"0042-773X" . . "Aortic stenosis - editorial"@en . "N" . "[62C0385C334D]" . "RIV/00023884:_____/13:#0005732" . "Aort\u00E1ln\u00ED sten\u00F3za (AS) nemus\u00ED dlouho p\u016Fsobit \u017E\u00E1dn\u00E9 obt\u00ED\u017Ee, ale pokud se obt\u00ED\u017Ee objev\u00ED, m\u011Bla by b\u00FDt \u0159e\u0161ena co nejd\u0159\u00EDve. AS je v naprost\u00E9 v\u011Bt\u0161in\u011B p\u0159\u00EDpad\u016F operabiln\u00ED, a to i ve vy\u0161\u0161\u00EDm v\u011Bku. U izolovan\u00E9 AS je opera\u010Dn\u00ED mortalita n\u00EDzk\u00E1 (1-3 %). Operace zlep\u0161uje progn\u00F3zu i kvalitu \u017Eivota nemocn\u00FDch. V posledn\u00EDch letech je mo\u017Enost \u0159e\u0161it AS i bez operace katetriza\u010Dn\u00ED implantac\u00ED biochlopn\u011B ve stentu (TAVI = transcatheter aortic valve implantation), kter\u00E1 je v\u0161ak zat\u00EDm rezervov\u00E1na pro vysoce rizikov\u00E9 pacienty odm\u00EDtnut\u00E9 kardiochirurgem. Z\u00E1va\u017En\u00E1 aort\u00E1ln\u00ED sten\u00F3za m\u00E1 obvykle p\u0159i norm\u00E1ln\u00EDm pr\u016Ftoku vysok\u00FD gradient. Av\u0161ak existuj\u00ED i situace, kdy i z\u00E1va\u017En\u00E1 aort\u00E1ln\u00ED sten\u00F3za m\u016F\u017Ee m\u00EDt n\u00EDzk\u00FD gradient. Jednak se m\u016F\u017Ee jednat o t\u011B\u017Ekou aort\u00E1ln\u00ED sten\u00F3zu s n\u00EDzk\u00FDm gradientem p\u0159i systolick\u00E9 dysfunkci a n\u00EDzk\u00E9 ejek\u010Dn\u00ED frakci lev\u00E9 komory (LK). V ned\u00E1vn\u00E9 dob\u011B byla v\u0161ak pops\u00E1na i t\u011B\u017Ek\u00E1 aort\u00E1ln\u00ED sten\u00F3za s n\u00EDzk\u00FDm gradientem a norm\u00E1ln\u00ED ejek\u010Dn\u00ED frakc\u00ED. N\u00EDzk\u00FD gradient je zde d\u00E1n n\u00EDzk\u00FDm pr\u016Ftokem (tepov\u00FD objem < 35 ml/m2) p\u0159i t\u011B\u017Ek\u00E9 diastolick\u00E9 dysfunkci LK, v\u011Bt\u0161inou u mal\u00FDch a t\u011B\u017Ece hypertrofick\u00FDch komor. Jedn\u00E1 se o pokro\u010Dilou formu AS s \u010D\u00E1ste\u010Dn\u011B ireverzibiln\u00ED subendokardi\u00E1ln\u00ED fibr\u00F3zou. Tito pacienti maj\u00ED hor\u0161\u00ED progn\u00F3zu ne\u017E AS s vysok\u00FDm gradientem a p\u0159itom existuje vysok\u00E9 riziko podcen\u011Bn\u00ED v\u00FDznamnosti tohoto typu AS. V\u00FD\u0161e uveden\u00E9 probl\u00E9my jsou d\u016Fvodem, pro\u010D by i st\u0159edn\u011B v\u00FDznamnou AS nebo AS s n\u00EDzk\u00FDm gradientem m\u011Bl v\u017Edy vy\u0161et\u0159ovat kardiolog, nejl\u00E9pe se zku\u0161enostmi v hodnocen\u00ED chlopenn\u00EDch vad a s n\u00E1vaznost\u00ED na kardiochirurgick\u00E9 pracovi\u0161t\u011B."@cs . . "aortic stenosis, low gradient, TAVI"@en . "1"^^ . . . "1"^^ . . . "59" . "Vnit\u0159n\u00ED l\u00E9ka\u0159stv\u00ED" . "Aort\u00E1ln\u00ED sten\u00F3za -editorial"@cs . . . "2"^^ . "61513" . "Aort\u00E1ln\u00ED sten\u00F3za -editorial" . . "Popelov\u00E1, Jana" . "RIV/00023884:_____/13:#0005732!RIV14-MZ0-00023884" . . . "4" . . "Aort\u00E1ln\u00ED sten\u00F3za -editorial"@cs . "Aort\u00E1ln\u00ED sten\u00F3za (AS) nemus\u00ED dlouho p\u016Fsobit \u017E\u00E1dn\u00E9 obt\u00ED\u017Ee, ale pokud se obt\u00ED\u017Ee objev\u00ED, m\u011Bla by b\u00FDt \u0159e\u0161ena co nejd\u0159\u00EDve. AS je v naprost\u00E9 v\u011Bt\u0161in\u011B p\u0159\u00EDpad\u016F operabiln\u00ED, a to i ve vy\u0161\u0161\u00EDm v\u011Bku. U izolovan\u00E9 AS je opera\u010Dn\u00ED mortalita n\u00EDzk\u00E1 (1-3 %). Operace zlep\u0161uje progn\u00F3zu i kvalitu \u017Eivota nemocn\u00FDch. V posledn\u00EDch