Ｓｔ．Ｊｕｄｅ　Ｍｅｄｉｃａｌ弁置換患者における経頭蓋超音波検査（ＴＣＤ）によるＨｉｇｈ　Ｉｎｔｅｎｓｉｔｙ　Ｔｒａｎｓｉｅｎｔ　Ｓｉｇｎａｌ（ＨＩＴＳ）の臨床的意義について

DOI 被引用文献1件 参考文献27件

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  • Clinical Significance of High Intensity Transient Signal(HITS) by Transcranial Doppler Sonography in Patients with St. Jude Medical Heart Valve.

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Recently, high-intensity transient signals (HITS) obtained by transcranial Doppler ultrasonography (TCD) were reported to reflect micro-emboli in cerebral arteries. Frequent detection of HITS in patients with mechanical valve replacement has been reported for many years. However, the mechanism and significance of these signals has remained unclear. We attempted to elucidate whether HITS indicate a risk of cerebral infarction in patients with mechanical valve (St. Jude Medical valve: SJM) replacement, and also carried out an animal experimental study to clarity the mechanism of HITS formation.<BR>HITS was frequently detected in patients with SJM valves. The HITS count after surgery in patients with cerebral infarction (83 ± 66/15 min) was significantly higher than that in patients without a history of stroke (7 ± 7/15 min) (p<0.001) . The HITS count in patients with mechanical valve replacement appeared to increase with time after surgery. Thus, the HITS count appeared to indicate the risk of cerebral infarction after mechanical valve replacement. In the experimental study, injection of clotted blood into the aorta produced low-frequency and small-intensity HITS. Introduction of micro-bubbles into the aorta produced high-frequency and large-signal-intensity HITS. These two kinds of HITS were detected in patients with SJM valves. Thus, HITS in patients with SJM valves may be produced by both gaseous and solid micro-emboli.

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