Методы определения степени кальцификации зоны имплантации транскатетерных клапанов и их клиническая значимость

   Транскатетерная имплантация аортального клапана (ТИАК) является важным хирургическим методом лечения пациентов с тяжелым стенозом АК. Степень и распространение кальцификации в зоне имплантации клапанов (створки аортального клапана, фиброзное кольцо аортального клапана и выводной отдел левого желудочка) являются важными факторами, определяющими исход ТИАК. Оптимизация скрининга кальцификации зоны имплантации клапана на компьютерной томографии позволяет выявить истинные, значительно более низкие частоту и степень парапротезной регургитации. В настоящее время в медицинском сообществе активно обсуждается оптимальный порог единиц Хаунсфилда для сканирования зоны имплантации клапана при компьютерно-томографическом исследовании с контрастным усилением, который позволит избежать неточного определения количества, объема и массы кальцификатов в зоне имплантации клапана. Выделяют два основных подхода для оценки кальцификации зоны имплантации клапана, в каждом из которых используются несколько вариантов разнообразных алгоритмов выбора единиц Хаунсфилда. Эта неоднородность методов и подходов привела к ограниченному пониманию необходимых показателей кальцификации, которые можно использовать в клинической практике для будущей стратификации рисков ТИАК. В статье представлен обзор двух основных подходов к оценке кальцификации зоны имплантации клапанов, результаты сравниваются с результатами, полученными традиционным методом Агатстона, оценивается клиническая значимость каждого из методов для прогнозирования частоты парапротезной регургитации.

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