Mitral Valve Surgery - Surgery Series, 2/2/21
21:57-25:23
So this image here, this first one here is a transthoracic echo and this is called a parasternal long view and it lays out the left atrium and the left ventricle very nicely.
最初の画像は、経胸壁心エコーの傍胸骨長軸像です。このアプローチでは、左心房と左心室がはっきりとみえます。
So right here, this is the left atrium. This thing that's moving right here is the mitral valve. This is the anterior leaflet of the mitral valve and this is the posterior leaflet. Blood flows from the left atrium into the left ventricle and then the left ventricle squeezes that blood out the left ventricular outflow tract right here to through the aortic valve into the aortic root and aorta, which is not very well imaged on, on this type of image but you can see that right here and the right ventricles over here.
この部分が左心房で、ここで動いているのが僧帽弁です。こちらが前尖で、こちらが後尖です。血液は左心房から左心室に流れます。左心室から押し出された血液は左室流出路から大動脈弁へと向かい、大動脈基部、そして大動脈へと流れます。このアプローチでは大動脈はよくみえませんが、ここにあります。
And an important thing to notice here is that kind of a simple way to describe this is if you look at this mitral valve apparatus and draw a line, a straight line right at the base of these leaflets you should not see the leaflets deviate and beyond that line into the left atrium. So you should see, they really almost like this is a hockey stick here. It should not go beyond this line that you've created, otherwise that is prolapse of the leaflet and you can see here, on this image at least is a really good way to see the anterior leaflet prolapsing backwards into the left atrium and it's not as easy to see but you can see a little bit of the posterior leaflet prolapsing backwards as well.
前尖と後尖の根本を結んだ直線から、左心房側へと弁尖がはみ出していないことが重要です。前尖がホッケースティックのようにみえますが、この部分が先程の直線を超えた場合が僧帽弁逸脱です。この画像では、前尖が左心房側へと逸脱しているのがわかります。分かりにくいですが、後尖も逸脱しています。
This next image here is another transthoracic echo and same person, same patient. This is called a four chamber view and so what you're seeing here is the left ventricle. Here is the mitral valve. Right here, here's the left atrium and then this is the right side of the heart with the right ventricle and the right atrium and this is another example, another view where you can really see particularly that anterior leaflet right here of the mitral valve prolapsing backwards so if the line is across here you see this anterior leaflet really dip down pretty in a very exaggerated way into that left atrium, can't see it as well of with the posterior valve, posterior leaflet but there is prolapse there too.
次の画像も同じ患者さんの経胸壁心エコーの長軸四腔像です。この部分が左心室、僧帽弁はここです。この部分が左心房で、右の部分はここが右心室、こちらが右心房です。僧帽弁前尖が左心房側へと大きく落ち込んでいるのがわかります。後尖については、よく見えませんがやはり逸脱があります。
Next image is same four chamber view but with doppler so we see flow and so normal flow should be from the left atrium into the left ventricle and it should not be in the backward direction.
次の画像も長軸四腔像ですが、ドプラ法を使っています。正常な血液の流れは、左心房から左心室（下から上）ですので、逆流があってはいけません。
So what you see here, this bright orange flash in the left atrium. That's all regurgitation backwards from the left ventricle into the left atrium and that's abnormal and there are many different ways to assess the severity of of mitral regurgitation but suffice it to say here that it fills the majority of this, this orange flash fills the majority of that left atrium and it, it goes really all the way to the superior part of that left atrium and we can even measure, for instance, flow backward, flow into the pulmonary veins that are supposed to be draining blood out of the lungs into the atrium.
この部分にオレンジ色が見えますが、これは全て左心室から左心房への逆流で、異常所見です。僧帽弁逆流の重症度を評価する方法は様々ありますが、少なくともこの画像からは、このオレンジ色の部分が左心房の大部分に及んでいるということがわかります。そのため、一例ですが、血液を肺から左心房へと送る肺静脈に逆流している血液量まで測定することができます。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
