Degenerativne bolesti srčanih zalistaka

master's thesis

• Title (english): Degenerative heart valve disease
• Author: Dubravka Šipuš
• Mentor: Jadranka Šeparović Hanževački (mentor)
• Committee member: Davor Miličić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Jadranka Šeparović Hanževački (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Degenerativne bolesti srčanih zalistaka predstavljaju sve veći zdravstveni problem. Procjenjuje se da u industrijski razvijenim zemljama 2,5% populacije boluje od bolesti srčanih zalistaka. Degenerativne bolesti su vodeći uzrok i zbog toga prevalencija bolesti zalistaka raste s dobi. Degenerativne bolesti srčanih zalistaka su heterogena skupina bolesti s različitim patofiziološkim mehanizmima te makroskopskim i histološkim obilježjima. Na aortnom zalistku degenerativne se promjene očituju kao aortoskleroza koja može napredovati u degenerativnu kalcificiranu aortnu stenozu. To je aktivni proces koji uključuje oštećenje endotela, upalu, lipidnu infitraciju i kalcifikaciju. Prevalencija aortne stenoze je 0,4% u općoj populaciji, a 2,8% u populaciji starijih od 75 godina. Kad se razviju simptomi aortne stenoze, prognoza bolesti je loša, bez kirurškog liječenja je smrtnost 50% u godinu dana. TAVI je znatno poboljšao preživljenje i kvalitetu života neoperabilnih bolesnika. Mitralni zalistak zahvaćen degenerativnim promjenama je miksomatozno promijenjen. Dolazi do zadebljanja zalistka i korda zbog odlaganja glikozaminoglikana što rezultira produljenjem i pucanjem korda, širenjem mitralnog prstena te prolapsom mitralnog zalistka i posljedično mitralnom insuficijencijom. Razvojem teške mitralne insuficijencije 90% bolesnika će umrijeti ili biti podvrgnuto operaciji mitralnog zalistka tijekom 10 godina. U dijagnostici bolesti srčanih zalistaka važnu ulogu ima ehokardiografija. Iako su bolesti srčanih zalistaka sve veći zdravstveni problem, nema farmakološke terapije koja bi usporila napredak bolesti te je jedina terapija kirurški popravak ili zamjena zalistka.

Abstract (english)

Degenerative heart valve disease is an emerging health problem with broad consequences. The prevalence of valvular heart disease is estimated at 2.5% in industrialized nations. The increased prevalence of valvular disease with age reflects the predominance of degenerative etiologies. Although widely used, the term “degenerative valve disease” encompasses heterogeneous lesions with regard to pathophysiological, macroscopic, and histological involvement of the valves. Calcific aortic valve disease is a form of degenerative valve disease. Its early stage is called aortic sclerosis and it may progress to the later stage – aortic stenosis. Calcific aortic valve disease is an active biological process marked by basement membrane disruption, inflammatory cell infiltration, lipid deposition, and calcification. The prevalence of aortic stenosis is estemated at 0.4% but it increases to 2.8% after 75 years of age. Symptomatic aortic stenosis has a poor outcome, inoperable patients have a mortality of 50% at 1 year. TAVI is associated with a significant reduction in symptoms and mortality in inoperable patients. Degenerative mitral valve disease is a pathologic condition in which the mitral valve leaflets and chordae are thickened due to abnormal accumulations of glycosaminoglycans. Degenerative lesions, such as chordal elongation, chordal rupture, leaflet tissue expansion, and annular dilation typically result in mitral regurgitation due to leaflet prolapse. At 10 years, 90% of patients with a severe mitral regurgitation had either died or undergone surgical repair. Echocardiography is the gold standard for diagnosis of degenerative valve disease. Despite the increasing prevalence of degenerative valve disease, there are no medical therapies to halt or delay disease progression, and the only available treatment is valve replacement or repair, to which not all patients are suited.

• Keywords: bolesti srčanih zalistaka; aortna stenoza; mitralna insuficijencija
• Keywords (english): heart valve diseases; aortic valve stenosis; mitral valve insufficiency
• Language: croatian
• URN:NBN: urn:nbn:hr:105:980843
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-18 10:55:00