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  • 學位論文

僧帽瓣逆流馬爾濟斯犬之左心室及右心室流出血量之差異性

The Differences between Outflow Volume of Left and Right

指導教授 : 江強華

摘要


僧帽瓣逆流佔犬隻後天性心臟瓣膜疾病數量之最,對此疾病以都卜勒心臟超音波檢查大多著重於瓣膜結構研究與心臟功能評估,而對左心室及右心室流出血量差異性的評估研究尚不多見,故本研究採集81隻臨床上最易發生僧帽瓣逆流之馬爾濟斯犬為研究對象,包括對照組 (n=23)及實驗組 (n=58) 則預先依據紐約心臟學會 (NYHA) 分級標準之外觀臨床症狀與理學檢查數值實施分級之第Ⅰ級 (n=15)、第Ⅱ級 (n=17)、第Ⅲ級 (n=14)、第Ⅳ級 (n=12),進行左、右心室的心搏量及心輸出量差異性研究;結果顯示,左、右心室心搏量差異值 (RVSV-LVSV) 呈現出與NYHA分級具有r值為0.84,( P<0.01 ) 極顯著的相關性,從對照組至NYHA分級的Ⅰ~Ⅳ級全部呈現出明顯差異 (P<0.05)。本研究嘗試將左、右心室心搏量的差異量區分為<0.2 mL、0.21-1.0 mL、1.1-2.0 mL、2.1-3.0 mL、>3.1 mL共5組,分別以NYHA分級與僧帽瓣逆流最高流速比較其差異性,各組均呈現出極顯著差異 ( P <0.01 );本研究之結論為:採用心內分流研究模式針對僧帽瓣逆流犬隻左、右心室流出血量的差異評估是可行的,且藉由左、右心室心搏量的差異,配合NYHA分級標準並參考僧帽瓣逆流最高流速,可作為僧帽瓣逆流所造成心衰竭嚴重度之預估,此外,左、右心室心搏量的差異與僧帽瓣逆流最高流速的關係亦呈現正相關。

並列摘要


Abstract Student ID:N9816002 Title of thesis:The Differences between Outflow Volume of Left and Right Ventricle in Maltese Breed Dogs with Mitral Regurgitation Total page:75 Name of Institute: Graduate Institute of Department of Veterinary Medicine, National Pingtung University of Science and Technology Graduate date:June, 2012 Degree Conferred:Master Name of student:Shih-Yung Yeh Adviser:Chiang-Hua Chiang The contents of abstract in this thesis: Mitral regurgitation is the most common acquired valvular heart disease in the dog. Most previous studies assessed the structure and function of valves on Doppler echocardiographic examination in mitral regurgitation, and they seldom offered the information about the differences of outflow blood between the left and right ventricles. Clinically, Maltese is the most common species with mitral regurgitation so this study collects 81 Malteses for assessment, including the control group (n = 23) and the experimental group (n = 58). According to the clinical signs and the value of physical examination of New York Heart Association (NYHA), the experimental group (n = 58) with mitral regurgitation can be classified to grade Ⅰ (n = 15), grade Ⅱ (n = 17), grade Ⅲ (n = 14) and grade Ⅳ (n = 12). This study focuses on analyzing the correlation and the differences of stroke volume and cardiac output between left and right ventricles. The results indicate that there exists positive correlation between the differences of stroke volume among the both ventricles (RVSV-LVSV) and gradeⅠ~grade Ⅳ of NYHA ( r = 0.84, (P <0.01), and the result also exists the significant difference between the control group and gradeⅠ~grade Ⅳ of NYHA (P <0.05). We try to quantify the differences of the stroke volume between left and right ventricles divided into total five groups, including four groups of the experimental group 0.21-1.0 mL, 1.1-2.0 mL, 2.1-3.0 mL, > 3.1 mL and the control group <0.2 mL, and then, the results of comparing the maximum velocity of mitral regurgitation of these five groups with the degrees of mitral regurgitation of NYHA presents the significant difference (P <0.01). In conclusion, use this research model of intracardiac shunt to evaluate the differences of outflow among the both ventricles in dogs with mitral regurgitation is available. The both measuring methods, assess the differences of stroke volume between the left and right ventricle and estimate the degrees of mitral regurgitation of NYHA, can help estimate the degrees of heart failure which is caused by mitral regurgitation. Furthermore, there is high positive correlation between the differences of stroke volume among two ventricles and the maximum velocity of mitral regurgitation. Keywords: dogs, Doppler echocardiography, mitral regurgitation, stroke volume

參考文獻


Blase A. The current therapy for mitral regurgitation. J Am Coll Cardiol 52 : 319-326, 2008.
Bonagura JD, Herring DS. Echocardiography: Acquired heart disease. Vet Clin North Am Small Anim Pract 15: 1209-1224, 1985.
Bonagura JD, Herring DS. Echocardiography: Congenital heart disease. Vet Clin North Am Small Anim Pract 15:1195-1208,1985.
Bonagura JD. M-mode echocardiography: Basic principles. Vet Clin North Am Small Anim Pract 13: 299-319, 1983.
Carabello BA, Crawford FA. Valvular heart disease. N Engl J Med 337: 32- 41, 1997.

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