高山 鉄郎, 古田 直樹, 水野 明, 三枝 正裕

Tetsuro TAKAYAMA, Naoki FURUTA, Akira MIZUNO, Masahiro SAIGUSA

東京大学医学部胸部外科

Department of Thoracic Surg. Faculty of Medicine, Univ. of Tokyo

キーワード : mitral stenosis, ultrasonic cardiotomography, anatomical classification, operation method, open mitral commissurotomy

　It is well known that materials and durability of artificial valves today are not ideal for mitral stenotic patients. In these cases, we prefer, if possible, to do Open Mitral Commissurotomy (O.M.C.) rather than to do Mitral Valve Replacement (M.V.R.).
　If we can know the exact detailed anatomical changes in the mitral valve complex, it will be very useful for us to perform O.M.C. successfully.
　We studied clinical findings using Ultrasonic Cardio Tomography (U.C.T.G.) on 81 (27 preoperative cases. 54 postoperative cases) mitral stenotic patients. Then, we classified their U.C.T.G. image patterns as follows from the view point of their anatomical severity.
　Type I: The valve complex is soft and pliable, and its movement is sufficient.
　Type II: The shortening of the subvalvular lesions are seen, and the movement of the valve complex is moderately limited.
　Type III: The shortening and the fusion of the valve complex are great and its movement is severely limited.
　Type IV: The changes in the post, leaflet are great and the post, leaflet is fixed in semiclosed position.
　This new classification system helped us to decide proper operation methods.
　For Type I and Type II, O.M.C. with or without additional procedures for the subvalvular lesions.
　For Type III and Type III + IV. most probably M.V.R.
　Functional classifications, such as that of NYHA, do not always coincide with our anatomical classification but we feel that our anatomical classification system is more useful to decide operative methods and to estimate operative results.