7-valvulopatii aortice presented
DESCRIPTION
cardiologieTRANSCRIPT
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Valva aortica normalaValva aortica normala
Valva cu trei cuspe si trei comisuri
Cuspe cu structura fibroasa + endoteliu
Insertie pe inelul aortic (fibros)
Suprafata VAo normale: 2.6 - 3.6 cm2
Sinusuri Valsalva: spatiul intre portiunea
aortica a cuspelor si perete aortic:
Sinus CS
Sinus CD
Sinus non-coronar
Valva cu trei cuspe si trei comisuri
Cuspe cu structura fibroasa + endoteliu
Insertie pe inelul aortic (fibros)
Suprafata VAo normale: 2.6 - 3.6 cm2
Sinusuri Valsalva: spatiul intre portiunea
aortica a cuspelor si perete aortic:
Sinus CS
Sinus CD
Sinus non-coronar
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Relatie de vecinatate cu:
foita Mi ant si inelul mitral
Fasciculul His
Relatie de vecinatate cu:
foita Mi ant si inelul mitral
Fasciculul His
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Care este definitia stenozei aortice?
Care este definitia stenozei aortice?
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Stenoza aortica (SAo)Stenoza aortica (SAo) Definitie. Valvulopatie caracterizata prin:
Obstructia la ejectie a VS cu
Aparitia unui gradient (=diferenta) de presiune
ventriculo - aortic
Leziuni hemodinamice ale:
Valvei Ao
Tract de ejectie al VS
Ao suprasigmoidiana
Incidenta:
25% din valvulopatiile cronice
80% din SAo asimptomatice sunt M
(M/F = 2-4/1)
cu varsta: de 5 x mai frecventa > 60 ani,
decat < 30 ani
Definitie. Valvulopatie caracterizata prin:
Obstructia la ejectie a VS cu
Aparitia unui gradient (=diferenta) de presiune
ventriculo - aortic
Leziuni hemodinamice ale:
Valvei Ao
Tract de ejectie al VS
Ao suprasigmoidiana
Incidenta:
25% din valvulopatiile cronice
80% din SAo asimptomatice sunt M
(M/F = 2-4/1)
cu varsta: de 5 x mai frecventa > 60 ani,
decat < 30 ani
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Care este etiologia stenozei aortice?
Care este etiologia stenozei aortice?
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Etiologia SAo valvulare:Etiologia SAo valvulare: Congenitala:
Unicuspidia
Bicuspidia
(Tricuspidia)
Dobandita:
RAA: incidenta in
Calcificata idiopatica
Aterosclerotica
- < 30 ani = SAo congenitala
- 30-70 ani = RAA, bicuspidie
- > 70 ani = SAo degenerativa
- Dezvoltare lenta (decade)
Congenitala:
Unicuspidia
Bicuspidia
(Tricuspidia)
Dobandita:
RAA: incidenta in
Calcificata idiopatica
Aterosclerotica
- < 30 ani = SAo congenitala
- 30-70 ani = RAA, bicuspidie
- > 70 ani = SAo degenerativa
- Dezvoltare lenta (decade)
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UnicuspidiaaorticaUnicuspidiaaortica
Cuspa unica; orificiu central sau excentricCuspa unica; orificiu central sau excentric
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Bicuspidia aortica- cea mai frecventa cardiopatie congenitala -
Bicuspidia aortica- cea mai frecventa cardiopatie congenitala -
Nu este leziune stenozanta “per se”
Stenoza apare prin calcificare in timp
Nu este leziune stenozanta “per se”
Stenoza apare prin calcificare in timp
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SAo RAASAo RAA
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SAo “degenerativa”SAo “degenerativa” Proces metabolic activ:
Acumulare de colesterol
Inflamatie
Calcificare
Similar aterosclerozei
“Scleroza valvulara Ao”: ingrosarea
cuspelor fara gradient
25% din cei > 65 ani;
Mai ales la: HTA, DZ, fumatori,
dislipidemici, sex F
risc crescut cu 50% de IMA si de deces
Proces metabolic activ:
Acumulare de colesterol
Inflamatie
Calcificare
Similar aterosclerozei
“Scleroza valvulara Ao”: ingrosarea
cuspelor fara gradient
25% din cei > 65 ani;
Mai ales la: HTA, DZ, fumatori,
dislipidemici, sex F
risc crescut cu 50% de IMA si de deces
ACC / AHA Guidelines for Management of Valvular Heart Disease. Circulation 2006; 114:e84 – e231.ACC / AHA Guidelines for Management of Valvular Heart Disease. Circulation 2006; 114:e84 – e231.
