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左室駆出動態が末梢動脈血流に及ぼす影響を明らかにする目的で,弁膜症例について頸動脈血流と左室駆出血流速度波形との関係を検討した.対象は弁膜症患者104例(平均年齢62±13歳),内訳は,大動脈弁閉鎖不全症37例,大動脈弁狭窄症17例,僧帽弁閉鎖不全症31例,僧帽弁狭窄症19例である.対照は,拡張型心筋症32例,肥大型非閉塞性心筋症12例とした.計測は,心エコー図検査と頸動脈エコー図検査を行い,左室駆出分画,心係数,1回抽出係数,平均左室円周方向心筋線維短縮速度,総頸動脈径,左室流出路ピーク駆出血流速度(LV Flow),総頸動脈ピーク収縮期血流速度(Car Flow)を計測した.大動脈弁狭窄症を除く全ての患者はLV Flowが速くなるほどCar Flowも速く,両者に正相関がみられた.大動脈弁狭窄症はLV Flowは速いほどCar Flowは遅く,両者は負の相関関係がみられた.また,大動脈弁狭窄症では弁狭窄が重症例ほどCar Flowは低下していた. Car Flowに弁膜症における左室駆出血行動態を反映した., In order to clarify the effects of left ventricular (LV) ejection hemodynamics on peripheral arterial blood flow, I studied the correlation between LV ejection flow velocity and carotid arterial systolic flow velocity in patients with various valvular heart diseases and compared them with those in patients with idiopathic cardiomyopathy as the controls. I used the pulsed Doppler and continuous wave Doppler methods to measure blood flow velocity. One hundred four patients including 37 with aortic regurgitation (AR), 17 aortic stenosis (AS), 31 mitral regurgitation (MR), 19 mitral stenosis, 32 dilated cardiomyopathy (DCM), and 12 hypertrophic nonobstructive cardiomyopathy (HNCM), were analyzed. The parameters of the LV systolic function, including ejection fraction (EF), cardiac index (CI), stroke index (SI) and mean ventricular circumferential fiber shortening (mVcf), were calculated using M mode echocardiography based on the criteria of the American Society of Echocardiography. In the AS group, the peak LV ejection flow velocity was significantly faster and the peak left common carotid arterial flow velocity was significantly slower than in the other groups, and there was a significant negative correlation between the two velocities. However, all patients except those in the AS group showed significant positive correlations between the two velocity. Namely, as the LV ejection flow velocity increased, the carotid arterial flow velocity also increased. The cardiomyopathy groups demonstrated the same findings. So, we concluded that the carotid arterial blood flow velocity reflected the LV ejection hemodynamics. In AS, the decrement of carotid arterial flow velocity showed the severity of aortic valve stenosis.

学位の種類：医学 学位授与年月日：1990/9/15 指導：香取, 瞭 教授(Director: Prof. Katori, Ryo) 報告番号：甲第157号 学内授与番号：医甲120 NDL書誌ID：000000236344

In order to investigate the pathogenetic difference of mitral valve prolapse between patients with idiopathic mitral valve prolapse （MVP） and those with straight back syndrome （SBS）, two-dimensional echocardiographic analysis was performed in 8 age matched patients with MVP, 13 patients with SBS and 9 normal subjects. All echocardiographic images were recorded by a 3/4 inch video tape recorder. From these video tape recording images, the endocardial surface of the left ventricle, the mitral commissures and the papillary muscles in the short axis view were traced every 3 frames from R wave to the end of T wave of the electrocardiogram. The atrial surface of the mitral leaflets on the longitudinal axis view was also traced. Furthermore, the lesion of prolapse was examined from the medial to the lateral side in patients with MVP and those with SBS by scanning of the longitudinal axis view. Pulsed Doppler echocardiographic study was also performed in all subjects to investigate the mitral and tricuspid regurgitation. In all cases, cardio-thoracic ratio （CTR） and the ratio of anteroposterior diameter and transverse diameter of the thorax （APDT/TDT） were calculated from the chest roentgenogram. Prolapsed distance （P. D.）, ellipsoidal index （E. I.）, distance from the gravity point to each mitral commissure （ML, MM） and that from the gravity point to each midpoint of the papillary muscle （PL, PM） were measured from those tracing images. Displacement index of the mitral apparatus （D. I.） was calculated as （ML/PL）/ （MM/PM）. CTR was larger in the MVP group and APDT/TDT was smaller in SBS than those in other groups. Characteristic echocardiographic manifestations were observed in all patients with SBS. The anterior mitral leaflet was prolapsed across the posterior one and the lesion of prolapse was located in the centromedial portion. Ellipsoidal left ventricle was observed from end-diastole to mid-systole at the mitral valve and the papillary muscle levels in SBS, but not in MVP and normal control groups. Left ventricular wall motion was characteristic in patients with SBS. Hypokinesis-like wall motion was found from the intraventricular septum to the inferior wall. The postero-medial papillary muscle moved for anterior direction, and the antero-lateral papillary muscle for horizontal direction. On the other hand, synchronous wall motion and papillary muscle movement were observed in the other 2 groups. A significant positive correlation was demonstrated between P. D. and D. I. values in SBS group, while no relationship was found between 2 parameters in patients with MVP. Mitral regurgitation was detected in all patients with MVP. Three patients had severe regurgitation, while the other patients had mild to moderate regurgitation. Mild tricuspid regurgitation was demonstratedin 4 patients with MVP. In patients with SBS, only 4 out of 13 cases showed a mild mitral regurgitation. From these results, it was suggested that mitral valve prolapse in patients with SBS was produced by an abnormal movement of the mitral apparatus due to ellipsoidal left ventricle, and that the mechanism of mitral valve prolapse in patients with SBS may be different from that of patients with MVP.