Promene aortnog zida kod odraslih osoba sa degenerativnom stenozom trikuspidnog aortnog zaliska: morfometrijski dokazi i implikacije za ehokardiografiju
Sažetak
Apstrakt
Uvod/Cilj. Istraživanja usmerena isključivo na stenozu trikuspidalnog aortnog zaliska aorte bez teške dilatacije nisu rađena, kao što nijedna studija nije imala za cilj korelaciju nalaza svetlosne mikroskopije sa ehokardiografskim parametrima. Ovo istraživanje je sprovedeno na osnovu pretpostavke da nalaženje patohistoloških promena u zidu aorte, različitog stepena težine, može uticati na kreiranje strategije operisanja aorte. Cilj rada je bio da se kod bolesnika sa teškom degenerativnom stenozom trikuspidnog aortnog zaliska stepenuju patohistološke promene zida ascendentne aorte, koja nije bila značajno dilatirana i korelišu sa ehokardiografskim parametrima, u cilju procene pogodnog vremena simultane zamene ascedentne aorte i aortnog zaliska. Metode. Morfološkom analizom je bilo obuhvaćeno 37 uzoraka, uzetih od bolesnika kod kojih je vršena operacija zamene aortne valvule i od kontrolne grupe ispitanika. Ehokardiografski parametri [dijametri aorte na nivou ventrikulo-aortnog spoja (AA), sinusa Valsalve (SV) i sinotubularnog spoja (STJ), najveći dijametar ascendentne aorte (AscA), indeks sinus Valsalve (SVI) i AscA/AA indeks], izmereni kod bolesnika sa stenozom aortne valvule, bili su korelisani sa morfološkim nalazom, starošću i polom ispitanika. Rezultati. Morfometrijskom analizom potvrđeno je da su reprezentativni uzorci prikupljeni iz regiona najvećeg hemodinamskog stresa. Potvrđeno je progresivno oštećenje elastičnih lamela u tri različita gradusa. Potvrđeno je veće oštećenje elastičnih lamela kod starijih osoba i kod žena. Morfometrijski parametri zida ascendentne aorte korelisali su značajno sa ehokardiografskim parametrima: AA, SV, AscA i SVI. Vrednosti izmerenih ehokardiografskih parametara bile su veće kod bolesnika sa najtežim gradusom morfometrijskih promena (gradus 3), mlađih od 65 godina. Vrednost AscA veća od 4,5 cm bila je udružena sa ireverzibilnim morfološkim promenama. Zaključak. Hemodinamski stres uzrokovan stenozom aortnog zaliska dovodi do oštećenja elastičnih lamela zida aorte koja se mogu gradirati patohistološki i korelisati sa ehokardiografskim parametrima ascendentne aorte što obezbeđuje dodatni kriterijum za odlučivanje kod onih bolesnika kod kojih se razmatra zamena aortnog zaliska istovremeno sa zamenom asendentne aorte.
Reference
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