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??
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FiziopatologieFiziopatologie1) Gradientul transvalvular (VS – Ao) depinde de:
Suprafata valvei Ao:
SAo larga: > 1.5 cm2; gradient mediu < 25 mm Hg
SAo medie: 1.0 – 1.5 cm2; gradient mediu 25 – 40 mm Hg
SAo stransa: < 1 cm2; gradient mediu > 40 sau gradient maxim > 70 mmHg
functia VS
2) Functia sistolica a VS
pres. intracavitara = intraparietale = HVS concentrica
Sarcomere in paralel; miocitelor
3) Functia diastolica: prima afectata
complianta VS
relaxarea VS
Umplere cu presiuni = presiunii in AS si capilarul pulmonar
1) Gradientul transvalvular (VS – Ao) depinde de:
Suprafata valvei Ao:
SAo larga: > 1.5 cm2; gradient mediu < 25 mm Hg
SAo medie: 1.0 – 1.5 cm2; gradient mediu 25 – 40 mm Hg
SAo stransa: < 1 cm2; gradient mediu > 40 sau gradient maxim > 70 mmHg
functia VS
2) Functia sistolica a VS
pres. intracavitara = intraparietale = HVS concentrica
Sarcomere in paralel; miocitelor
3) Functia diastolica: prima afectata
complianta VS
relaxarea VS
Umplere cu presiuni = presiunii in AS si capilarul pulmonarACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.ACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.
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FiziopatologieFiziopatologie4) Ischemia miocardica (subendocardica = angina, aritmii, MSC)
Mecanisme:
HVS si densitatii capilare
presiunii intracavitare si intraparietale
timpului de ejectie
Compresia coronarelor intramurale
AS coronara
Anomalii de coagulare: disfunctie plachetara si F. von
Willebrand
In SAo severa
Echimoze, epistaxis (20%)
Dispare dupa inlocuire valvulara
4) Ischemia miocardica (subendocardica = angina, aritmii, MSC)
Mecanisme:
HVS si densitatii capilare
presiunii intracavitare si intraparietale
timpului de ejectie
Compresia coronarelor intramurale
AS coronara
Anomalii de coagulare: disfunctie plachetara si F. von
Willebrand
In SAo severa
Echimoze, epistaxis (20%)
Dispare dupa inlocuire valvulara
ACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.ACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.
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Care sunt manifestarile clinice in stenoza aortica?Care sunt manifestarile
clinice in stenoza aortica?
