Статья
МЕХАНИЗМЫ РАЗВИТИЯ ДИСФУНКЦИЙ БИОЛОГИЧЕСКИХ ПРОТЕЗОВ КЛАПАНОВ СЕРДЦА
В настоящей работе проведен анализ современных публикаций по механизмам развития дисфункций биологических протезов (БП) клапанов сердца. На основании литературных данных о хорошо известных, а также в настоящее время активно изучаемых причин нарушения работы БП предпринята попытка выделить основные патогенетические направления формирования дисфункции БП. Помимо процесса естественного старения (износа) ткани клапана, развивающегося в ходе непрерывных циклических механических воздействий, и сопровождающегося формированием очагов кальцификации путем пассивного и активного процесса минералообразования, проведен анализ возможного неблагоприятного влияния протез-обусловленных и реципиент-ассоциированных факторов. К протез-обусловленным причинам развития дисфункций были отнесены технологические и технические факторы, неблагоприятное воздействие которых на клапан, возможно на этапе предимплантационной подготовки и непосредственно в ходе имплантации. С позиций реципиент-ассоциированных неблагоприятных условий для долгосрочного функционирования биологического протеза рассмотрены основные дисметаболические, иммунные, гемостазиологические и гиперпролиферативные (гиперпластические) состояния. На основании этого впервые предложена классификация дисфункций БП, основанная на патогенетических механизмах формирования нарушения работы клапана с учетом их морфологических проявлений.
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