加川 憲作¹, 赤松 繁², 荒川 迪生¹, 絲堺召 悦司², 野田 俊之¹, 三輪 啓志¹, 平川 千里¹

Kensaku KAGAWA¹, Shigeru AKAMATSU², Michio ARAKAWA¹, Etsuji TERAZAWA², Toshiyuki NODA¹, Hiroshi MIWA¹, Senri HIRAKAWA¹

¹岐阜大学医学部第二内科, ²岐阜大学医学部麻酔科

¹The Second Department of Internal Medicine, Gifu University School of Medicine, ²Department of Anesthesiology, Gifu University School of Medicine

キーワード : Pulmonary vein flow, Mitral inflow, Systolic fraction, Left ventricular filling dynamics

To assess the relation between the mitral inflow dynamics and pulmonary vein flow dynamics, we studied 26 surgical patients with no signs of cardiac disorder under general anesthesia by transesophageal Doppler echocardiography. Analyzing the mitral inflow velocities during the early filling period (E wave) and during the atrial contraction period (A wave) , the pulmonary vein flow velocities during the left ventricular systole (S wave) and during the left ventricular diastolic early filling period (D wave) , we measured the following variables: acceleration halftimes of E and D waves (AHT_E, AHT_D); deceleration halftimes of their waves (DHT_E, DHT_D); peak flow velocities of E and A waves (E, A); and the ratio of E to A (E/A), and the ratio of S area to the sum of S area and D area [Sa/(Sa+Da): systolic fraction] , which is regarded as the ratio of the left atrial storage volume to the left (or right) ventricular stroke volume. Deceleration halftime of pulmonary vein diastolic flow velocity (DHT_D) correlated positively with that of mitral early inflow velocity (DHT_E) (r=0.72) , and systolic fraction [Sa/(Sa+Da)] correlated with acceleration halftime of mitral inflow velocity (AHT_E) , and with the ratio of peak early to peak late mitral inflow velocities (E/A) (r=0.64, r=-0.81). These results suggest that 1)pulmonary vein flow dynamics reflects mitral inflow dynamics during mid-diastole, and the left ventricle seems to be filled first with blood stored in the left atrium and then with blood coming from the pulmonary vascular bed, and 2) the left atrial "storage function" estimated as a systolic fraction of the pulmonary vein flow velocity seems to be enhanced with the impairment of left ventricular "diastolic function".