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Manifestari cliniceManifestari cliniceSimptome: Asimptomatici pana la
gradient > 40-50 mmHg
DISPNEE de EFORT (75%) HVS severa +/- IVS
ANGINA (70%) 50% din cei > 40 ani au AS
coronara
SINCOPA: SAo stransa; prin hipo-TA sau aritmii V
MSC: 15% din MSC sunt anterior
asimptomatici
Simptome: Asimptomatici pana la
gradient > 40-50 mmHg
DISPNEE de EFORT (75%) HVS severa +/- IVS
ANGINA (70%) 50% din cei > 40 ani au AS
coronara
SINCOPA: SAo stransa; prin hipo-TA sau aritmii V
MSC: 15% din MSC sunt anterior
asimptomatici
Semne: SUFLU de EJECTIE
galop
Z II dedublat paradoxal
Clic sistolic focar aortic
Freamat sistolic + tril pe vase
mari
Soc apexian hiperdinamic
TA = N
TAs>200 mmHg exclude SAo stransa)
“pulsus parvus et tardus”
Semne: SUFLU de EJECTIE
galop
Z II dedublat paradoxal
Clic sistolic focar aortic
Freamat sistolic + tril pe vase
mari
Soc apexian hiperdinamic
TA = N
TAs>200 mmHg exclude SAo stransa)
“pulsus parvus et tardus”
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Explorari paraclinice: EKGExplorari paraclinice: EKG
HVS cu “G”
alterat
BRS
Aritmii: FA = 10% din pts ESV si TV
nesustinuta la Holter
HVS cu “G”
alterat
BRS
Aritmii: FA = 10% din pts ESV si TV
nesustinuta la Holter
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Explorari paraclinice: RxExplorari paraclinice: Rx
Opacitate cardiaca normala
in HVS concentrica
Dilatatie Ao post-stenotica
Calcificari valvulare
Dilatatie VS si semne
pulmonare de ICS
Opacitate cardiaca normala
in HVS concentrica
Dilatatie Ao post-stenotica
Calcificari valvulare
Dilatatie VS si semne
pulmonare de ICS
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Bicuspidie AoBicuspidie Ao
Unicuspidie AoUnicuspidie Ao
ECO: morfologia valvei Ao: anomalii congenitale
ECO: morfologia valvei Ao: anomalii congenitale
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Stenoza aortica degenerativa: ecografie
2D
Stenoza aortica degenerativa: ecografie
2D
• Calcificarile valvei Ao
• Deschidere limitata a cuspelor
• HVS concentrica; diametrele VS
• Calcificarile valvei Ao
• Deschidere limitata a cuspelor
• HVS concentrica; diametrele VS
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Severitatea SAo: ex Doppler
Severitatea SAo: ex Doppler
• CALCULAREA GRADIENTULUI
transvalvular aortic:
• SAo severa: G max>70 mmHg
• Functia diastolica a VS
• Calcularea DC
• CALCULAREA GRADIENTULUI
transvalvular aortic:
• SAo severa: G max>70 mmHg
• Functia diastolica a VS
• Calcularea DC
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Severitatea SAo: planimetria
Severitatea SAo: planimetria
SAo severa: suprafata VAo < 1 cm2 (sau < 0.6 cm2 / m2)
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Cateterismul stang si coronarografia
Cateterismul stang si coronarografia
Masurarea gradientului
Ventriculografie = FE
Coronarografie:
obligatorie dupa 40 ani
Aprecierea severitatii
valvulopatiilor asociate
Masurarea gradientului
Ventriculografie = FE
Coronarografie:
obligatorie dupa 40 ani
Aprecierea severitatii
valvulopatiilor asociate
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Dg. pozitiv si diferentialDg. pozitiv si diferential SAo = * suflu de ejectie in focar aortic
* HVS (ECG, eco)
* gradient transvalvular la eco
* +/- confirmarea gradientului la cateterism
Dg. diferential: CMHO
Insuficienta mitrala
DSA
Stenoza pulmonara
Scleroza valvulara aortica
SAo = * suflu de ejectie in focar aortic
* HVS (ECG, eco)
* gradient transvalvular la eco
* +/- confirmarea gradientului la cateterism
Dg. diferential: CMHO
Insuficienta mitrala
DSA
Stenoza pulmonara
Scleroza valvulara aortica
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Criteriile ecocardiografice de severitate ale SAo
Criteriile ecocardiografice de severitate ale SAo
+ G max > 70 mmHg+ G max > 70 mmHg
ACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.ACC / AHA Guidelines for Management of Valvular HD. Circulation 2006; 114:e84 – e231.
