: mm 86 mm EF mm

Transcription

1 37 Vol. 35, pp , : Ejection fraction: EF44 IV 70 mm 86 mm EF mm 4 mm EF mm 70 mm Aortic Regurgitation: AR 2 3 AR Aortic Valve Replacement: AVR AR

2 38 : 68 : : : AR Ejection Fraction: EF 44 IV AR 0 mmhg AR AVR 5 6 : 65 cm 55 kg mmhg 84 2 Levine III VI Killip I 68 QRS 2 msec Fig Cardio-Thoracic Ratio: CTR 70 Fig 2 AR Left Ventricular diastolic Dimension Left Ventricular systolic Dimension: LVDd LVDs mm EF 46 Fig 3, 4 0 AVR Carpentier-Edwards 27 mm 26 BNP 673 pg ml 42 pg ml CTR 2 CTR 45 Fig LVDd Ds 4 24 mm EF 80 Fig 3 NYHA I ACC AHA Bonow 8 2 William LVDd PW LVDd 2 PW LVDd 86 mm PW 2 mm William 4.0 2

3 AR 39 Fig.. Electrocardiogram. A B Fig. 2. Chest X-ray films. left A pre operative right B post operative year 7 month later 3

4 40 Fig. 3. Echocardiography parasternal view. prasternal left ventricular long axis view left side pre operative LVDd 86 mm pre operative LVDs 70 mm EF 46 right side post operative at year 7 month later LVDd 4 mm post operative at year 7 month later LVDs 24 mm EF 80 Donaldson grade ATPase Adenosine triphospatase, SDH Succinate dehydrogenase, Glycogen 6 Terada 23 MIBG 4 Defect score 7 AVR AR AR 4

5 AR 4 Fig. 4. Color doppler echocardiography. The aortic valve was bicuspid. Color doppler echocardiography showed a severe aortic regurgitant jet. In the left ventricle, remarkable hypertrophy and di#use wall motion abnormality were observed, which indicated the increased left ventricular stroke volume. Chaliki HP, Mohty D, Avierinos J-F, Scott CG, Scha# HV, Tajik AJ and Enriquez-Sarano M. Outcomes after aortic valve replacement in patients with severe aortic regurgitation and markedly reduced left ventricular function. Circulation 2002; 06: Bonow RO, Picone AL, McIntosh CL, Jones M, Rosing DR, Maron BJ, Lakatos E, Clark RE and Epstein SE. Survival and functional results after valve replacement for aortic regurgitation from 976 to 983: influence of preoperative left ventricular function. Circuration 985; 72: Bonow RO, Carabello CB, Chatterjee K, de Leon C, Gaasch WH, Lytle BW, Nishimura RA, O Gara PT, O Rourke RA, Otto CM, Shah PM and Shanewise JS. ACC AHA Guidelines for the Management of Patients with Valvular Heart Disease. Circulation 2006; 4: Wisenbaugh T, Spann JF and Carabello BA. Di#erences in myocardial performance and load between patients with similar aount of chronic aortic versus chronic mitral regurgitation. J Am Coll Cardiol 984; Gaasch WH, Andrias WC and Levine HJ. The e#ect of aortic valve replacement on left ventricular volume, mass and function. Circulation 978; 58: Donaldson RM, Florio R, Rickards AF, Bennett JG, Yacoub M, Ross DN and Olsen E. Irreversible morphological changes contributing to depressed cardiac function after surgery for chronic aortic regurgitation. Br Heart J 982; 48: Terada K and Sugihara H. Clinical evaluation of 23I-metaiodobenzylguandine myocardial scintigram in patients with valvular heart disease. J of Cardiology 995; 25:

6 42 Abstract A Case of Svere Aortic Regurgitation with Dramatically Improved Cardiac Function after AVR Masaki Izumo, Kengo Suzuki, Hisao Matsuda, Takafumi Nakagawa, Takashi Shimozato, Akio Hayashi, Masachika Tamura, Naohiko Osada, Fumihiko Miyake, Haruo Makuuchi 2,andSachihiko Nobuoka 3 We report a patient with left ventricular dysfunction who had severe aortic regurgitation caused by congenital bicuspid aortic valve and dramatically improved cardiac function after aortic valve replacement. The patient was a 68-year-old male. At the age of 40 years, he was a heart murmur was pointed out at a health check-up. As he was asymptomatic at that time, he received no treatment. In April 2003, he was admitted to our hospital due to the first heart failure and diagnosed as severe aortic regurgitation caused by bicuspid aortic valve. Cardiac catheterization revealed no significant stenosis in the coronary arteries; though, left ventriculography showed di#use ventricular wall motion abnormality ejection fraction: EF 44. Since aortography also revealed class IV aortic regurgitation, we performed an aortic valve replacement with Carpentier-Edwards 27 mm valve. Echocardiography before surgery showed remarkable left ventricular hypertrophy and myocardial dysfunction with the left ventricular diameter at the end systole LVDs of 70 mm, that diameter at the end diastole LVDd of 86 mm, and EF of 46. Echocardiography 6 months after surgery revealed a dramatically improved left ventricular contraction and its function with LVDs of 24 mm, LVDd of 4 mm, and EF of 80. In the cases of aortic insu$ciency accompanied with left ventricular dysfunction, it has been reported that the patients with LVDs of 60 mm or greater and or with the long-term left ventricular dysfunction have a poor outcome after surgery. The patient of this study had 70 mm LVDs and the long-term left ventricular dysfunction; however, aortic valve replacement resulted in remarkable improvement of cardiac function. In the present study, we discuss aortic regurgitation with myocardial dysfunction based on some references, how physicians determine when surgical intervention is necessary and whether recovery of cardiac function can be anticipated after aortic valve replacement. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine 2 Department of Cardiovascular, surgery, St. Marianna University School of Medicine 3 Division of General Internal Medicine, St. Marianna University School of Medicine 6