letech je mo\u017Enost \u0159e\u0161it AS i bez operace katetriza\u010Dn\u00ED implantac\u00ED biochlopn\u011B ve stentu (TAVI = transcatheter aortic valve implantation), kter\u00E1 je v\u0161ak zat\u00EDm rezervov\u00E1na pro vysoce rizikov\u00E9 pacienty odm\u00EDtnut\u00E9 kardiochirurgem. Z\u00E1va\u017En\u00E1 aort\u00E1ln\u00ED sten\u00F3za m\u00E1 obvykle p\u0159i norm\u00E1ln\u00EDm pr\u016Ftoku vysok\u00FD gradient. Av\u0161ak existuj\u00ED i situace, kdy i z\u00E1va\u017En\u00E1 aort\u00E1ln\u00ED sten\u00F3za m\u016F\u017Ee m\u00EDt n\u00EDzk\u00FD gradient. Jednak se m\u016F\u017Ee jednat o t\u011B\u017Ekou aort\u00E1ln\u00ED sten\u00F3zu s n\u00EDzk\u00FDm gradientem p\u0159i systolick\u00E9 dysfunkci a n\u00EDzk\u00E9 ejek\u010Dn\u00ED frakci lev\u00E9 komory (LK). V ned\u00E1vn\u00E9 dob\u011B byla v\u0161ak pops\u00E1na i t\u011B\u017Ek\u00E1 aort\u00E1ln\u00ED sten\u00F3za s n\u00EDzk\u00FDm gradientem a norm\u00E1ln\u00ED ejek\u010Dn\u00ED frakc\u00ED. N\u00EDzk\u00FD gradient je zde d\u00E1n n\u00EDzk\u00FDm pr\u016Ftokem (tepov\u00FD objem < 35 ml/m2) p\u0159i t\u011B\u017Ek\u00E9 diastolick\u00E9 dysfunkci LK, v\u011Bt\u0161inou u mal\u00FDch a t\u011B\u017Ece hypertrofick\u00FDch komor. Jedn\u00E1 se o pokro\u010Dilou formu AS s \u010D\u00E1ste\u010Dn\u011B ireverzibiln\u00ED subendokardi\u00E1ln\u00ED fibr\u00F3zou. Tito pacienti maj\u00ED hor\u0161\u00ED progn\u00F3zu ne\u017E AS s vysok\u00FDm gradientem a p\u0159itom existuje vysok\u00E9 riziko podcen\u011Bn\u00ED v\u00FDznamnosti tohoto typu AS. V\u00FD\u0161e uveden\u00E9 probl\u00E9my jsou d\u016Fvodem, pro\u010D by i st\u0159edn\u011B v\u00FDznamnou AS nebo AS s n\u00EDzk\u00FDm gradientem m\u011Bl v\u017Edy vy\u0161et\u0159ovat kardiolog, nejl\u00E9pe se zku\u0161enostmi v hodnocen\u00ED chlopenn\u00EDch vad a s n\u00E1vaznost\u00ED na kardiochirurgick\u00E9 pracovi\u0161t\u011B." . . "CZ - \u010Cesk\u00E1 republika" . "Aortic stenosis (AS) may be clinically silent for a long time. However, AS should be treated as soon as possible, if symptoms appear,. In most cases it is possible to perform surgery with a low mortality of 1-3% in isolated AS. The operation improves prognosis as well as the quality of life. In the last years we have the possibility of treatment the AS without surgery by transcatheter implantation of the bioprosthesis in stent (TAVI = transcatheter aortic valve implantation). This method is still reserved for inoperabile patient with a high risk of surgery. Severe AS has usually high gradient in normal flow. However, in some situations even severe AS may have low gradient. It may be severe AS with low flow due to systolic dysfunction and low ejection fraction (EF) of the left ventricle (LV). Recently a %22 paradoxical low-flow, low-gradient severe AS%22 with normal EF was described. Low gradient in this case is due to low flow with a stroke volume < 35 ml/m2 and severe diastolic dysfunction. These patients have usually small and severely hypertrophic LV with partially irreversible subendocardial fibrosis. These patient have worse prognosis than patients with AS with high gradient and the severity of AS may be easily underestimated. Therefore, AS with low gradient as well as moderate AS should be examined by cardiologists with experience in the evaluation of valve diseases."@en . "Aort\u00E1ln\u00ED sten\u00F3za -editorial" . "Aortic stenosis - editorial"@en . . .