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Care este evolutia si care sunt complicatiile stenozei
aortice?
Care este evolutia si care sunt complicatiile stenozei
aortice?
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Evolutie, complicatiiEvolutie, complicatii80% din SAo simptomatice neoperate: exit in 4 ani
Progresia SAo medii: suprafetei cu 0.1 cm2 / an; gradientului cu 7 mmHg / an
Prognostic in functie de simptome: Dispnee prin IVS: 1.5 – 2 ani
Sincopa: 3 ani
Angina pectorala = 3 – 5 ani
MS aritmica la 10-20% di SAo
COMPLICATII: IVS, ICC: cauza de deces
Endocardita infectioasa
Embolii sistemice
BAV si/sau BR
IMA: embolic sau tromboza coronariana
Aritmii V severe (TV si FV) = MSC
80% din SAo simptomatice neoperate: exit in 4 ani
Progresia SAo medii: suprafetei cu 0.1 cm2 / an; gradientului cu 7 mmHg / an
Prognostic in functie de simptome: Dispnee prin IVS: 1.5 – 2 ani
Sincopa: 3 ani
Angina pectorala = 3 – 5 ani
MS aritmica la 10-20% di SAo
COMPLICATII: IVS, ICC: cauza de deces
Endocardita infectioasa
Embolii sistemice
BAV si/sau BR
IMA: embolic sau tromboza coronariana
Aritmii V severe (TV si FV) = MSC
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Tratamentul SAo asimptomatice: medicamentos
Tratamentul SAo asimptomatice: medicamentos
SAo usoare si medii apreciate Eco:
Profilaxia EI
Profilaxia RAA
Tulburari de ritm:
Supraventriculare: FA = conversie rapida, electrica sau chimica (m.a. in SAo)
TV-FV resuscitate: amiodaron, sotalol; CHIRURGIE in SAo
Angina pectorala: NTG – sincopa!
doze mici de beta blocant sau calciu blocant in SAo
IC: tratament chirurgical
Vasodilatatoarele, diureticele, digitalicele cresc gradientul in SAo
Restrictie de efort si de sodiu
SAo usoare si medii apreciate Eco:
Profilaxia EI
Profilaxia RAA
Tulburari de ritm:
Supraventriculare: FA = conversie rapida, electrica sau chimica (m.a. in SAo)
TV-FV resuscitate: amiodaron, sotalol; CHIRURGIE in SAo
Angina pectorala: NTG – sincopa!
doze mici de beta blocant sau calciu blocant in SAo
IC: tratament chirurgical
Vasodilatatoarele, diureticele, digitalicele cresc gradientul in SAo
Restrictie de efort si de sodiu
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Tratamentul SAo simptomatice:
chirurgical
Tratamentul SAo simptomatice:
chirurgical Copii si adolescenti: Simptomatici
Asimptomatici cu gradient > 70 mmHg
Comisurotomie la vedere; valvuloplastie cu balon
Restenozare = protezare
Adulti: SAo stranse simptomatice
SAo stranse asimpt. cu IVS
Nu se opereaza SAo stranse asimptomatice!
Protezare mecanica
Risc operator: fara IVS 2-4%, cu IVS 10-25%
Insuficienta cardiaca: tratament chirurgical Vasodilatatoare, diuretice, digitala cresc gradientul in SAo
SAo severa la varste extreme: valvuloplastie
percutana cu balon; insertie percutanata de valva
Ao
Copii si adolescenti: Simptomatici
Asimptomatici cu gradient > 70 mmHg
Comisurotomie la vedere; valvuloplastie cu balon
Restenozare = protezare
Adulti: SAo stranse simptomatice
SAo stranse asimpt. cu IVS
Nu se opereaza SAo stranse asimptomatice!
