curs valvulopatii tricuspidiene si pulmonare
DESCRIPTION
MedicinaTRANSCRIPT
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- ST postreumatismala
- ST miocardita cu eosinofile
STENOZA TRICUSPIDIANA
ETIOLOGIE
- ST carcinoid
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- ST postreumatismala
- ST miocardita cu eosinofile
MORFOPATOLOGIE
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STENOZA TRICUSPIDIANA
FIZIOPATOLOGIE
- gradient diastolic presiune medie 4 mmHgeste suficient pentru a creste presiunea AD pentru a produce congestie sistemica
- gradient diastolic creste in inspir scade in expir
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FIZIOPATOLOGIE
- Gradient diastolic AD/VD, acentuat inspir
Dilatatie AD
- jugulare turgescente
- hepatomegalie, edeme, ascita
Congestie v. cava superioara si v. cava inf
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Manifestari clinice1. - Semne bolii in care apare ST
- jugulare turgescente
- hepatomegalie, edeme, ascita
2.- Manifestari ST
- uruitura diastolica, clacment deschidere, intarire Zg I CDT la 0,06’ inciderea pulmonarei
-accentuare uruitura diastolica in inspir - manevra Rivero- Callvalo
-Zg II nu este intarit la pulmonara
- semne de congestie VD mai importante decat congestia pulmonara ( diferentiere SM)
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Examene paraclinice
1. Rx grafia cord-plaman- AD marit
- Vena cava superioara largita
2. ECG
- P inalt ascutit simetric D2, D3, aVF
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Eco- 2D
- AD marit
- valva tricuspida ingrosata, rigida
- Vegetatie tricuspidiana
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Tratament
- ST stransa - valvuloplastie
- Protezare valvulara ST cu leziuni aparat subvalvular la gradient diastolic > 4mmHg =suprafata valvulara 1,5-2cm 2
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INSUFICIENTA TRICUSPIDIANAETIOLOGIE
- 1. Boli ce genereaza hipertensiune pulmonara
- postreumatismala, congenitala- S. Marfan- Endocardita infectioasa- Carcinoid, miocardita cu eosinofile,
- cardiopatii congenitale (S. Ebstein), canal atrioventricular comun
- 2. Anomalii valva tricuspida
- cord pulmonar cronic
- cardiomiopatii dilatative
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FIZIOPATOLOGIE
- Regurgitat AD
Remodelare excetrica VD
- jugulare turgescente
- hepatomegalie, edeme, ascita
IVD
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Manifestari clinice
1. - Semne bolii in care apare RT
- jugulare turgescente,unda “y” proeminenta - puls sistolic jugular
2.- Manifestari RT
- suflu holosistolic tricuspidian, - accentuare in inspir manevra Rivero- Callvalo
- Zg III, Zg I diminuat
- Manifestari IVD
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Examene paraclinice
1. Rx grafia cord-plaman
- AD marit
- AP largita
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Examene paraclinice
1. ECG
- HVD
- BRD
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1. ECO - 2D
Miscare paradoxala sept IV
- incarcare volum VD
- etiologia RT
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2. ECO - Doppler color
- fluxul regurgitant
- aria fluxului regurgitant
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Tratament
- RT cronica : tratament IVD –
diuretice, restrictie sare
2
- Protezare valvulara RT acuta cu IVD (endocardita, ruptura cordaje tendinoase)
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STENOZA PULMONARAEtiologie- congenitala – majoritar – supravalvulara, valvulara,subvalvulara
- post reumatismala - ff rar
- carcinoid
- compresie externa - masa tumorala mediastinala
- embriopatie rujeolica
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Evolutie
-SP moderata: gradient sistolic de varf (“peak” ) transvalvular - 50 si 80 mmHg
- SP severa: gradient sistolic de varf (“peak” ) transvalvular > 80 mmHg
- SP – boala evolutiva cu accentauarea SP prin traumatism hemodinamic
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Morfopatologie
- carcinoid
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Fiziopatologie
SP(remodelare VP - agravarea SP)
incarcare postsarcina VD
HVD
IVD ( 40 ani)
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Manifestari cliniceSubiectiv: dependent de gradul SP
palpitatii, precordialgii, astenie, sincope
Obiectiv:foc. pulmonarei: suflu sistolic de ejectie -
intensitate crescuta (SP stransa - varf tardiv, holosistolic )
click de ejectie precede suflul
(valva supla)
- suflu presistolic, prin contractie atriala viguroasa
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Examene paraclinice
RX cord-plaman
Dilatatie poststenotica AP
HVD
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ECG - normala
HVD
BRD
SP – medie, usoara
SP – severa
ECG -
HAD – P inalt V1
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ECO - 2D“domul” AP
HVD
“domul” AP
ECO - transesofagian
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CINEANGIOGRAFIA VD
“domul” AP
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INSUFICIENTA PULMONARA
Etiologie
1. Hipertensiunea pulmonara- IP functionala
- post reumatismala - ff rar
- carcinoid
2. Leziuni valva pulmonara
- congenital - dilatatia trunchiului arterei pulmonare
- endocardita
- boli de tesut conjunctiv
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Fiziopatologie
IP
incarcare presarcina VD
HVD excentrica
IVD
IP fara HP - bine tolerata
IP cu HP - rau tolerata, agravarea IVD
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Manifestari clinice
Subiectiv: palpitatii, precordialgii, astenie,
Obiectiv:
foc. pulmonarei: suflu diastolic de regurgitatie Zg III, IV
(IP functionala - suflu Graham Steel)
suflu sistolic “ de insotire”
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ECG
HVD
BRD
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Examene paraclinice
RX cord-plaman
Dilatatie AP
HVD
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ECO - Doppler
Flux regurgitant pulmonar
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Tratament chirurgical
Stenoza pulmonara
Valvuloplastie
Insuficienta pulmonara
reconstructie valvulara