Перенесенный COVID-19 и возможность проведения транскатетерного протезирования аортального клапана у больного с тяжелым аортальным стенозом (разбор клинического случая)

Представлен летальный случай тяжелого стеноза устья аорты у больного с не диагностированной вовремя, длительно персистирующей ковидной инфекцией. Больной был госпитализирован для решения вопроса об оперативной коррекции аортального порока. При поступлении отмечались явления недостаточности кровообращения на уровне 3–4-го ФК по NYHA и клиника стенокардии. Подробный сбор анамнеза об эпидемиологическом окружении и симптомах перенесенной осенью 2020 г. пневмонии вызвал подозрение на ее ковидный генез. Впоследствии это предположение было подтверждено данными лабораторных, инструментальных исследований, а также результатами патолого-анатомического вскрытия. Исследование микропрепаратов показало признаки развернутого васкулита с тромбозами мелких ветвей легочной артерии и фокусами пневмофиброза различной степени давности, что также свидетельствовало в пользу перенесенной ковидной инфекции. Учитывая тяжесть состояния больного при поступлении, проведение экстренного вмешательства на аортальном клапане не представлялось возможным. После стабилизации состояния и регрессии явлений недостаточности кровообращения планировалось одномоментное выполнение эндоваскулярной реваскуляризации коронарного русла и транскатетерного протезирования аортального клапана. Выполнить запланированное оперативное вмешательство не удалось. Иммуносупрессивное действие вируса SARS-CoV-2, по-видимому, привело к активизации аутофлоры и повышению восприимчивости к внутрибольничной инфекции. Присоединившаяся в ходе госпитализации двусторонняя полисегментарная бактериальная пневмония на фоне постковидных изменений в паренхиме легких способствовала развитию острого коронарного синдрома с желудочковыми нарушениями ритма. Пациент скончался от острой сердечно-легочной недостаточности. В статье также описаны представления об оперативной тактике ведения больных со стенозом устья аорты в условиях пандемии.

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