Mitral Valve Surgery - Surgery Series, 2/2/21
29:10-31:53
The line that we draw in the sand as far as when we decide when sur, when it is time for surgery is whether someone is symptomatic or not. If someone is symptomatic that's the answer that it's time for a time to repair or replace but ideally repair that, that mitral valve.
僧帽弁逆流において手術適応の目安となるのは、自覚症状があるかどうかです。自覚症状がある場合には、僧帽弁の修復または置換が必要となりますが、望ましいのは修復です。
Sometimes it's difficult to tease out whether the mitral valve is the cause of that, those symptoms so occasionally there are two common scenarios.
自覚症状の原因が僧帽弁かどうか判断が難しい場合があります。この場合、一般には2つのシナリオが考えられます。
We get someone who is very young and physically fit and they have no symptoms but they have really, really severe regurgitation and all the indicators the, the heart might be dilating, the the ventricle might look like it's getting weaker, the pressures are high but they don't have symptoms and so what we can try to do is provoke symptoms by having them pushing them hard on an exercise test.
1つ目のシナリオは、患者さんが非常に若く、肉体的に健康で無症状ではあるものの、かなり重度の僧帽弁逆流があり、心臓の拡張や左室の機能低下、高血圧といった所見が全てみられる場合です。このケースでは運動負荷試験を行い、症状を誘発させてみます。
Another scenario is that someone might have a lot of other medical problems. They might have a left ventricular problem unrelated, they might have lung problems and we have to tease out whether their symptoms are in fact related to the mitral valve and if we do that, we could do that, for example, with an invasive test with cardiac catheterization to measure pressures. If we determine that the valve is the cause of their symptoms then it is absolutely the time to go to the operating room.
もう一方のシナリオは、患者さんに僧帽弁逆流以外の左心室や肺の問題などが多く認められる場合です。こうしたケースでは、本当に僧帽弁が一因となっているのかを、例えば、心カテーテルで圧を測定して確認します。僧帽弁が原因であることがわかれば、手術の適応となります。
In people who have severe mitral regurgitation that is asymptomatic we follow with echo and the decision about proceeding with surgery really is more objective. It's based on measurements and parameters on the echo. So if we measure the size of the ventricle and at the end of the heart squeezing it begins to dilate beyond 40 mm or if the left the ejection fraction goes below 60 percent that's when we know it's time to go to the OR.
重度の僧帽弁逆流があり、無症状である場合には、エコーで経過観察を行います。手術の判断については、より客観的なエコーの測定値に基づいて行います。左室収縮末期径が40mmを超え、左室駆出率が60%未満の場合には、手術適応となります。
And occasionally just because the population that we're talking about with, with Marfan syndrome and related conditions generally when they can present with these valve problems they tend to be much younger and healthier and able to tolerate surgery very well and may have other indications to go to the operating room such as the the root, their aortic root might be at or near the time when repair is indicated or their aortic valve might be nearing time for a time to be addressed.
一般にマルファン関連疾患の方は、非常に若く健康的で、手術への耐性が高い時期に、こうした弁膜症を発症する傾向にあります。また、大動脈基部や大動脈弁の修復などの理由で手術が必要となることもあります。
In those folks even if they don't meet the parameters of the size of the ventricle and ejection fraction it may be a good time to discuss surgery because if the risk of surgery is low and the likelihood of a good repair is high.
このような方々においては、手術リスクが低く、成功率が高い場合には、左心室のサイズや駆出率が手術適応の基準に満たない場合でも、手術を検討することがあります。
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。
