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RECOARCTATIA DE AORTACAZ CLINIC
NADIA ANGHELACHE, MARINELA SERBAN, MARIAN ALBU
INSTITUTUL DE BOLI CARDIOVASCULARE “PROF. DR. C.C. ILIESCU “INSTITUTUL CLINIC FUNDENI
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• Pacientul C.I., in varsta de 36 de ani, din mediul urban
• AHC: nesemnificative• APP: la varsta de 6 ani interventie
chirurgicala pentru coarctatie de aorta
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MOTIVELE INTERNARII
TAs = 200mmHg
TAs = 100mmHg
claudicatie intermitenta
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EXAMENUL OBIECTIV
• TA brat drept=200/90 mmHg• TA brat stang =190/90 mmHg• TAs membre inferioare = 100 mmHg• AV=96/minut regulat• Suflu sistolic gradul IV/VI in spatiul IV intercostal stang
parasternal , suflu sistolic gradul IV/VI interscapular• Puls palpabil la nivelul arterelor femurale bilateral si diminuat
distal bilateral
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ECG: ritm sinusal, 75/minut, axa QRS -15,HVS, modificarisecundare de repolarizare
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Radiografia toracica
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Ecocardiografia
• transtoracica: HVS ( SIV=19 ) Ao inel=19 Ao asc=28 Ao crosa=20valve aortice tricuspide
• transesofagiana:- pintene fibros ce proemina intraluminal la nivelul emergentei subclaviei, realizand un canal circulant de 3-4 mm
-gradient la nivelul aortei descendente80mmHg
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Rezonanta magnetica nucleara
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Aortografia
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Tratament chirurgical
Rezectie + anastomozatermino-terminala
Rezectie + anastomozatermino-terminala extinsa
Incidenta crescuta a restenozei
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Aortoplastie cu petec deDacron
Rezectie + interpozitie de graft
prostetic
Avantaj : incizia redusa a
peretelui aortic
Risc de anevrism
Indicatii:- coarctatie + anevrism
- recoarctatie
Risc de anevrism si infectii
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Aortoplastia cu “ flap” artera subclavie
Avantaje: - tehnica operatorie simpla
-timp operator scurt
Dezavantaje: - sacrifica circulatia membrului sup. stang
- anevrism
- recoarctatie
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Angioplastia cu balon
• De prima intentie in recoarctatia de aorta
• “ Balloon dilatation has largely been accepted as the treatment of choice for recoarctation of the aorta. “
Stent implantation for aortic coarctation and recoarctation
A.G. Magee Heart 1999
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Angioplastia cu balon
• Rezultate bune 60-75% cazuri• Complicatii : - gradient rezidual transstenotic > =20 mmHg
in ~ 25 % din cazuri- restenozare- anevrism
• Implantarea de stent creste eficienta procedurii ( reduce gradientul presional transstenotic si riscul de anevrism )
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Angioplastie cu balon
Pre-procedura Post-procedura
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Angioplastie cu balon
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Gradientul sistolic transstenotic
Pre-angioplastie Post-angioplastie
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TAs=140mmHg
TAs=110mmHg
Claudicatie intermitenta
LA EXTERNARE