日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 33(2): 135-139 (2017)
doi:10.9794/jspccs.33.135

ReviewReview

房室弁の解剖:小児循環器疾患の診断と治療のための基礎知識Anatomy of the Atrioventricular Valves for Understanding Pediatric Cardiac Diseases

1山梨大学大学院総合研究部医学域外科学講座第2Department of Surgery, University of Yamanashi ◇ Yamanashi, Japan

2山梨大学医学部附属病院医療の質・安全管理室Hospital Safety Administration, University of Yamanashi Hospital ◇ Yamanashi, Japan

発行日:2017年3月1日Published: March 1, 2017
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房室弁の解剖知識は,小児循環器疾患の診断や治療の質を高める上で不可欠である.僧帽弁では,弁尖,弁輪,支持組織の構造と機能,また腱索や乳頭筋の変異を理解する.先天性僧帽弁膜症では,弁尖の異型性だけでなく,弁下組織にも異常を伴うことが多い.僧帽弁周囲にある左冠動脈回旋枝,冠状静脈洞,中心線維体,大動脈弁などとの関係も重要である.三尖弁では,弁尖,腱索,乳頭筋の構造,また中隔尖から前尖に多くみられる変異を理解する.三尖弁周囲にある大動脈弁,刺激伝導系(Koch三角)や膜様部中隔との関係も重要である.代表的な房室弁異常を伴う疾患として,房室中隔欠損症とエプスタイン奇形がある.前者では共通房室弁の変異,正常とは異なる刺激伝導系など,後者では高度逆流をきたしうる中隔尖,後尖の変形や付着部の偏位,右室形態の多様性を理解する.単心室型疾患では,体循環を担う三尖弁の耐用性や共通房室弁の逆流が予後に影響する.

Anatomical knowledge of atrioventricular valves is essential to enhance the quality of diagnosis and treatment of pediatric cardiac diseases. Basic structure and function of the mitral valve, which consists of two leaflets, annulus, chordae, and papillary muscles as well as their variations, should be properly recognized. In particular, dysplasia of the leaflets and abnormalities of subvalvar apparatus are frequently seen in congenital valvular diseases. Left circumflex coronary artery, coronary sinus, central fibrous body, and the aortic valve are located around the perimeter of the mitral valve. Basic structure of three leaflets, chordae, and papillary muscles of the tricuspid valve and its variations, which are occasionally seen in septal and anterior leaflets, should be recognized. Relationship to the aortic valve and the conduction system, including Koch’s triangle and membranous septum, are also important anatomical points. Atrioventricular septal defect and Ebstein’s anomaly are closely related to abnormalities of atrioventricular valves. Variations in common atrioventricular valve and anomalous location of the conduction system are particularly important for understanding atrioventricular septal defect. However, deformity and apical deviation of the septal and the posterior leaflets of the tricuspid valve, which may cause severe regurgitation, are pathognomonic in Ebstein’s anomaly. Accordingly, the right ventricle varies in size and shape. In single ventricle with univentricular physiology, durability of the tricuspid valve in systemic circulation and regurgitation of the common atrioventricular valve are important issues that may influence prognosis.

Key words: atrioventricular valve; anatomy; pediatric cardiology; congenital heart disease

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