članak: 1 od 1  
Srpski arhiv za celokupno lekarstvo
2004, vol. 132, br. 7-8, str. 219-229
jezik rada: srpski
neklasifikovan
doi:10.2298/SARH0408219C

Ishod i prognoza hirurškog lečenja bolesnika sa teškom aortnom stenozom u odnosu na postojanje i težinu pridružene aortne regurgitacije
aOpšta bolnica, Zdravstveni centar, Novi Pazar, SCG
bUniverzitet u Beogradu, Medicinski fakultet, Institut za kardiovaskularne bolesti 'Dedinje'

e-adresa: scatovic@ptt.yu

Sažetak

Uticaj pridružene aortne regurgitacije (AR) na ishod zamene aortne valvule zbog izolovane aortne mane sa značajnom stenozom (AC) još nije potpuno jasan.U cilju procene tog uticaja praćeno je stanje 122 bolesnika sa simptomima bolesti. Bolesnici su podeljeni U dve grupe: grupa AC - bez aortne regurgitacije ili sa blagom regurgitacijom (1+) i grupa AS+AR - sa značajnom aortnom regurgitacijom (2+, 3+, 4+). Godinu dana posle operacije uz pregled je urađen i šestominutni test hodanja, a NYHA klasa je procenjena ponovo nakon 18 meseci. Bolesnici grupe AC bili su značajno stariji, dok su bolesnici grupe AS+-AR imali značajno veći indeks mase i teledijastolni volumen leve komore. Vrednosti za preoperacionu NYHA klasu, ejekcionu frakciju, srednji gradijent pritiska, tip i veličinu implantirane proteze i istovremenu revaskularizaciju miokarda nisu ce razlikovale među grupama ispitanika. Godinu dana posle operacije U prosečnoj NYHA klasi i učestalosti NYHA klase III/IV među grupama nije bilo razlike. Distanca manja od 300 metara na testu hodanja postizana je znatno češće u grupi AS+AR (64%) nego u grupi AC (36%) (p=0,044). Osamnaest meseci nakon operacije NYHA klasa III/IV je bila znatno češća u grupi AS+AR (26%) nego u grupi AC (8%) (p=0,0343), a među bolesnicima te grupe, zavisno od stepena aortne regurgitacije, nije bilo značajne razlike (p=0,815). Multivarijantnom analizom je pridružena značajna aortna regurgitacija, potvrđena kao nezavisni prediktor slabijeg funkcionalnog kapaciteta. Kod bolesnika sa značajnom aortnom stenozom pridružena značajna aortna regurgitacija, nezavisno od njenog stepena, nosi rizik lošijeg postoperacionog funkcionalnog kapaciteta.

