Remodelácia aortálneho koreňa bola po prvý krát publikovaná v 80. rokoch minulého storočia. Dnešná remodelácia koreňa aorty je geometricky presne definovaná a indikovaná u každého pacienta s regurgitáciou aortálnej chlopne pri aneuryzme koreňa aorty. Cieľom práce je zhodnotiť strednedobé výsledky remodelácie koreňa aorty v našich podmienkach a rizikové faktory, ktoré majú na túto stabilitu vplyv. Do súboru bolo zaradených 103 pacientov podstupujúcich remodeláciu koreňa aorty od januára 2011 do decembra 2013. Sledovanie pacientov bolo uskutočnené echokardiografickou kontrolou v korelácii so odporúčaniami medzinárodného registra AVIATOR. Analýza prežívania pacientov zameraná na prežívanie bez reoperácie a nálezu aortálnej regurgitácie tretieho a vyššieho stupňa zaznamenala hemodynamickú stabilitu remodelácie koreňa aorty v horizonte 4 rokov na úrovni 89 % a v horizonte 6 rokov na úrovni 86 %. Univariačná regresná analýza neidentifikovala žiaden z porovnávaných vstupných a peroperačných parametrov ako faktor ovplyvňujúci stabilitu remodelácie a prežívanie. Remodelácia koreňa aorty a reimplantácia aortálnej chlopne dnes predstavujú pri vhodných anatomických pomeroch optimálnu terapeutickú stratégiu pre pacientov s aortálnou regurgitáciou a aneuryzmou koreňa aorty. Pri dodržaní požadovaných postupov prináša remodelácia koreňa aorty z hľadiska strednedobého, ale aj dlhodobého sledovania veľmi optimistické výsledky.
Aortic root remodeling was first published in the 1980s. Today's aortic root remodeling is geometrically precisely defined and indicated in every patient with aortic valve regurgitation in aortic root aneurysm. The aim of the work is to evaluate the medium-term results of aortic root remodeling in our conditions and the risk factors that have an impact on this stability. The work included 103 patients undergoing aortic root remodeling from January 2011 to December 2013. Patient follow-up was performed by echocardiographic control in correlation with the recommendations of the international AVIATOR registry. The analysis of patient survival focused on survival without reoperation and without the finding of aortic regurgitation of the third and higher degree recorded the hemodynamic stability of aortic root remodeling 4 years after surgery at the level of 89% and 6 years after the surgery at the level of 86%. Univariate regression analysis did not identify any of the compared factors and intraoperative parameters as factors affecting remodeling stability and survival. Remodeling of the aortic root and reimplantation of the aortic valve today represent an optimal therapeutic strategy for patients with aortic regurgitation and aortic root aneurysm in appropriate anatomical conditions. If the required procedures are followed, the remodeling of the aortic root brings very optimistic results from the point of view of medium-term as well as long-term follow-up.
Infective endocarditis was initially defined as a disease of patients with pre-existing valvular abnormalities. In contemporary medicine a valvular prosthesis and implanted medical devices are the most common risk factors for infective endocarditis. A case report is presented regarding an 18-year-old female with a medical history of a 12-year implanted Amplatzer occluder. Echocardiography showed an endocarditis focus in the right atrium communicating to the left atrium and destruction of the non-coronary leaflet of the aortic valve, with aortic valve insufficiency. Blood culture was positive for multi-resistant Staphylococcus aureus. The aortic valve, the Amplatzer device and part of the anterior leaflet of the mitral valve were excised. Pericardium was used for reconstruction of the anterior leaflet of the mitral valve, the interatrial septum and the wall of the left atrium. A mechanical prosthesis of the aortic valve was implanted. Control echocardiography was done four months after surgery. The evaluation did not show any recurrence of endocarditis. The published literature shows, in correlation with the presented case report, the occurrence of endocarditis late in the course of Amplatzer implantation highlights the need for vigilance in the population of patients with the device.
- MeSH
- aortální insuficience diagnostické zobrazování chirurgie MeSH
- chirurgická náhrada chlopně MeSH
- echokardiografie MeSH
- endokarditida * diagnostické zobrazování chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- mitrální insuficience diagnostické zobrazování chirurgie MeSH
- mladiství MeSH
- septální okluder * škodlivé účinky MeSH
- Staphylococcus aureus patogenita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
