高度肺高血圧症をともなった重度大動脈弁狭窄症の 1 手術例
肺高血圧合併大動脈弁疾患の予後は不良で，外科治療の成績も満足いくものではなく，手術適応に一定の見解が得られていない．透析中の 58 歳男性が大動脈弁狭窄症による急性心不全と診断され，術前検査で高度肺高血圧を認めた．術前にPDE III 阻害薬を投与し，肺高血圧症の改善をみた後に大動脈弁置換術を行なった．本症例のように術前に PDE III 阻害薬で肺高血圧の改善を認めたことは手術適応を決める 1 つの方法になると考えられた．...
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| Published in | 日大医学雑誌 Vol. 70; no. 2; pp. 107 - 111 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本大学医学会
01.04.2011
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0029-0424 1884-0779 |
| DOI | 10.4264/numa.70.107 |
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| Abstract | 肺高血圧合併大動脈弁疾患の予後は不良で，外科治療の成績も満足いくものではなく，手術適応に一定の見解が得られていない．透析中の 58 歳男性が大動脈弁狭窄症による急性心不全と診断され，術前検査で高度肺高血圧を認めた．術前にPDE III 阻害薬を投与し，肺高血圧症の改善をみた後に大動脈弁置換術を行なった．本症例のように術前に PDE III 阻害薬で肺高血圧の改善を認めたことは手術適応を決める 1 つの方法になると考えられた． |
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| AbstractList | 肺高血圧合併大動脈弁疾患の予後は不良で，外科治療の成績も満足いくものではなく，手術適応に一定の見解が得られていない．透析中の 58 歳男性が大動脈弁狭窄症による急性心不全と診断され，術前検査で高度肺高血圧を認めた．術前にPDE III 阻害薬を投与し，肺高血圧症の改善をみた後に大動脈弁置換術を行なった．本症例のように術前に PDE III 阻害薬で肺高血圧の改善を認めたことは手術適応を決める 1 つの方法になると考えられた． |
| Author | 高坂, 彩子 渡辺, 康夫 古川, 力丈 高森, 達也 高木, 康博 柏崎, 暁 瀬在, 明 大島, 暢 永島, 正明 塩野, 元美 前嶋, 司 八幡, 貴治 豊田, 朗 丸山, 範晃 平山, 篤志 福島, 聖二 田中, 俊行 秋山, 謙次 |
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| References | 6) Wang H, Gong M, Zhou B, et al. Compariso of inhaled and intravenous milrinone in patients with pulmonary hypertension undergoing mitral valve surgery. Adv Ther 2009; 26: 462-468. 7) Givertz MM, Hare JM, Loh E, et al. Effect of bolus milrinone on hemodynamic variables and pulmonary vascular resistance in patients with severe left ventricular dysfunction: a rapid test for reversibility of pulmonary hypertension. J Am Coll Cardiol 2996; 28: 1775-1780. 9) Sezai A, Hata M, Niino T, et al. Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac surgery: a randomized controlled study. J Am Coll Cardiol 2009; 54: 1058-1064. 11) Wakui S, Sezai A, Tenderich G, et al. Experimental investigation of direct myocardial protective effect of atrial natriuretic peptide in cardiac surgery. J Thoracic Cardiovasc Surg 2010; 139: 918-925. 17) Bleizlffer S, Ruge H, Hoerer J, et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. J Am Coll Cardiol: Cardiovascular Interventions 2010; 3: 524-530. 12) Sezai A, Shiono M, Akiyama K, et al. A case of aortic valve replacement with St. Jude medical Regent valve (first implant in Japan). Ann Thorac Cardiovasc Surg 2005; 11: 329-334. 3) Pai RG, Varadarajan P, Kopoor N, et al. Aortic valve replacement improves survival in severe aortic stenosis associated with severe pulmonary hypertension. Ann Thorac Surg 2007; 84: 80-86. 13) Sezai A, Kasamaki Y, Abe K, et al. Assessment of the St. Jude Medical Regent prosthetic valve by continuous-wave Doppler and dobutamine stress echocardiography. Ann Thorac Surg 2010; 89: 87-92. 4) Solina A, Papp D, Ginsberg S, et al. A comparison of inhaled nitric oxide and milrinone for the treatment of pulmonary hypertension in adult cardiac surgery patients. J Cardiothorac Vasc Anesth 2000; 14: 12-17. 5) Zamanian RT, Haddad F, Doyle RL, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35: 2037-2050. 16) Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: first results from a multicentre real-world registry. Eur Heart J 2010; 23 (in press). 14) Al-Attar N, Ghodbane W, Himbert D, et al. Unexpected complications of transapical aortic valve implantation. Ann Thorac Surg 2009; 88: 90-94. 10) Sezai A, Hata M, Niino T, et al. Continuous low-dose infusion of human atrial natriuretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting: The NU-HIT (Nihon University working group study of low-dose Human ANP Infusion Therapy during cardiac surgery) for left ventricular dysfunction. J Am Coll Cardiol 2010; 55: 1844-1851. 1) Varadarajan P, Kappor N, bansal RC, et al. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg 2006; 82: 2111-2115. 8) Cody RJ. Renal and hormonal effects of phosphodiesterase III inhibition in congestive heart failure. Am J Cardiol 1989; 63: 31A-34A. 2) Malouf JF, Enriquez-Sarano M, Pellikka PA, et al. Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications. J Am Coll Cardiol 2002; 40: 789-795. 15) Rodes-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk. Acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55: 1080-1090. 18) Rodes-Cabau J, Dumont E, Boone RH, et al. Cerebral embolism following transcatheter aortic valve implantation comparison of transfemoral and transapical approaches. J Am Coll Cardiol 2010; 28: 18-28. |