Protezare mecanica
Risc operator: fara IVS 2-4%, cu IVS 10-25%
Insuficienta cardiaca: tratament chirurgical Vasodilatatoare, diuretice, digitala cresc gradientul in SAo
SAo severa la varste extreme: valvuloplastie
percutana cu balon; insertie percutanata de valva
Ao
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Modalitatea de insertie a VAo percutane
Modalitatea de insertie a VAo percutane
EliberareEliberare
ExpansionareExpansionare
Insertie Insertie
Traversareavalvei native
Traversareavalvei native
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Cum definiti insuficienta aortica?
Cum definiti insuficienta aortica?
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Insuficienta aortica (IAo)Insuficienta aortica (IAo)
Definitie. Valvulopatie caracterizata prin refluarea
sangelui din aorta in VS in diastola
Incidenta in
¾ din pts cu IAo pura sunt M
Asocierea cu valvulopatii Mi = F
Cauze:
Leziuni valvulare intrinseci (cuspe)
Leziuni ale inelului aortic si aortei ascendente
Leziuni mixte
Definitie. Valvulopatie caracterizata prin refluarea
sangelui din aorta in VS in diastola
Incidenta in
¾ din pts cu IAo pura sunt M
Asocierea cu valvulopatii Mi = F
Cauze:
Leziuni valvulare intrinseci (cuspe)
Leziuni ale inelului aortic si aortei ascendente
Leziuni mixte
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Care este etiologia insuficientei aortice?Care este etiologia
insuficientei aortice?
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EtiologieEtiologie RAA
Endocardita infectioasa
Acuta = ulceratii valvulare
Subacuta = vegetatii pe valva
patologica
Lues tertiar: mezoaortita
luetica
Anomalii congenitale:
DSV inalt situat
Anevrism congenital de sinus
Valsalva
Bicuspidia aortica
RAA
Endocardita infectioasa
Acuta = ulceratii valvulare
Subacuta = vegetatii pe valva
patologica
Lues tertiar: mezoaortita
luetica
Anomalii congenitale:
DSV inalt situat
Anevrism congenital de sinus
Valsalva
Bicuspidia aortica
Anevrismul AS de aorta ascendenta
Degenerescenta mixoida si
“Aortic Root Disease” Sdr. Marfan, Ehlers-Danlos
PR
SA, alte artropatii sero-negative
Vasculite: b. Takayasu, arterita
Horton
IAo ACUTA Traumatisme toracice
Anevrismul disecant de aorta +/-
Sdr. Marfan
EI acuta
Anevrismul AS de aorta ascendenta
Degenerescenta mixoida si
“Aortic Root Disease” Sdr. Marfan, Ehlers-Danlos
PR
SA, alte artropatii sero-negative
Vasculite: b. Takayasu, arterita
Horton
IAo ACUTA Traumatisme toracice
Anevrismul disecant de aorta +/-
Sdr. Marfan
EI acuta
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Anevrism AS de aorta ascendenta
Anevrism AS de aorta ascendenta
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Endocardita
infectioasa
Endocardita
infectioasa
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Sdr. MarfanSdr. Marfan Spondilita ankilozantaSpondilita
ankilozanta
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Fiziopatologie (I)Fiziopatologie (I)IAo Cronica
1. Volumul regurgitat depinde de: Suprafata orificiului de regurgitare Diferenta diastolica de presiune Ao – VS
presiunii diastolice in aorta presiunii telediastolice VS
Durata diastolei
2. Modificarile compensatorii ale VS Supraincarcarea cr. de volum = vol. telediastolic = DILATATIE VS
presiunii telediastolice HVS: sarcomere aranjate in serie Tahicardie sinusala; VS hiperkinetic; DC = N in repaus
“MITRALIZAREA” IAo
IAo Cronica
1. Volumul regurgitat depinde de: Suprafata orificiului de regurgitare Diferenta diastolica de presiune Ao – VS
presiunii diastolice in aorta presiunii telediastolice VS
Durata diastolei
2. Modificarile compensatorii ale VS Supraincarcarea cr. de volum = vol. telediastolic = DILATATIE VS
presiunii telediastolice HVS: sarcomere aranjate in serie Tahicardie sinusala; VS hiperkinetic; DC = N in repaus
