循環器ジャーナル72巻2号

2024年04月発行

特集 心エコー　何をどこまで評価できるか？ Ⅲ. 心エコーを活かして構造的心疾患を診断・治療する

TRの心エコー診断と治療方針

著者： 宇都宮裕人¹

所属機関： ¹広島大学大学院医系科学研究科循環器内科学

ページ範囲：P.309 - P.321

POINT
・三尖弁複合体の解剖学的知識を得ておくことが，心エコー検査の質を担保する．
・三尖弁の2D断面における弁葉の同定法を知っておく．
・三尖弁閉鎖不全症を見た場合に，その原因・機序・部位と逆流重症度・右心系の形態と機能を含めた評価を行う．
・重症度評価が5-point scaleになるので，縮流部径や有効逆流弁口面積などの定量評価の重要性が高くなっている．
・三尖弁閉鎖不全症に対する治療適応は，①逆流の原因や重症度，②右心不全症状の有無，③左心系弁膜症に対する手術の必要性，さらには④手術リスクとなるような併存症（右室機能低下，肺高血圧，臓器うっ血による肝腎機能低下など）を考慮に入れて判断する．
・TriClip術の臨床導入により，心エコー評価に求められる項目は格段に増えることが予想される．

参考文献

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