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英文誌(2004-)

Journal of Medical Ultrasonics

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1990 - Vol.17

Vol.17 No.04

Original Article(原著)

(0372 - 0378)

心疾患における冠静脈洞(Coronary Sinus)径計測の意義

The Clinical Significance of Dilated Coronary Sinus in Heart Diseases

伊志嶺 みち子, 高元 俊彦, 新田 政男, 谷口 興一, 丸茂 文昭

Michiko ISHIMINE, Toshihiko TAKAMOTO, Masao NITTA, Koichi TANIGUCHI, Fumiaki MARUMO

東京医科歯科大学医学部 第二内科

Tokyo Medical & Dental University Second Department of Internal Medicine

キーワード : Coronary sinus, Persistent left superior vena cava, Coronary malformation, Tricuspid regurgitation

To evaluate the clinical significance of dilated coronary sinus, the distal and proximal diameters of coronary sinus were measured using two–dimensional echocardiography on the posteriorly angulated apical four chamber view. Seventy two patients (mean age of 50 yrs.) with various heart diseases, including 45 cases of pressure overloading states (15 of HHD: hypertensive heart disease, 15 of CP: cor pulmonale, 15 of MS: mitral stenosis), 21 cases of volume overloading states (12 cases of TR: tricuspid regurgitation, 9 cases of ASD: atrial septal defect), 4 cases of LSVC: persisent left superior vena cava and two cases of CAVF: coronary arterio–venous fistula, and 16 normal control subjects were selected in this series.
The estimated mean diameters of coronary sinus were 0.64 cm (0.3–0.8 cm) in normal control subjects, 0.59 cm (0.3–0.7 cm) in HHD, 0.55 cm (0.4–0.8 cm) in CP, 0.73 cm (0.3–1.4 cm) in MS, 1.38 cm (0.4–2.3 cm) in TR, 0.60 cm (0.3–0.8 cm) in ASD, 2.8 cm (1.9–4.2 cm) in LSVC and 4.2 cm (3.5, 4.8 cm) in CAVF, respectively. Both LSVC and CAVF had venous⁄arterial drainage to the coronary sinus, so that unusual dilatation, twitching and⁄or tortuousness was easily detected. Additional saline contrast studies via the antecubital vein gave a definite diagnosis of LSVC.
Besides the congenital anomalies with abnormal drainage, TR had the largest coronary sinus among the heart disease groups. The color flow Doppler study showed that significant regurgitation flow was present even at a site of 3–4 cm distal from the coronary sinus outlet. The distal⁄proximal coronary sinus ratio was significantly large in TR, and might suggest that TR jet created the caudal dilatation of the coronary sinus.
Elevated right ventricular end–diastolic pressure, which might increase the resistance against coronary sinus flow, was poorly related to the diameter of the coronary sinus (r = 0.42). Moreover, there was no relationship between the size of coronary sinus and cardiac mass derived by Reicheck’s method (r = 0.03). Measurements of blood velocities and profiles of coronary sinus flow were not available in most cases due to heart motion or the unsuitable echo–beam direction to the blood stream.
In conclusion, a markedly dilated coronary sinus is a sign of either abnormal drainage to the coronary sinus or tricuspid regurgitation. No relationship was found between the diameter of the coronary sinus and left ventricular mass or right ventricular end–diastolic pressure.