“MITRALIZAREA” IAo
“Cord bovin”“Cord bovin”
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Fiziopatologie (II)Fiziopatologie (II)3) Ischemia miocardica
Tahicardie - tahiaritmie tensiunii intraparietale HVS presiunii de perfuzie coronara +/- AS coronara
IAo acuta Refluarea sangelui in VS de volum normal (fara dilatatie cavitara,
HVS) Singurul mecanism compensator = TAHICARDIA brusca a presiunii telediastolice, DC eficace
3) Ischemia miocardica Tahicardie - tahiaritmie tensiunii intraparietale HVS presiunii de perfuzie coronara +/- AS coronara
IAo acuta Refluarea sangelui in VS de volum normal (fara dilatatie cavitara,
HVS) Singurul mecanism compensator = TAHICARDIA brusca a presiunii telediastolice, DC eficace
presiunii in capilarul pulmonar, IVS acuta severa = EPA, soc presiunii in capilarul pulmonar, IVS acuta severa = EPA, soc
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Care sunt manifestarile clinice ale insuficientei
aortice?
Care sunt manifestarile clinice ale insuficientei
aortice?
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Manifestari cliniceManifestari clinice SIMPTOME = IAo severa
Palpitatii Cefalee pulsatila Dispnee de efort Angina pectorala (20-50%) Durere toracica in disectia de aorta
SEMNE Cardiace
Soc apexian “en dome” Cardiomegalie SUFLU DIASTOLIC URUITURA Austin-Flint Suflu sistolic de Imi Diminuarea Z II Galop ventricular sau atrial
SIMPTOME = IAo severa Palpitatii Cefalee pulsatila Dispnee de efort Angina pectorala (20-50%) Durere toracica in disectia de aorta
SEMNE Cardiace
Soc apexian “en dome” Cardiomegalie SUFLU DIASTOLIC URUITURA Austin-Flint Suflu sistolic de Imi Diminuarea Z II Galop ventricular sau atrial
Periferice = IAo severa Dans arterial “pulsus celer et altus” Puls capilar Hippus pupilar Semnul palariei, etc.
HTA sistolica, diferentiala > 60 mmHg
IAo ACUTA Suflu diastolic scurt sau inaudibil Z I diminuat sau absent Diferentiala normala Context de disectie aortica, etc
Periferice = IAo severa Dans arterial “pulsus celer et altus” Puls capilar Hippus pupilar Semnul palariei, etc.
HTA sistolica, diferentiala > 60 mmHg
IAo ACUTA Suflu diastolic scurt sau inaudibil Z I diminuat sau absent Diferentiala normala Context de disectie aortica, etc
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Explorari paraclinice: RxExplorari paraclinice: Rx Cord “in sabot”, “in gat de lebada” … Cord “in sabot”, “in gat de lebada” …
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Explorari paraclinice: ECGExplorari paraclinice: ECG
HVS Tahicardie sinusala,
FA BAV gr I, BR Q septale
HVS Tahicardie sinusala,
FA BAV gr I, BR Q septale
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Explorari paraclinice: EcoExplorari paraclinice: Eco
Cauza si mecanismul de
regurgitare
Cauza si mecanismul de
regurgitare
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Mecanismul de regurgitareMecanismul de regurgitare
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Explorari paraclinice: Eco
Explorari paraclinice: Eco
Calcularea FE, a DC si a
volumului regurgitat
Severitatea regurgitarii
la Doppler color
Grosimea jetului la origine
Suprafata jetului in VS
Prezenta efectului de
convergenta suprasigmoidian
Calcularea FE, a DC si a
volumului regurgitat
Severitatea regurgitarii
la Doppler color
Grosimea jetului la origine
Suprafata jetului in VS
Prezenta efectului de
convergenta suprasigmoidian
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Explorari paraclinice: cateterismul stang
Explorari paraclinice: cateterismul stang
Aortografie; explorare hemodinamica; coronarografie;
ventriculografie
Aortografie; explorare hemodinamica; coronarografie;
ventriculografie
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Care sunt complicatiile si evolutia insuficientei
aortice?
