Аннотация
Функциональная трикуспидальная регургитация всегда связана с расширением фиброзного кольца, и в большинстве случаев для коррекции порока аннулопластика является достаточной. Сохранение умеренной или тяжелой трикуспидальной регургитации после коррекции пороков левых
камер сердца ассоциируется с более плохими непосредственными и отдаленными результатами.
Для коррекции трикуспидальной регургитации используются два принципиально разных метода
аннулопластики – шовная, или безиплантационная, и имплантационная. С распространением
опорных колец для аннулопластики появилось много печатных работ, в которых сравнивают шовную пластику и использование полосок, мягких и жестких опорных колец. Так, большинство авторов считают, что применение опорных колец предпочтительнее шовных методов аннулопластики, так как частота рецидива трикуспидальной регургитации при шовной аннулопластике выше.
При возникновении функциональной трикуспидальной регургитации помимо аннулодилатации
важную роль в нарушении коаптации створок, приводящем к клапанной недостаточности, играет
дилатация и/или дисфункция правого желудочка. Иногда выполнить ремоделирование правого
желудочка невозможно. Таким образом, для расширения возможностей реконструктивной хирургии трикуспидального клапана помимо вмешательств на кольце в некоторых случаях требуется
вмешательство на створках и подклапанных структурах. Реконструктивная хирургия трикуспидального клапана продолжает развиваться, предстоит прояснить еще много вопросов от показаний к конкретному методу аннулопластики до расширения возможностей реконструктивных
операций.
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Об авторах
Казумян Баграт Врамович, аспирант; orcid.org/0000-0002-6717-4537
