arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2022-28-3-300-310arthyper-2209Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEРасслаивающая аневризма аорты после протезирования двустворчатого аортального клапанаDissecting aortic aneurysm after prosthetics of the bicuspid aortic valvehttps://orcid.org/0000-0002-4287-1221ВахненкоЮ. В.VahnenkoJ. V.

Вахненко Юлия Викторовна — кандидат медицинских наук, ассистент кафедры госпитальной терапии с курсом клинической фармакологии

д.95, ул. Горького, г. Благовещенск, 675000

Juliya V. Vahnenko, MD, PhD, Assistant, Department of Internal Diseases with the Course of Clinical Pharmacology

95 Gorky street, Blagoveshchensk, 675000

gen-45@rambler.ruhttps://orcid.org/0000-0003-3811-038XДоровскихИ. Е.DorovskihI. E.

Доровских Ирина Евгеньевна — кандидат медицинских наук, заведующая диагностическим отделением Клиники кардиохирургии

Благовещенск

Irina E. Dorovskih, MD, PhD, Head, Diagnostic Department, Cardiac Surgery Clinic

Blagoveshchensk

irina_dorovsk@mail.ruhttps://orcid.org/0000-0003-1767-5461ПоляковД. С.PolyakovD. S.

Поляков Дмитрий Сергеевич — рентгенолог Клиники кардиохирургии

Благовещенск

Dmitriy S. Polyakov, MD, Radiologist. Cardiac Surgery Clinic

Blagoveshchensk

dima130371@gmail.comhttps://orcid.org/0000-0002-6506-2646ЛюбенковК. А.LyubenkovK. A.

Любенков Кирилл Аркадьевич — сердечно-сосудистый хирург Клиники кардиохирургии

Благовещенск

Kirill A. Lyubenkov, MD, Cardiovascular Surgeon, Cardiac Surgery Clinic

Blagoveshchensk

cyril.lubenkov@gmail.comФедеральное государственное бюджетное образовательное учреждение высшего образования «Амурская государственная медицинская академия» Министерства здравоохранения Российской ФедерацииРоссияAmur State Medical AcademyRussian Federation202214062022283300310Copyright © Вахненко Ю.В., Доровских И.Е., Поляков Д.С., Любенков К.А., 20222022Вахненко Ю.В., Доровских И.Е., Поляков Д.С., Любенков К.А.Vahnenko J.V., Dorovskih I.E., Polyakov D.S., Lyubenkov K.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2209

В статье обсуждаются проблемы двустворчатого аортального клапана и ассоциированной с ним вальвулоаортопатии: принципы отдельных классификаций, механизмы и факторы риска формирования дилатации аорты, мнения специалистов о показаниях к хирургическому лечению заболевания и его объемах. Рассмотрена история болезни пациентки с L-R-вариантом I типа этого порока, диагноз которого выставлен ей в возрасте 24 лет, а операция протезирования аортального клапана по поводу его выраженной недостаточности проведена в 34 года. Перед операцией размер аорты на уровне восходящего отдела составлял 4,8 см, а по прошествии 7 лет при контрольной эхокардиографии выявлена выраженная дилатация восходящей аорты с признаками расслоения. Это подтверждает мнение исследователей о разных механизмах формирования данного порока и связанной с ним аортопатии и доказывает, что последняя обусловлена не только гемодинамическими факторами, так как существенно прогрессирует и после изолированного протезирования аортального клапана, требуя повторного хирургического вмешательства. Важным предиктором роста диаметра аорты является исходно выраженная аортальная недостаточность, а факторами риска — артериальная гипертензия и интенсивное курение в анамнезе.

The article discusses the problems of bicuspid aortic valve and associated valvulo-aortopathy, including the principles of separate classifications, mechanisms and risk factors of aortic dilatation formation, indications for surgical treatment and type of surgery. A clinical case of the patient with L-R variant of the 1st type of this defect is presented. The valvular pathology she was diagnosed at the age of 24 and aortic valve replacement operation was performed at the age of 34 due to its severe insufficiency. Before the operation, the diameter of the ascending aorta was 4,8 cm, and after 7 years, control echocardiography showed pronounced dilatation of the ascending aorta with signs of dissection. This confirms the opinion about different mechanisms of the formation of this defect and related aortopathy and proves that the latter is caused not only by hemodynamic factors, as it progresses significantly after isolated aortic valve replacement, requiring repeated surgical intervention. An important predictor of aortic diameter growth is pronounced aortic insufficiency at baseline, and the risk factors are hypertension and smoking in past.

 

двустворчатый аортальный клапанморфологические типы и вариантывальвулоаортопатиярасслаивающая аневризма аортыпредикторы и факторы риска прогрессирования вальвулоаортопатииэхокардиографиякомпьютерная томография с контрастированием аортыпоказания к хирургическому лечениюbicuspid aortic valvemorphological types and variantsvalvulo-aortopathydissecting aortic aneurysmpredictors and risk factors of valvulo-aortopathy progressionechocardiographycomputed tomography with aortic contrastindications for surgical treatmentReferencesMessner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol. 2019;133:76– 85. doi:10.1016/j.yjmcc.2019.05.023Messner B, Bernhard D. Bicuspid aortic valve-associated aortopathy: Where do we stand? J Mol Cell Cardiol. 2019;133:76– 85. doi:10.1016/j.yjmcc.2019.05.023Sievers H-H, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. 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The authors declare that there are no conflicts of interest present.