Natural history of the aortic wall changes in adults with the degenerative tricuspid aortic valve stenosis: The morphometric proofs and implications for echocardiography

Borović, Saša D.; Labudović-Borović, Milica M.; Todorović, Vera N.; Rakočević, Jelena T.; Erić-Marinković, Jelena; Kostić, Jelena V.; Trifunović, Zoran; Milojević, Predrag S.

doi:10.2298/VSP170317082B

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Vojnosanitetski pregled

2019, vol. 76, br. 3, str. 241-258

Promene aortnog zida kod odraslih osoba sa degenerativnom stenozom trikuspidnog aortnog zaliska - morfometrijski dokazi i implikacije za ehokardiografiju

Borović Saša D.^a, Labudović-Borović Milica M.^b

, Todorović Vera N.^c, Rakočević Jelena T.^b, Erić-Marinković Jelena^d

, Kostić Jelena V.^e, Trifunović Zoran^e, Milojević Predrag S.^a

^aUniverzitet u Beogradu, Medicinski fakultet, Institut za kardiovaskularne bolesti 'Dedinje'
^bUniverzitet u Beogradu, Medicinski fakultet, Institut za histologiju i embriologiju
^cUniverzitet Privredna akademija u Novom Sadu, Stomatološki fakultet, Pančevo
^dUniverzitet u Beogradu, Institut za medicinska istraživanja
^eVojnomedicinska akademija, Beograd

e-adresa: sborovic2001@yahoo.com

Projekat:

Molekularna regulacija strukturne organizacije limfatičnih organa (MPNTR - 175005)
Antioksidativna zaštita i potencijali za diferencijaciju i regeneraciju mezenhimalnih matičnih ćelija iz različitih tkiva tokom procesa starenja (MPNTR - 175061)
Funkcionalni, funkcionalizovani i usavršeni nano materijali (MPNTR - 45005)
Karotidna bolest u Srbiji - patološka dinamika, prevencija, dijagnostika i inovativni terapijski postupci (MPNTR - 41002)
Akutni koronarni sindrom: istraživanje vulnerabilnosti (plaka, krvi i miokarda), optimalno lečenje i određivanje prognostičkih faktora (MPNTR - 41022)

Ključne reči: aorta; starenje; zalistak; aortni; stenoza; ehokardiografija; zalisci srca; veštački; histološke tehnike; tkiva

Sažetak

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 ventrikuloaortnog 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.

Abstract

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscA of more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP170317082B
objavljen u SCIndeksu: 25.04.2019.
metod recenzije: dvostruko anoniman

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