An analysis of the relation-ship between shunt stenoses and frequency characteristics of shunt murmur

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  • シャント狭窄に伴うシャント音周波数特性変化の解析
  • シャント キョウサク ニ トモナウ シャントオン シュウハスウ トクセイ ヘンカ ノ カイセキ

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Abstract

It is important to conduct daily shunt examination, especially diagnosing shunt stenoses for hemodialysis patients. Auscultation of shunt murmur is the most common method of diagnosing shunt stenosis in the hemodialysis therapy because it is easy and non-invasive. Based on clinical experience, high frequency components of the shunt murmur are observed when a shunt has one or more stenoses. However, this method has not been established as an objective diagnosis standard. Therefore, we tried to analyze the relation-ship between stenosis levels and frequency components of the shunt murmur as a basic study to establish an objective diagnostic standard of the shunt stenosis by the shunt murmur. For this purpose, frequency characteristics of some shunt murmur samples of an arterio-venous fistura (AVF) recorded at 3～6 locations were analyzed using short-term Fourier transformation at the beginning. Secondly, we analyzed the significance of differences in average values of frequency spectra of shunt murmurs between stenosis levels. The findings demonstrated that significant differences in frequency levels of shunt murmurs between stenosis levels especially at the anastomosis (upper stream of the stenosis), the stenotic segment and just behind the stenotic segment of the shunt, while there were no significant differences at the mid-point of the shunt (far down stream from the stenosis). It is considered that from the flow field theory, blood flow becomes turbulent with the progression of shunt stenosis, which causes a high frequency of shunt murmur at the anastomosis, stenotic segment and just behind the stenotic segment. It is expected that these findings may be applicable to establishing a clinical guideline for shunt stenosis based on shunt murmur.

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