Matsuhisa M, Beppu S, Shimomura K, Naito H, Izumi S, Kimura E, Ichida S, Sakakibara H, Nimura Y
National Cardiovascular Center Hospital, Research Institute, Osaka.
J Cardiogr. 1986 Sep;16(3):699-709.
To elucidate the function of the pericardium, alterations in jugular phlebograms, intracardiac pressures and cardiac volumes induced by postural changes were examined in seven patients with complete absence of the left pericardium. Ten patients with ischemic heart disease were studied as controls. Jugular phlebograms in patients with complete absence of the left pericardium showed decreased depths of the x descent and the tall v waves followed by the deep y descents (M-shaped pattern) in the supine position. These jugular abnormalities were exaggerated in the left lateral decubitus position. By contrast, the jugular phlebograms tended to return to normal, but remained abnormal in the right lateral decubitus position. Right atrial pressure curves showed similar postural effects. However, the jugular phlebograms and right atrial pressure curves in patients with ischemic heart disease were not altered by postural changes. The characteristic alterations of the jugular phlebograms are useful indicators for diagnosing complete absence of the left pericardium. The lack of a prompt decrease in pericardial pressure during ventricular ejection due to the absence of the pericardium is one of the causes of a decreased depth of the x descent in pericardial defect. However, this cannot explain the postural alteration of the jugular phlebogram. Another possible mechanism is the decreased excursion of the tricuspid ring during systole. As indicated in our previous report, there is anterior movement of the cardiac apex during systole in cases of pericardial defect, which is exaggerated in the left lateral decubitus position and decreased in the right lateral decubitus position due to the lack of normal pericardial support. This anterior swinging motion may inhibit the descent of the tricuspid ring toward the apex, resulting in a decreased depth of the x descent of the jugular phlebogram and the right atrial pressure curve and their postural alterations. The right ventricular volume as calculated from cardiac computerized tomography and the right ventricular end-diastolic pressure were not altered significantly by postural changes in the control cases. These indices increased to a greater extent in the left lateral decubitus position than in other postures in cases with pericardial defects.(ABSTRACT TRUNCATED AT 400 WORDS)
为阐明心包的功能，我们对7例完全缺失左心包的患者进行了研究，观察体位改变引起的颈静脉搏动图、心内压力和心脏容积的变化。选取10例缺血性心脏病患者作为对照。完全缺失左心包的患者，其颈静脉搏动图在仰卧位时显示x波降支深度减小，v波高大，随后是y波深降支（M型模式）。这些颈静脉异常在左侧卧位时更为明显。相比之下，颈静脉搏动图在右侧卧位时倾向于恢复正常，但仍异常。右心房压力曲线显示出类似的体位效应。然而，缺血性心脏病患者的颈静脉搏动图和右心房压力曲线不受体位改变的影响。颈静脉搏动图的特征性改变是诊断完全缺失左心包的有用指标。由于心包缺失，心室射血期间心包压力缺乏迅速下降是心包缺损时x波降支深度减小的原因之一。然而，这无法解释颈静脉搏动图的体位改变。另一种可能的机制是收缩期三尖瓣环的活动度降低。如我们之前的报告所示，心包缺损病例在收缩期心脏尖部向前移动，由于缺乏正常的心包支持，在左侧卧位时这种移动更为明显，而在右侧卧位时则减小。这种向前摆动运动可能会抑制三尖瓣环向心尖的下降，导致颈静脉搏动图和右心房压力曲线的x波降支深度减小及其体位改变。在对照病例中，通过心脏计算机断层扫描计算的右心室容积和右心室舒张末期压力不受体位改变的显著影响。在心包缺损的病例中，这些指标在左侧卧位时比在其他体位时升高得更多。（摘要截断于400字）
