富山県立中央病院小児科Department of Pediatrics, Toyama Prefectural Central Hospital ◇ Toyama, Japan
目的：perimembranous VSD症例の生後1か月時点における標準12誘導心電図による予後予測の有用性を明らかにすること．
対象と方法：生後1か月時点で標準12誘導心電図が施行され，1歳時に経過観察を受けたperimembranous VSD 44例を対象として，自然閉鎖群（C群）14例，未閉鎖群（U群）17例，手術群（O群）13例の3群に分類し，心電図所見を比較検討した．また，O群対非O群（C群＋ U群），C群対非C群（O群＋ U群）により手術および自然閉鎖の予測因子も検討した．
結果：結果は（C群vs. U群vs. O群，p値）と記載する．3群の比較ではO群でV1の陽性T波（0％ vs. 11.8％ vs. 84.6％，p＜0.001）が有意に多く，V5のR波が有意に高かった（1.81 (0.72–2.88) mV vs. 2.07 (0.90–3.77) mV vs. 2.34 (1.55–3.85) mV, p＝0.027）．O群と非O群の比較ではV1の陽性T波が有意に多く（84.6％ vs. 6.5％，p＜0.001），V1のR波は有意に高かった（1.64 (0.60–4.73) mV vs. 1.21 (0.29–2.62) mV, p＝0.015）．一方，非C群とC群の比較ではV1の陽性T波が有意に少なく（0％ vs. 43.3％，p＝0.003），V5のR波（1.81 (0.72–2.88) mV vs. 2.13 (0.90–3.85) mV, p＝0.025）とS波（0.61 (0.35–1.55) mV vs. 0.99 (0.26–2.98) mV, p＝0.036）は有意に低かった．
結論：perimembranous VSD症例の生後1か月時点における標準12誘導心電図は予後予測に有用であることが示唆された．
Objective: To investigate whether 12-lead electrocardiography at 1 month after birth can predict the prognosis of patients with perimembranous ventricular septal defect (VSD).
Methods: We divided 44 perimembranous VSD cases were divided into three groups according to the outcome at the age of 1 year as follows: naturally closed (n＝14), unclosed (n＝17), operative (n＝13) and compared their electrocardiographic findings with those at the age of 1 month. We also compared the operative group with the nonoperative groups (naturally closed and unclosed) and the naturally closed group with the non-naturally closed groups (operative and unclosed) to identify factors predictive of operation and natural closure, respectively.
Results: The results are shown by (naturally closed vs. unclosed vs. operative; p value). By comparing all the groups, we found that V1 positive T-wave (0％ vs. 11.8％ vs. 84.6％; p＜0.001) was significantly more frequent and the the frequency of the V5 R-wave (1.81 mV [0.72–2.88 mV] vs. 2.07 mV [0.90–3.77 mV] vs. 2.34 mV [1.55–3.85 mV]; p＝0.005) was significantly higher in the operative group. V1-positive T-wave (84.6％ vs. 6.5％; p＜0.001) was significantly more frequent and V1 R-wave (1.64 mV [0.60–4.73 mV] vs. 1.21 mV [0.29–2.62 mV]; p＝0.015) was significantly higher in the operative group than in the nonoperative group. In the naturally closed group, the V5 R-wave (1.81 mV [0.72–2.88 mV] vs. 2.13 mV [0.90–3.85 mV]; p＝0.025) and V5 S-wave (0.61 mV [0.35–1.55 mV] vs. 0.99 mV [0.26–2.98 mV]; p＝0.036) were significantly lower.
Conclusion: In patients with perimembranous VSD, 12-lead electrocardiography at 1 month of age may predict the prognosis at 1 year of age.
Key words: ventricular septal defect; 12 lead electrocardiogram; infant
© 2021 特定非営利活動法人日本小児循環器学会© 2021 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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