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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3906_Библиотеки_им_академика_М_И_Перельмана

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   
   
    
 
 I
• Раздельное протезирование аортального клапана и вос-
     
   ,  
       -
    (
 ).
• Пациентам с синдромами Марфана, Лойеса-Дитца, Элерса-
        
    
     
  ( ),   -
 ,  ,   -
   - 
(  ).

Class I –   I.  >>> . /
    .
Class IIa –   IIa.  >> . -
   . 
  / .
Level B –   .  
 .     -
    -
.
Level C –   C.  
  .   
,     
.
161

II. :     -
   (Guidelines on the diagnosis and treatment
of aortic diseases)
: European Society of Cardiology (ESC)
: 2014
: [84]
• Хирургическое вмешательство показано пациентам с анев-
  ,     50
      (I ).
• Требуется обсуждение необходимости хирургического
      
  ,   -
 (IIa ):
• 45 мм у пациентов с синдромом Марфана и факторами риска
(   ;  
    3 /   
        -
;      /
  ;  );
• 50 мм у пациентов с двустворчатым аортальным клапаном
    ( ; -
 ;    ; -
      3 / 
      
   ;  
   );
• 55 мм у пациентов без эластопатии.
• Диаметр аорты меньшего значения может стать показани-
   ,   
      
 ,     -
 ,   , -
     (IIb ).

Class I –   I.   /
   ,       -
162
   
 , , . (
/).
Class II –   II.  -
 /     /-
     .
 –   /   -
/ ( ).
b – /    -
 / ( ).
Level C –   .   -
 /  ,  -
, .
163

III. :      -
-  (Guideline for the Management
of Patients With Valvular Heart Disease)
: American Heart Association (AHA); American
College of Cardiology (ACC)
: 2014
: [192]
 I
• Оперативное вмешательство направленное на реконструк-
       -
      
 ,     -
    5,5  ( -
 B).
 IIa
• Оперативное вмешательство, направленное на рекон-
      
  ,     -
  ,   
     5,0   
    (  -
      
 ≥ 0,5 /). (  .)
• Протезирование восходящего отдела аорты обосновано
     , -
     -
      
     -
    4,5  ( -
 ).
Class I –   I.  >>> . /
    .
Class IIa –   IIa.  >> . -
   . 
  / .
164
   
Class IIb –   IIb.  ≥ . -
      -
 .   
  .
Level B –   .  
 .     -
    -
.
Level C –   C.  
  .   
,     
.
165

IV. :    --
  (Guidelines on the management of valvular heart
disease)
: European Society of Cardiology (ESC); European
Association for Cardio-Thoracic Surgery (EACTS)
: 2012
: [268]
   
    ( 
    
)
• Хирургическое вмешательство показано пациентам с син-
     ,  
     ≥50
(     
   .   
       -
     
) (I ).
• Необходимость в хирургическом вмешательстве должна
      -
      
  (IIa ):
- ≥45        
 (    / 
   >2 / ( 
       
 ,     
 ,     -
   ); -
     -
 ;  );
- ≥50       -
    ( , 
,     
     > 2 / (
     
166
   
    ,   
   ,   
    ).
- ≥55     .

Class I –   I.   /
   ,       -
 , , . (
/).
Class II –   II.  -
 /     /-
     .
 –   /   -
/ ( ).
Level C –   .   -
 /  ,  -
, .
167

 
1.  ..     “ -
”      
? / . . ,  .., 
..,  .. // .  . ..  –
2013. –  2– 135–139.
2.  .  :  
[ ]. URL: https://racvs.ru/clinic/les/2016/
Aortic-stenosis.pdf (accessed: 02.02.2017).
3.  ...  . / .
. , . .  – -, 2011.– 1232c.
4.  ..     
     -
    :  ? / .
. , . . ,  .. //   -
  – 2012. – . 5 –  5– 29–33.
5.  ..     
   «» / . . , 
.. //   -  – 2012.
– . 5 –  1– 49–51.
6.  ..      -
  /  ..,  ..,  ..,
 ..,  .. //   -
  – 2012. – . 5 –  3– 4–8.
7.  ..  :  -
 [ ]. URL: https://racvs.ru/clinic/
les/2016/Aortic-regurg.pdf (accessed: 02.02.2017).
8.  ..-  / . . -
, . .  – : , 1989.– 742c.
9.  ..       -
 -   
    / . .
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)     / . . -
, . . , . . , . . , . .
, . . , . . , . . , .
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   
. , . . , . .  //   -
-  – 2010. – . 3 –  2– 39–45.
11.  ..     .
,  .. -  / . .  – ,
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. . / . . , . . , . .
- –  , 2004. . 1– 325c.
13.  ..    
      -
  / . . , . . , . . ,
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 / . . , . . , . .  – -
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    / . . , .
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       -
  Wheat -   2511457 - 
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  I        -
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