Клапанная болезнь сердца при антифосфолипидном синдроме (обзор литературы)

Обзор посвящен особенностям клапанной болезни сердца (КБС) при антифосфолипидном синдроме (АФС). Кроме эпидемиологических данных и классификационных критериев АФС, приводятся сведения о распространенности, патогенетических механизмах, патоморфологических особенностях КБС, которая характеризуется веррукозным эндокардитом (или эндокардитом Либмана-Сакса), утолщением створок и дисфункцией клапанов. Основные патогенетические события КБС обусловлены воздействием антифосфолипидных антител, локальной агрегацией тромбоцитов, миграцией воспалительных клеток и отложением иммунных комплексов. Течение КБС при АФС нередко осложняется тромбоэмболическими осложнениями, включая эмболизацию артерий головного мозга и коронарных артерий. Диагностика КБС при АФС основывается на результатах эхокардиографии (ЭхоКГ), что позволяет выявить утолщение створок, веррукозные образования и оценить функцию клапанного аппарата. Использование чреспищеводной ЭхоКГ позволяет уточнить особенности клапанного поражения при неубедительных результатах трансторакальной ЭхоКГ. Обсуждаются вопросы ведения больных с АФС, имеющих КБС, с оценкой результатов применения антитромбоцитарной, антикоагулянтной, иммуносупрессивной терапии и хирургической коррекции выраженной клапанной патологии. Выполнение кардиохирургических вмешательств ассоциируется с повышенным риском развития послеоперационных осложнений, обусловленных кровотечениями или тромбозом, а также смертности.

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