Ključne reči

Reference

Bittner, V., Weiner, D.H., Yusuf, S., Rogers, W.J., McIntyre, K.M., Bangdiwala, S.I., Kronenberg, M.W., Kostis, J.B., Kohn, R.M., Guillotte, M. (1993) Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction. SOLVD Investigators. JAMA, 270(14): 1702-7
Bittner, V., Weiner, D.H., Ghali, J.K. (1993) The six minute walk test predicts prognosis in patients with heart failure and preserved ejection fraction. Circulation, 88(4.part 2), str. 590-6
Bonow, R.O., Carabello, B., de Leon, A., i dr. (1998) ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines. J Am Coll Cardiol, 32(5): 1486-588
Braunwald, E. (1998) Aortic stenosis. u: Braunwald E. i dr. (ur.) Heart disease: A textbook of cardiovascular medicine, Philadelphia, itd: W.B. Saunders, str. 1035-43
Cahalin, L.P., Mathier, M.A., Semigran, M.J., Dec, G.W., DiSalvo, T.G. (1996) The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest, 110(2): 325-32
Carabello, B.A., Stewart, J.W., Crawford, A. (1998) Aortic stenosis. u: Topol E. (ur.) Cardiovascular medicine, New York-Philadelphia, itd: Lippincott
Cohn, J.N., Rector, T.S. (1988) Prognosis of congestive heart failure and predictors of mortality. Am J Cardiol, 62(2): 25A-30A
Colan, S.D., Borow, K.M., Neumann, A. (1984) Left ventricular end-systolic wall stress-velocity of fiber shortening relation: A load-independent index of myocardial contractility. J Am Coll Cardiol, 4(4): 715-24
Connolly, H.M., Oh, J.K., Orszulak, T.A., Osborn, S.L., Roger, V.L., Hodge, D.O., Bailey, K.R., Seward, J.B., Tajik, A.J. (1997) Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators. Circulation, 95(10): 2395-400
Craver, J.M., Weintraub, W.S., Jones, E.L., Guyton, R.A., Hatcher, C.R. (1988) Predictors of mortality, complications, and length of stay in aortic valve replacement for aortic stenosis. Circulation, 78(3 Pt 2): I85-90
Deutscher, S., Rockette, H.E., Krishnaswami, V. (1984) Diabetes and hypercholesterolemia among patients with calcific aortic stenosis. J Chronic Dis, 37(5): 407-15
Devereux, R.B., Alonso, D.R., Lutas, E.M., Gottlieb, G.J., Campo, E., Sachs, I., Reichek, N. (1986) Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings. Am J Cardiol, 57(6): 450-8
du Bois, D., du Bois, E.F. (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition, 5(5): 303-11; di
Duarte, I.G., Murphy, C.O., Kosinski, A.S., Jones, E.L., Craver, J.M., Gott, J.P., Guyton, R.A. (1997) Late survival after valve operation in patients with left ventricular dysfunction. Ann Thorac Surg, 64(4): 1089-95
Feigenbaum, H. (1994) Echocardiography. Philadelphia: Lea and Febinger
Guyatt, G.H., Pugsley, S.O., Sullivan, M.J., Thompson, P.J., Berman, L., Jones, N.L., Fallen, E.L., Taylor, D.W. (1984) Effect of encouragement on walking test performance. Thorax, 39(11): 818-22
Hegrenaes, L., Hatle, L. (1985) Aortic stenosis in adults. Non-invasive estimation of pressure differences by continuous wave Doppler echocardiography. Br Heart J, 54(4): 396-404
Henry, W.L., Gardin, J.M., Ware, J.H. (1980) Echocardiographic measurements in normal subjects from infancy to old age. Circulation, 62(5): 1054-61
Hwang, M.H., Hammermeister, K.E., Oprian, C., Henderson, W., Bousvaros, G., Wong, M., Miller, D.C., Folland, E., Sethi, G. (1989) Preoperative identification of patients likely to have left ventricular dysfunction after aortic valve replacement. Participants in the Veterans Administration Cooperative Study on Valvular Heart Disease. Circulation, 80(3 Pt 1): I65-76
Krayenbuehl, H.P., Turina, M., Hess, O.M., Rothlin, M., Senning, A. (1979) Pre- and postoperative left ventricular contractile function in patients with aortic valve disease. Br Heart J, 41(2): 204-13
Lentner, C. (1990) Geigy scientific tables. Basel: CIBA-GEIGY Ltd
Lipkin, D.P., Scriven, A.J., Crake, T., Poole-Wilson, P.A. (1986) Six minute walking test for assessing exercise capacity in chronic heart failure. Br Med J (Clin Res Ed), 292(6521): 653-5
Logeais, Y., Langanay, T., Roussin, R., Leguerrier, A., Rioux, C., Chaperon, J., de Place, C., Mabo, P., Pony, J.C., Daubert, J.C. (1994) Surgery for aortic stenosis in elderly patients. A study of surgical risk and predictive factors. Circulation, 90(6): 2891-8
Lucas, C., Stevenson, L.W., Johnson, W., Hartley, H., Hamilton, M.A., Walden, J., Lem, V., Eagen-Bengsten, E. (1999) The 6-min walk and peak oxygen consumption in advanced heart failure: Aerobic capacity and survival. Am Heart J, 138(4 Pt 1): 618-24
Lund, O., Flo, C., Jensen, F.T., Emmertsen, K., Nielsen, T.T., Rasmussen, B.S., Hansen, O.K., Pilegaard, H.K., Kristensen, L.H. (1997) Left ventricular systolic and diastolic function in aortic stenosis. Prognostic value after valve replacement and underlying mechanisms. Eur Heart J, 18(12): 1977-87
Lund, O. (1990) Preoperative risk evaluation and stratification of long-term survival after valve replacement for aortic stenosis. Reasons for earlier operative intervention. Circulation, 82(1): 124-39
Morris, J.J., Schaff, H.V., Mullany, C.J., Rastogi, A., McGregor, C.G., Daly, R.C., Frye, R.L., Orszulak, T.A. (1993) Determinants of survival and recovery of left ventricular function after aortic valve replacement. Ann Thorac Surg, 56(1): 22-9; disc
Otto, C.M., Kuusisto, J., Reichenbach, D.D., Gown, A.M., O'Brien, K.D. (1994) Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies. Circulation, 90(2): 844-53
Packer, M., Bristow, M.R., Cohn, J.N., Colucci, W.S., Fowler, M.B., Gilbert, E.M., Shusterman, N.H. (1996) The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. N Engl J Med, 334(21): 1349-55
Powell, D.E., Tunick, P.A., Rosenzweig, B.P., Freedberg, R.S., Katz, E.S., Applebaum, R.M., Perez, J.L., Kronzon, I. (2000) Aortic valve replacement in patients with aortic stenosis and severe left ventricular dysfunction. Arch Intern Med, 160(9): 1337-41
Rao, L., Mohr-Kahaly, S., Geil, S., Dahm, M., Meyer, J. (1999) Left ventricular remodeling after aortic valve replacement. Z Kardiol, 88(4): 283-9
Roul, G., Germain, P., Bareiss, P. (1998) Does the 6-minute walk test predict the prognosis in patients with NYHA class II or III chronic heart failure?. Am Heart J, 136(3): 449-57
Savage, D.D., Garrison, R.J., Kannel, W.B., Levy, D., Anderson, S.J., Stokes, J., Feinleib, M., Castelli, W.P. (1987) The spectrum of left ventricular hypertrophy in a general population sample: The Framingham Study. Circulation, 75(1 Pt 2): I26-33
Stephan, P.J., Henry, A.C., Hebeler, R.F., Whiddon, L., Roberts, W.C. (1997) Comparison of age, gender, number of aortic valve cusps, concomitant coronary artery bypass grafting, and magnitude of left ventricular-systemic arterial peak systolic gradient in adults having aortic valve replacement for isolated aortic valve steno. Am J Cardiol, 79(2): 166-72
Teichholz, L.E., Kreulen, T., Herman, M.V., Gorlin, R. (1976) Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol, 37(1): 7-11
Uwabe, K., Kitamura, M., Hachida, M., Endo, M., Hashimoto, A., Koyanagi, H. (1995) Long-term outcome of left ventricular dysfunction after surgery for severe aortic stenosis. J Heart Valve Dis, 4(5): 503-7; dis
Waszyrowski, T., Kasprzak, J.D., Krzeminska-Pakula, M., Drozdz, J., Dziatkowiak, A., Zaslonka, J. (1996) Regression of left ventricular dilatation and hypertrophy after aortic valve replacement. Int J Cardiol, 57(3): 217-25