| References_xml | – reference: 3) Pai RG, Varadarajan P, Kopoor N, et al. Aortic valve replacement improves survival in severe aortic stenosis associated with severe pulmonary hypertension. Ann Thorac Surg 2007; 84: 80-86. – reference: 9) Sezai A, Hata M, Niino T, et al. Influence of continuous infusion of low-dose human atrial natriuretic peptide on renal function during cardiac surgery: a randomized controlled study. J Am Coll Cardiol 2009; 54: 1058-1064. – reference: 6) Wang H, Gong M, Zhou B, et al. Compariso of inhaled and intravenous milrinone in patients with pulmonary hypertension undergoing mitral valve surgery. Adv Ther 2009; 26: 462-468. – reference: 14) Al-Attar N, Ghodbane W, Himbert D, et al. Unexpected complications of transapical aortic valve implantation. Ann Thorac Surg 2009; 88: 90-94. – reference: 1) Varadarajan P, Kappor N, bansal RC, et al. Clinical profile and natural history of 453 nonsurgically managed patients with severe aortic stenosis. Ann Thorac Surg 2006; 82: 2111-2115. – reference: 4) Solina A, Papp D, Ginsberg S, et al. A comparison of inhaled nitric oxide and milrinone for the treatment of pulmonary hypertension in adult cardiac surgery patients. J Cardiothorac Vasc Anesth 2000; 14: 12-17. – reference: 13) Sezai A, Kasamaki Y, Abe K, et al. Assessment of the St. Jude Medical Regent prosthetic valve by continuous-wave Doppler and dobutamine stress echocardiography. Ann Thorac Surg 2010; 89: 87-92. – reference: 10) Sezai A, Hata M, Niino T, et al. Continuous low-dose infusion of human atrial natriuretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting: The NU-HIT (Nihon University working group study of low-dose Human ANP Infusion Therapy during cardiac surgery) for left ventricular dysfunction. J Am Coll Cardiol 2010; 55: 1844-1851. – reference: 2) Malouf JF, Enriquez-Sarano M, Pellikka PA, et al. Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implications. J Am Coll Cardiol 2002; 40: 789-795. – reference: 7) Givertz MM, Hare JM, Loh E, et al. Effect of bolus milrinone on hemodynamic variables and pulmonary vascular resistance in patients with severe left ventricular dysfunction: a rapid test for reversibility of pulmonary hypertension. J Am Coll Cardiol 2996; 28: 1775-1780. – reference: 16) Zahn R, Gerckens U, Grube E, et al. Transcatheter aortic valve implantation: first results from a multicentre real-world registry. Eur Heart J 2010; 23 (in press). – reference: 17) Bleizlffer S, Ruge H, Hoerer J, et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. J Am Coll Cardiol: Cardiovascular Interventions 2010; 3: 524-530. – reference: 5) Zamanian RT, Haddad F, Doyle RL, et al. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35: 2037-2050. – reference: 8) Cody RJ. Renal and hormonal effects of phosphodiesterase III inhibition in congestive heart failure. Am J Cardiol 1989; 63: 31A-34A. – reference: 12) Sezai A, Shiono M, Akiyama K, et al. A case of aortic valve replacement with St. Jude medical Regent valve (first implant in Japan). Ann Thorac Cardiovasc Surg 2005; 11: 329-334. – reference: 18) Rodes-Cabau J, Dumont E, Boone RH, et al. Cerebral embolism following transcatheter aortic valve implantation comparison of transfemoral and transapical approaches. J Am Coll Cardiol 2010; 28: 18-28. – reference: 15) Rodes-Cabau J, Webb JG, Cheung A, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk. Acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55: 1080-1090. – reference: 11) Wakui S, Sezai A, Tenderich G, et al. Experimental investigation of direct myocardial protective effect of atrial natriuretic peptide in cardiac surgery. J Thoracic Cardiovasc Surg 2010; 139: 918-925. |
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| Snippet | 肺高血圧合併大動脈弁疾患の予後は不良で，外科治療の成績も満足いくものではなく，手術適応に一定の見解が得られていない．透析中の 58 歳男性が大動脈弁狭窄症による急性心不全と診断され，術前検査で高度肺高血圧を認めた．術前にPDE III... |
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| SubjectTerms | 大動脈弁狭窄症 肺高血圧 |
| Title | 高度肺高血圧症をともなった重度大動脈弁狭窄症の 1 手術例 |
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