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

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   
       -
   ?
      .
      –  
.
,     ,  -
      ,  ,  
      
  3-5-7-10      -
 .      
 .       
 ,    -
  ,    -
        99%
     .
       .
       ?
 ,    ,  
   ,   -
    ,    -
    ?
   ,   ,  -
     .
     -
       -
  -   -
     ;
    -
,      .
11
 1.
     
 1.
  
  
   -

1
   (Pars ascendens aortae; Aorta
ascendens, .)    ,   -
   ,  –  -
 ,    -
 .     
  (Bulbus aortae, .),     
  (Sinus aortae, . ).   -
     (Crista supravalvularis,
.).   (Valva aortae, .)   -
 – ,    (valvula semilunaris dextra, sinistra,
posterior, .),    (noduli valvarium
semilunarium, .),  (Lunulae valvularum semilunarium,
.)   (Commissurae valvularum semilunarium, .) [89].
 ,     -
  ,    
      -
  ,     -
          
  ()    [89, 158, 244].
 ,      -
        ,
     -
   (American Heart Association/
American College of Cardiology),    -
     --
  (European Society of Cardiology/European
Association for Cardio-Thoracic Surgery) [84, 123, 192, 268, 269]. ,
 ,   ,   -
 (ascending aorta, .)   ,  -
1
     1998
     (International
Federation of Associations of Anatomists) [89].
12
   
      .  
       
– « »     .
    /-
    . , -
   ,    
 .
* * *
 –      -
.     
    . 
       
  ,   [26, 45].
      
( 1).     . -
,        
 «    ». -
       
 .   , -
    , -
        -
 [6, 26, 42, 87, 158].
 1.  -
  
1 –  
2 –  -

3 –  
  
4 –   -
  
  -
  -
   .
  -
   
,  – -
  [6, 24, 125].
13
 1.
     
  –  ,  -
     . 
     .
     «
 », , ,    ( 2)
[24, 27, 31, 207].
     
 «»    , 
     
  ( 2).      -
 -  [24, 27, 207].
 2.   «»  ,
     -
  (1);     (2).
       
 ( 2, 3, 4) [25, 125, 130, 147, 158, 207, 244, 256]:
• три полулунных линии прикрепления створок АК к стенке
  (  ) –    -
    «» ;
• три комиссуры АК – точки слияния двух соседних полулун-
    ;
• синотубулярный гребень – чётко визуально дифференци-
 ,   
   ;
14
   
• подкомиссуральные треугольники (пространства Генле
[11]) – ,    -
    
 ,   –  ;
• вентрикуло-аортальное соединение – анатомически детер-
     -
   ;
• три синуса аорты – расширения стенки корня аорты, соот-
     
   (   -
      Antonio Maria Valsalva
–  [11]);
• три створки АК.
 3.     
1 –    
2 –    
3 –  
4 –   
5 –  - 
6 –    
7 – - 
      
 ,     -
  .    -
15
 1.
     
    ,  « -
».  ,    
     
«»     [12, 24, 158].
   
   .  
-   -
 ,      -
   ,  
     
.  ,    
     (-
)  ,    –
     , ,  -
      
   ( 3, 4) [138, 256, 288].
 4.  – , -
    .  -
  .
    
       (-
 ).
1 –    
2 –  - 
3 –  
4 –    
5 –    
6 –   ( )
16
   
      -
     (  -
       
    ):
• подкомиссуральный треугольник между левым коронар-
      -
-  [138, 256, 288];
• подкомиссуральный треугольник между некоронарным и
    -
    -
 .      -
  ,     –   
[138, 256, 288].
     -
 –    .  -
  «» ( ),   
        
[25, 138, 158, 207, 256, 288].
  –    , -
  .    
 . -,     -
,      -
    ,    
   . -,  
  ,        -
,    ,  
    .  ,  -
   ,  -
 ,       
   ,     
  .       ,
       ,
   ,     ,  
    [62, 77, 147].
       ,  [6,
52, 62, 77, 147, 220, 267]:
• проведение крови из полости левого желудочка в полость
;
17
 1.
     
• придание току крови ламинарного характера;
• динамическая минимизация сопротивления току крови
(        -
,      -
 );
• оптимизация коронарной перфузии;
• образование «затвора» между полостью левого желудочка
  ;
• формирование каркаса для створок АК;
• подавление избыточного давления и редукция напряжения
 ,      
   ;
• ограничение контакта створок АК со стенкой аорты во вре-
   .
  «» ,  -
,  ,   -
 ,       
   ,   
    .   -
    
       -
    ,  
,        
  .     -
        -
        [6,
52, 62, 77, 147, 220, 267].
  –      -
,      
    .    
,     «» -
 ,  ,  –   -
     ,  
 [130, 148, 157].
* * *
      -
     [108, 158, 176, 178, 241, 263].
18
   
«Кольцо» АК ( )  
      -
       . 
    «»   
  .    
    :   -
 – ,    –  -
 .  «»  
,     [45, 176, 179, 236].
,   «» ,   ,
    ,  .
        .
      ,
    ,   .   
      -
.    «»   -
         [205,
236].
Подкомиссуральные треугольники  -
     .
      .
     
    -
   .  -
      -
    
      ,
  ,     -
 .  ,    -
   ,    . -
      
  ,   , 
  ,     -
.       
      ,   
 [25, 27, 256, 288].
ó       ,  
 ,    ,   
19
 1.
     
  –  ,   .
  «»   
   ,    -
- :  , -
 ,    II  III,   -
.  –     –  
    . 
  vasa vasorum,    -
 I .     -
 .       
     -
      -
.       
,     
.     -
 .     -
 ,       «
»,       
      [178].
Синотубулярное соединение     -
 ,    ,   ó -
         
    ,  
       [24, 178].
Створки АК      -
.       . 
      -
    : lamina
ventricularis, lamina radialis, lamina spongiosa, lamina brosa 
lamina arterialis [108].     
    -
 .     
 ,     . 
     
       [178, 241, 271].
Lamina arterialis    
  ,   -
  ,    -