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

人工弁とその合併症

著者： 太田光彦¹

所属機関： ¹虎の門病院循環器センター内科

ページ範囲：P.334 - P.343

Point
・心エコー図検査を行う前に人工弁の種類やサイズ，手術時期などの情報を収集し，身体所見や血液データまで確認する準備が大切である．
・人工弁狭窄は人工弁劣化のほかに血栓弁やパンヌスなどで起こることを知る．
・経弁逆流は生理的に生じることがあるが，弁周囲逆流はすべて異常である．
・経胸壁心エコー図検査で人工弁異常が疑われた場合や観察が困難な場合には，躊躇せずに経食道心エコー図検査で評価することを常に心がける．

参考文献

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2) Banbury MK, Cosgrove DM 3rd, White JA, et al:Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg 72:753-757, 2001

3) Gao G, Wu Y, Grunkemeier GL, et al:Durability of pericardial versus porcine aortic valves. J Am Coll Cardiol. 44:384-388, 2004

4) Zoghbi WA, Chambers JB, Dumesnil JG, et al;Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound:a report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 22:975-1014, 2009

5) Ben Zekry S, Saad RM, Ozkan M, et al:Flow acceleration time and ratio of acceleration time to ejection time for prosthetic aortic valve function. JACC Cardiovasc Imaging. 4:1161-1170, 2011

6) Head SJ, Mokhles MM, Osnabrugge RL, et al:The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement:a systematic review and meta-analysis of 34 observational studies comprising 27186 patients with 133141 patient-years. Eur Heart J 33:1518-1529, 2012

7) Fernandes V, Olmos L, Nagueh SF, et al:Peak early diastolic velocity rather than pressure half-time is the best index of mechanical prosthetic mitral valve function. Am J Cardiol 89:704-710, 2002