Evolucija istovremene umerene i umerene do teške funkcionalne mitralne regurgitacije nakon operacije teške stenoze aortnog zaliska

  • Petar Dabić Dedinje Cardiovascular Institute, Belgrade
  • Saša Borović Dedinje Cardiovascular Institute
  • Predrag Milojević Dedinje Cardiovascular Institute Belgrade
  • Jelena V Kostić Clinical Center of Serbia
  • Zoran Trifunović Military Medical Academy
  • Rade Babić Dedinje Cardiovascular Institute
DOI: https://doi.org/10.2298/VSP180314102D
Ključne reči: zalistak, mitralni, insuficijencija;, zalistak, aortni, stenoza;, hirurgija, kardiovaskularna, procedure;, postoperativni period

Sažetak


Uvod/Cilj. Funkcionalna mitralna regurgitacija (FMR) je čest entitet kod bolesnika sa stenozom aortnog zaliska (AS), kojima je indikovana zamena aortnog zaliska (ZAZ). Cilj ove studije bio je da ispita evoluciju umerene i umerene do teške FMR nakon izolovane ZAZ, da identifikuje progno­stičke indikatore za perzistentnu MR posle operacije, i da ponudi preporuku za operaciju umerene i umerene do teške FMR u vreme ZAZ zbog AS. Metode. Retrospektivno je ispitano 39 konsekutivnih bolesnika sa umerenom i ume­renom do teškom FMR u trenutku izolovane ZAZ, od januara 2007. do decembra 2013. Godine. Prikljupljeni su preoperativni i postoperativni ehokardiografski podaci da bi se analizirala evolucija FMR nakon ZAZ. Bolesnici su bili podeljeni na perzistentnu grupu (n = 14) i grupu sa sma­njenom FMR (n = 25). Naknadna podela je bila na grupu sa bolesnik-proteza diskrepancom (PPD, n = 7) i non bolesnik-proteza diskrepancom (non PPD, n = 32). Udaljeno eho­kardiografsko praćenje je kompletirano kod 100% (39/39) bolesnika. Rezultati. Kod 64% (25/39) bolesnika, FMR je bila smanjena postoperativno (MR ˂ 2+), a kod 36% (14/39) bolesnika je perzistirala (MR ≥ 2+). Za razliku od perzistentne grupe, bolesnici sa smanjenom FMR su nakon operacije imali značajnu redukciju dijametra leve komore na kraju dijastole, dijametra leve komore na kraju sistole, debljine zadnjeg zida i septuma. Isti indikatori reverznog remodelovanja su nađeni i kod non PPD grupe u poređenju sa PPD grupom. Incidenca smanjenja postoperativne FMR je bila veća kod non PPD grupe (65,6%, p = 0,001) u odnosu na PPD grupu (42.9%, p = 0,125). Srednje vreme ehokar­diografskog praćenja bolesnika je bilo 39.5 ± 23.5 meseci. Zaključak. U skladu sa prethodnim studijama, ova studija takođe pokazuje poboljšanje FMR nakon ZAZ. Smanjenje stepena MR je udruženo sa ehokardiografskim parametrima reverznog remodelovanja leve komore. Preporučuje se kon­zervativan pristup bolesnicima sa umerenom i umereno do teškom FMR, sa stavom da je rekonstrukcija ili zamena nepotrebna u trenutku ZAZ zbog AS. PPD može da spreči smanjenje FMR, te se naglašava značaj izbora proteze odgo­varajuće veličine.

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Objavljeno
2021/05/06
Broj časopisa
Vol. 77 Br. 5 (2020): Vojnosanit Pregl
Rubrika
Originalni članak