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): 140-156 (2017)
doi:10.9794/jspccs.33.140

ReviewReview

房室弁の心エコーによる解剖学的評価Anatomical Assessment of the Atrioventricular Valve Using Echocardiography

静岡県立こども病院循環器科Shizuoka Children’s Hospital, Cardiac Department ◇ Shizuoka, Japan

発行日:2017年3月1日Published: March 1, 2017
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房室弁機能は先天性心疾患,特に単心室循環においてその予後に大きな影響を与える.単心室循環において房室弁閉鎖不全による心房圧の上昇は体静脈圧と肺静脈圧両方の上昇につながり,体循環と肺循環両方の鬱血を引き起こす.房室弁には僧帽弁,三尖弁,そして共通房室弁が存在するが,それぞれの形態は大きく異なり,特にheterotaxy症候群における共通房室弁はまさに多様であり,患者ごとに異なった形態を有する.そして,その機能維持には弁組織だけでなく,弁下構造,心室機能そして心房機能が深く関与する.弁構造はその複雑さゆえに完全な術前評価が未だに困難であるが,術中の経食道心エコーや三次元エコーを含めて心エコーに勝る画像検査は未だ存在しない.また,単心室のなかでも左心低形成症候群における三尖弁やheterotaxy症候群における共通房室弁はその解剖学的複雑さのために特に形成の難易度が高い房室弁であり,これらの房室弁に対する形成の方法論を確立することができればその予後改善に大きな貢献となる.本総説では心エコー,三次元エコーや経食道心エコーを用いた房室弁の解剖学的評価方法について概説する.

The function of the atrioventricular valve (AVV) has a great impact on the outcome of patients with congenital heart disease, especially those with single ventricular physiology. AVV regurgitation induces an elevation in atrial pressure, leading to an increase of both systemic and pulmonary venous pressure, and results in systemic and pulmonary congestion. There are three types of AVV: 1) mitral valve; 2) tricuspid valve; and 3) common AVV, all of which are morphologically very different. The AVV morphologies in patients with heterotaxy syndrome are extremely diversified, and thus are different from patient to patient. The function of the AVV is regulated not only by the valvar apparatus, but also by the subvalvar anatomy, ventricular, and atrial function. Although the precise preoperative anatomical assessment of the AVV still remains elusive, there are no other imaging modalities superior to echocardiography, including intraoperative transesophageal echocardiography or three-dimensional echocardiography. The tricuspid valve in patients with hypoplastic left heart syndrome or the common AVV with heterotaxy syndrome, are the most difficult AVVs to repair in single ventricles due to its complex anatomy. Thus, establishing the methodology for how to repair the AVV in this patient group would be a great contribution to prognostic improvement. Here an overview is presented on the usage of two-dimensional, three-dimensional, and transesophageal echocardiography to assess the anatomy of the AVV in pediatric patients.

Key words: atrioventricular valve; mitral valve; tricuspid valve; common atrioventricular valve; congenital heart disease

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This page was last modified on 2017-04-13T10:47:59.191+09:00


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