Care sunt complicatiile si evolutia insuficientei
aortice?
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Evolutie, complicatii ale IAo
Evolutie, complicatii ale IAo
IAo acuta – severa, exit rapid fara interventie chirurgicala
IAo cronice: Usoare – asimptomatice
Moderate sau severe – asimptomatice timp indelungat, apoi IVS IAo RAA – asimpt ptr 2 decade apoi IVS progresiva, exit in 10 ani
IAo luetice – apar in 15 ani de la primoinfectie, exit in 10 ani
COMPLICATII Endocardita infectioasa: risc cm mare de EI dintre valvulopatii
IC – mitralizarea IAo = supravietuire 2 ani
Tulburari de ritm sau conducere FA la numai 5% din IAo
BRS la 10% din IAo severe
BAV I
IAo acuta – severa, exit rapid fara interventie chirurgicala
IAo cronice: Usoare – asimptomatice
Moderate sau severe – asimptomatice timp indelungat, apoi IVS IAo RAA – asimpt ptr 2 decade apoi IVS progresiva, exit in 10 ani
IAo luetice – apar in 15 ani de la primoinfectie, exit in 10 ani
COMPLICATII Endocardita infectioasa: risc cm mare de EI dintre valvulopatii
IC – mitralizarea IAo = supravietuire 2 ani
Tulburari de ritm sau conducere FA la numai 5% din IAo
BRS la 10% din IAo severe
BAV I
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Tratamentul IAoTratamentul IAoTratament chirurgical:
Momentul operator greu de stabilit
Operatie: IAo cronica severa simptomatica, indiferent
de FEVS
IAo severa asimptomatica cu FE< 50%,
IAo acuta = urgenta chirurgicala
Protezarea poate sa nu normalizeze functia VS
Predictorul recuperarii functiei VS = VOL. TELESISTOLIC < 30 ml = prog. bun
30-90 ml = prog. intermediar
> 90 ml = prog. rezervat
Diametru telesistolic > 55 mm sau FE<50%: disfctie sistolica ireversibila
Tratament chirurgical: Momentul operator greu de stabilit
Operatie: IAo cronica severa simptomatica, indiferent
de FEVS
IAo severa asimptomatica cu FE< 50%,
IAo acuta = urgenta chirurgicala
Protezarea poate sa nu normalizeze functia VS
Predictorul recuperarii functiei VS = VOL. TELESISTOLIC < 30 ml = prog. bun
30-90 ml = prog. intermediar
> 90 ml = prog. rezervat
Diametru telesistolic > 55 mm sau FE<50%: disfctie sistolica ireversibila
Tratament medicamentos: In IAo asimptomatica cu FE > 50%
Urmarire clinica si eco la 6 – 12 luni
Profilaxia EI si a recurentei RAA
Restrictie de efort (mediu) CI in IAo severa cu disfunctie sistolica
Tratamentul vasodilatator: IECA si Ca-blocante
IC: IECA, diuretice, digoxin; CI beta-blocantele
Angina pectorala: NTG sl si PO
Tratament medicamentos: In IAo asimptomatica cu FE > 50%
Urmarire clinica si eco la 6 – 12 luni
Profilaxia EI si a recurentei RAA
Restrictie de efort (mediu) CI in IAo severa cu disfunctie sistolica
Tratamentul vasodilatator: IECA si Ca-blocante
IC: IECA, diuretice, digoxin; CI beta-blocantele
Angina pectorala: NTG sl si PO