Valvular cardiomyopathy

Ovaj rad donosi prikaz o najĉešćim uzrocima valvularne kardiomiopatije, njihove dijagnostike i lijeĉenja. Dva glavna patofiziološka oblika valvularnih poremećaja su regurgitacija (insuficijencija) i stenoza. Svaki od poremećaja, pojedinaĉno ili u kombinaciji moţe uzrokovati valvularnu kardiomiopatiju. Najĉešći valvularni poremećaji su aortna stenoza, aortna regurgitacija, mitralna stenoza, mitralna regurgitacija i poremećaji trikuspidalnog ušća. Aortna stenoza najĉešća je bolest zalistaka u zapadnom dijelu svijeta. Uglavnom je uzrokovana degenerativnom kalcifikacijom polumjeseĉastih zalistaka. Kod pacijenata s AS, stenoza napreduje tijekom godina te dovodi do kompenzatornog zadebljanja lijeve klijetke odnosno koncentriĉne hipertrofije. Progresijom teţine stenoze, javljaju se simptomi zaduhe, srĉanog zatajenja, angine i sinkope. AR je uzrokovana poremećajem aortnih listova, potpornih struktura i prstena, ili oboje. Reumatska vrućica ostaje najeĉšći uzrok AR u svijetu, meĊutim u razvijenim zemljama ĉešće su uroĊene bolesti koje zahvaćaju aortne zaliske ( npr.Marfanov sindrom). Mitralna regurgitacija takoĊer uzrokovana reumatskom bolešću srca, ali su vodeći uzrok u razvijenim zemljama degenerativne promjene mitralnih zalistaka. Mitralna stenoza uzrokovana je jednakim uzrocima kao i MR. Simptomi su jednaki kod oba poremećaja te ukljuĉuju anginu, zaduhu, sinkopu itd. Metoda izbora u dijagnostici svih poremećaja zalistaka je ehokardiografija kojom su sve strukturne promjene vidljive. Ostale slikovne metode su MSCT ili CMR ukoliko kvaliteta ehokardiografije ne zadovoljava. Lijeĉenje valvularnih poremećaja ovisi o vrsti zalistaka i teţini poremećaja. Asimptomatske pacijente s normalnom veliĉinom LV, neovisno o tipu zalistaka, trebalo bi periodiĉki pratiti, ukljuĉujući i ehokardiografski pregled. Simptomatske pacijente i pacijente s teškim stupnjem valvularnog poremećaja treba razmatrati za kiruršku zamjenu ili popravak zalistaka. Danas su sve dostupnije i perkutane metode intervencije. Farmakološka terapija takoĊer ovisi o vrsti zalistaka i teţini poremećaja, ali najĉešći lijekovi su diuretici, beta blokatori, vazodilatatori i ACE inhibitori.This review discusses about the most common causes of valvular cardiomyopathy, their diagnostics and management. Two main pathophysiological types of valve disorders are regurgitation (insufficiency) and stenosis. Both of these disorders and combinations of them can lead to valvular cardiomyopathy. The most common valvular disorders to focus on are aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation and changes of tricuspid valve. Aortic stenosis is the most prevalent valvular disease in the Western world. It is usually caused by degenerative calcification of semilunar valves. In the patients with AS, stenosis increases over the years and leads to compensatory left ventricular wall thickening called concentric hypertrophy. With the progression of stenosis severity, symptoms of dyspnea and heart failure, angina and syncope develop. AR is caused by abnormalities of the aortic leaflets, their supporting structures and annulus, or both. Rheumatic fever remains the most frequent cause of AR worldwide, but in the developed countries more frequent are congenital diseases that involve aortic valve (e.g., Marfan syndrome). Mitral regurgitation is also caused by rheumatic heart disease, but leading cause in developed countries are degenerative forms of mitral valves. Mitral stenosis is caused by the same clinical entities as MR. Symptoms are the same for both abnormalities and include angina, dyspnea, syncope etc. Diagnostic method of choice for all valvular disorders is echocardiography where all structural changes of valves are visible. Other imaging methods are MSCT or CMR if quality of echocardiography does not satsfy. Treatment of valvular disorders depends on the type of valve and severity of abnormalities. Asymptomatic patients with normal left ventricular size, regardless of the type of valves, should undergo periodic examinations, including echocardiography. Symptomatic patients and patients with severe valve disorders should be considered for surgical valve replacement or repair. Today it is possible to perform the procedure percutaneously. Pharmacological therapy also depends about type of valves and severity, but the most common drugs are diuretics, beta blockers, vasodilatators and ACE inhibitors