amplitude of mitral annular motion(MAM) and of interatrial septal motion(IAS) during systole, and proximal diameter of left upper PV with transesophageal echocardiography, and 2)left atrial dimension(LAD) and pressure half time(PHT) derived from transmitral flow velocity pattern by Hatle's method with transthoracic echocardiography.
The results were as follows: 1) Peak velocity of the systolic wave(S) of PVF was significantly decreased in the MS-Af, OMC, and severe MR groups compared with that of N group. Two patients with severe MR, in particular, had reversed systolic flow. There were significantly positive correlations between S and MAM or IAS, negative correlation between S and LAD in the MS and OMC groups. 2)Peak velocity of the diastolic wave(D) of PVF was significantly decreased in the MS groups, and increased in the severe MR group compared with that of the N group. There was significant correlation between D and PHT in the MS and OMC groups. The diastolic wave recorded as laminar flow in the MS group showed a peaked pattern in the rapid filling phase, with a gradual descending slope in velocity during mid-to late diastole. 3)There was no significant difference in the peak velocity of the atrial contraction wave(A) of PVF between the N and MS-SR groups. 4)PV dimension was significantly increased in the MS, OMC and MR groups compared with that of the N group, and there was a significant positive correlation between PV dimension and LAD in the MS and OMC groups.
Thus, this study demonstrates that use of systolic, diastolic, and atrial contraction waves of a pulmonary venous flow velocity pattern can help in understanding hemodynamic events between the left atrium and ventricle in mitral valve disease.