EHOKARDIOGRAFSKA PROCENA REMODELOVANJA LEVE KOMORE U MITRALNOJ REGURGITACIJI PREMA TIPU HIRURŠKE KOREKCIJE: REPARACIJE ILI ZAMENE MITRALNE VALVULE
Sažetak
Patofiziologija hronične primarne mitralne regurgitacije (engl. mitral regurgitation ‒ MR) uglavnom se zasniva na degenerativnom procesu. Neadekvatna adaptacija leve komore (engl. left ventricle ‒ LV) usled zapreminskog opterećenja dovodi do postepene dilatacije i slabosti. Jedinu adekvatnu terapijsku opciju u ovom slučaju predstavlja hirurška intervencija. Cilj ovog istraživanja bio je da proceni rane ehokardiografske parametre remodelovanje LV-a u hroničnom primarnom MR-u u dvema vrstama operativne korekcije: mehaničkoj zameni mitralne valvule (engl. mitral valve replacement ‒ MVR) i anuloplastici mitralnog zaliska protetskim prstenom (eng. mitral valve annuloplasty – MVA). Ehokardiografske varijable su izmerene ili izračunate korišćenjem 2D i M tehnike. Pored toga, varijable su procenjene u odnosu na ranu postoperativnu disfunkciju LV-a (engl. left ventricular dysfunction ‒ LVD). Ejekciona frakcija (engl. ejection fraction ‒ EF) bila je < 50%. Istraživanje je obuhvatilo 36 asimptomatskih pacijenata sa primarnim teškim MR-om (stepen 3‒4) koji su bili podvrgnuti hirurškoj korekciji zalistaka. Krajnji dijastolni prečnik LV-a značajno se poboljšao (6,11 cm ± 0,9 cm prema 5,50 cm ± 0,7 cm) u obema grupama (p < 0,006) posle intervencija. Kada je reč o zapreminama LV-a, nisu zabeležene značajne razlike između grupa. Neposredna postoperativna sistolna disfunkcija LV-a pokazala je sličnu incidenciju u grupama (43%). Značajna razlika između grupa uočena je kod pacijenata bez LVD-a, odnosno zabeležen je veći preoperativni prednji LVEF kod pacijenata sa MVA nego kod pacijenata sa MVR-om. Nasuprot tome, kod pacijenata sa LVD-om uočen je suprotan smer promene prednjeg LVEF-a. Može se zaključiti da postoje suptilne razlike u ranim postoperativnim ehokardiografskim parametrima između MVA i MVR procedura koje odražavaju suptilne specifičnosti ranog remodelovanja LV-a kod pacijenata sa hroničnim primarnim MR-om.
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