循環器ジャーナル68巻2号

2020年04月発行

特集 心エコー図で何を見る？—スクリーニングから精査まで Ⅴ．病棟編—精査とその解釈のために

大動脈弁逆流症（AR）

著者： 天野雅史¹

所属機関： ¹国立循環器病研究センター心臓血管内科部門心不全科

ページ範囲：P.285 - P.294

Point
・左室に対する「容量」ならびに「圧」負荷が同時に生じ，拡張末期容量（前負荷の指標）ならびに収縮末期容量（後負荷の指標）が共に増加することが，慢性大動脈弁逆流症における血行力学的な特徴である．
・大動脈弁逆流症例では，主に心エコー図検査を用いて逆流の病因・重症度・左室サイズや機能を評価し手術介入時期を検討するが，時にCTやMRIなどのマルティモダリティを用い，弁尖だけでなく大動脈基部を含めた大動脈複合体の評価を行う必要がある．
・重症慢性大動脈弁逆流症例では，大動脈弁置換術直後から左室に対する容量負荷が軽減するため，術前に左室機能低下を認めた症例でも大半が術後1年でいったん左室機能は正常化するが，術後慢性期に再増悪することがあるため注意深いフォローアップが必要である．

参考文献

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