左心低形成症候群と右側心房相同における房室弁輪面積時相変化：弁輪スペックルトラッキングを用いた検討

Masahiro Tsubura; 粒良昌弘; Masaki Nii; 新居正基; Ken Takahashi; 高橋健; Kiyohiro Takigiku; 瀧聞浄宏; Manatomo Toyono; 豊野学朋; Satoru Iwashima; 岩島覚; Nao Inoue; 井上奈緒; Mizuhiko Ishigaki; 石垣瑞彦; Keisuke Sato; 佐藤慶介; Jun Yoshimoto; 芳本潤; Sung-Hae Kim; 金成海; Norie Mitsushita; 満下紀恵; Kisaburo Sakamoto; 坂本喜三郎; Yasuhiko Tanaka; 田中靖彦

doi:10.9794/jspccs.35.30

左心低形成症候群と右側心房相同における房室弁輪面積時相変化：弁輪スペックルトラッキングを用いた検討Annular Atrioventricular Valve Area Dynamics in Patients with Hypoplastic Left Heart Syndrome and Right Atrial Isomerism: Insights Using Speckle-Tracking of the Atrioventricular Valve Annulus

粒良昌弘¹，新居正基¹，高橋健²，瀧聞浄宏³，豊野学朋⁴，岩島覚⁵，井上奈緒⁶，石垣瑞彦¹，佐藤慶介¹，芳本潤¹，金成海¹，満下紀恵¹，坂本喜三郎⁷，田中靖彦¹Masahiro Tsubura¹, Masaki Nii¹, Ken Takahashi², Kiyohiro Takigiku³, Manatomo Toyono⁴, Satoru Iwashima⁵, Nao Inoue⁶, Mizuhiko Ishigaki¹, Keisuke Sato¹, Jun Yoshimoto¹, Sung-Hae Kim¹, Norie Mitsushita¹, Kisaburo Sakamoto⁷, Yasuhiko Tanaka¹

¹ 静岡県立こども病院循環器科Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan

² 順天堂大学医学部付属順天堂医院小児科思春期科Department of Pediatrics and Adolescent Medicine, Juntendo University Hospital, Tokyo, Japan

³ 長野県立こども病院循環器小児科Department of Cardiology, Nagano Children’s Hospital, Nagano, Japan

⁴ 秋田大学医学部付属病院小児科Department of Pediatrics, Akita University Hospital, Akita, Japan

⁵ 中東遠総合医療センター小児科Department of Pediatrics, Chutoen General Medical Center, Shizuoka, Japan

⁶ 聖隷浜松病院小児循環器科Department of Pediatric Cardiology, Seirei Hamamatsu General Hosital, Shizuoka, Japan

⁷ 静岡県立こども病院心臓血管外科Department of Cardiovascular surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

受付日：2018年7月20日Received: July 20, 2018

受理日：2018年12月12日Accepted: December 12, 2018

発行日：2019年3月1日Published: March 1, 2019

背景：左心低形成症候群（HLHS）と右側心房相同（RAI）において，房室弁逆流の合併はその予後に大きな影響を与える．

方法：1) HLHS・RAI群：32例（HLHS 15例，RAI 17例）; 2）正常小児群：53例．IE-33/matrix probeを用いて心尖部四腔断面における三尖弁および共通房室弁のX-plane（弁輪の中央を通る四腔断面とこれに直交する断面）を記録．弁輪のtrackingにより二方向の弁輪径の経時変化を計測，弁輪面積を算出し2群間で比較した．心周期弁輪面積変化は収縮期に縮小する：1型；収縮期に拡大する：2型；面積変化の小さい：3型に分類した．また逆流の程度により軽度逆流群と高度逆流群に分類し，弁輪面積変化との関連を解析した．

結果：正常群：1型22例（42％），2型24例（45％），3型7例（13％）に対し，HLHS・RAI群：1型4例（13％），2型7例（22％），3型21例（65％）と，正常群に対しHLHS・RAI群に3型を多く認めた（p＜0.01）．逆流による分類では，軽度逆流群16例，高度逆流群は16例で，高度逆流群で3型を多く認めた（14例，88％）．

結論：HLHS・RAI群では三尖弁輪機能が低下しており，弁逆流を発生する一機序となっている．

Background: Atrioventricular valve regurgitation (AVVR) has a notable impact on the prognosis of patients with hypoplastic left heart syndrome (HLHS) and right atrial isomerism (RAI).

Methods: The study population comprised two groups: (1) HLHS and RAI group: n＝32 (HLHS＝15, RAI＝17), and (2) normal control group: n＝53. X-plane images of apical four-chamber view and orthogonal plane cutting through the center of annulus were acquired using transthoracic matrix array probe. Speckle-tracking of the two opposing points on the annulus in four-chamber plane and orthogonal plane was performed, and the distances of respective opposing points were consecutively measured along the cardiac cycle. Atrioventricular valve (AVV) area dynamics were classified into three categories according to the areal change pattern during systole in the normal group: Type-1: area decreases during systole; Type-2: area increases during systole; and Type-3: no significant areal change. The HLHS and RAI groups were subdivided into two subgroups according to the grade of AVVR: low-grade AVVR and high-grade AVVR, and the annular dynamics were compared between the groups.

Results: Normal group was classified into the subgroups as follows: Type-1＝22 (42％); Type-2＝24 (45％); and Type-3＝7 (13％). HLHS and RAI group was classified into the following subgroups: Type-1＝4 (13％), Type-2＝7 (24％), and Type-3＝21 (65％). Type-3 was predominant in the HLHS and RAI groups (p＜0.01). The subdivided groups were similarly classified into low-grade AVVR group (n＝16) and high-grade AVVR group (n＝16). Type-3 was predominant in the high-grade AVVR group (p＜0.01).

Conclusions: In patients with single ventricle associated with tricuspid valve or common AVV, significant valve incompetence was observed in those with reduced annular dynamics, suggesting the importance of annular function in the patients.

Key words: tricuspid valve; tricuspid valve regurgitation; hypoplastic left heart syndrome; right atrium isomerism

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

原著Original