抄録
The author have studied pulmonary circulatory dynamics in 21 patients with left heart failure, of which 15 were suffering from mitral valve disease.1) In all 4 cases of aortic regurgitation both pulmonary arterial pressure and wedge pressure were elevated, especially in the case with auricular fibrillation or flutter. In a case of constrictive adhesive pericarditis right ventricular diastolic pressure was high, suggesting the preclueded ventricular dilatation by constriction of pericardium. In a case of essential hypertension pulmonary arterial and wedge pressure showed a slight elevation, as an initial sign of backward congestion.2) In patients with mitral valve disease, pulmonary arterial and wedge pressure showed slight to marked elevation according to the severity of disease. In cases without objective symptomes the pulmonary arterial pressure remained normal but the wedge pressure in all cases showed elevation. In general cardiac output decreased.3) Little correlation between pulmonary blood pressure and systemic arterial oxygen saturation was observed. Circulating blood volume, red blood cell count and peripheral blood hemoglobin content increased in all cases.4) In cases, complicated with auricular fibrillation or flutter the wedge pressure contour showed no a-waves and embryonic c-waves followed by diminished or deformed suction curve (X-valley) and a large prominent v-waves. Effects of mitral valve regurgitation should to be deduced from the deformed X-valley. Because of the increased vascular tone by the elevated pulmonary venous pressure, the left atrial pressure variation was reflected with high fidelity in the pulmonary arterial wedge pressure curve. In cases with mitral valve stenosis and with normal sinus rythm prominent a-wave was observed.5) The author have proved indirectly the "atrial suction theory" (Maekawa) through the data, indicating the elevation of wedge pressure as the initial sign of left heart failure.
