Moldovanu Cătălina Maria, Pandele G I, Ambăruş V, Ionescu Simona
Clinica a III-a Medicală, Facultatea de Medicină, Universitatea de Medicină si Framcie "Gr.T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2009 Oct-Dec;113(4):964-74.
Degenerative aortic stenosis (AoS) is the most common valvular disease in adults; that's why, the aortic valve replacement is one of the most frequent cardiac surgical procedures. The etiology of degenerative AoS is actually well known, the primary lesion being aortic sclerosis. Aortic sclerosis shares many pathological features and risk factors with atherosclerosis and, because atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been postulated that cholesterol lowering therapy using statin drugs could modify the course of aortic sclerosis/stenosis. Some studies also demonstrated the implication of renin-angiotensin-aldosterone system in the degenerative aortic disease, and the use of angiotensin-converting enzyme inhibitors could also be used to delayed or even reverse the evolution of Ao sclerosis/stenosis. The paper reviews the latest literature date about the definition and prevalence of aortic sclerosis and stenosis as well as medical treatment of degenerative AoS.
Treatment with statins has not proved effective in preventing the progression of lesions valves but have an important role in patients with associated coronary artery disease. Angiotensin converting enzyme inhibitors does not influence the progression of lesions valves, but may play a role in cardiac remodeling.
退行性主动脉瓣狭窄(AoS)是成人中最常见的瓣膜疾病;因此,主动脉瓣置换术是最常见的心脏外科手术之一。退行性AoS的病因实际上是众所周知的,主要病变是主动脉硬化。主动脉硬化与动脉粥样硬化有许多病理特征和危险因素相同,并且由于动脉粥样硬化可以通过降低胆固醇来预防和/或逆转,因此有人推测使用他汀类药物进行降胆固醇治疗可以改变主动脉硬化/狭窄的病程。一些研究还证明肾素-血管紧张素-醛固酮系统在退行性主动脉疾病中的作用,并且使用血管紧张素转换酶抑制剂也可用于延缓甚至逆转AoS硬化/狭窄的进展。本文综述了关于主动脉硬化和狭窄的定义、患病率以及退行性AoS的药物治疗的最新文献资料。
他汀类药物治疗尚未被证明能有效预防瓣膜病变的进展,但在伴有冠状动脉疾病的患者中具有重要作用。血管紧张素转换酶抑制剂不会影响瓣膜病变的进展,但可能在心脏重塑中发挥作用。