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CARDIOPATIIVALVULARE
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DefiniţieDefiniţie
stenozstenozăă valvularăvalvulară = obstruc= obstrucţţia fluxuluiia fluxului
sanguin anterogradsanguin anterograd
regurgitare valvular regurgitare valvular ăă == prezenprezenţţaa
fluxului regurgitant retrograd,fluxului regurgitant retrograd,la nivelul oricla nivelul oricăăreia din cele patru valvereia din cele patru valve
cardiacecardiace
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GeneralităţiGeneralităţi
-- valvele inimii stângivalvele inimii stângi
-- ascultaascultaţţia cardiacia cardiacăă
-- evoluevoluţţia lent progresivia lent progresivăă
-- profilaxia endocarditeiprofilaxia endocarditeiinfecinfecţţioaseioase şşi a reumatismuluii a reumatismului
articular acutarticular acut- tratament medical corect- tratament medical corect
-- moment operator optimmoment operator optim
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STEO!A"ITRAL#
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DefiniţieDefiniţie
o$stru%o$stru%ţţia flu&ului 'iastoli% trans(itralia flu&ului 'iastoli% trans(itral
'atorit'atorităă unor )ro%ese )atologi%e %areunor )ro%ese )atologi%e %arere'u% aria orifi%iului valvular re'u% aria orifi%iului valvular (itral(itral
- frecvenţa crescută la femei- frecvenţa crescută la femei(2/ din pacienţi!(2/ din pacienţi!
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EtiologieEtiologie
*+ RAA*+ RAA (după "#-2$ ani!(după "#-2$ ani!
,+ C,+ Congenitalongenital ((ssiindromndromulul %utembac&er's%utembac&er's!!
-+ O$stru%ţia flu&ului 'in AS-+ O$stru%ţia flu&ului 'in AS (simul(simuleazăează ))!*!*
mixomul de +, tromb mare mobil n +,mixomul de +, tromb mare mobil n +, . cu. cu
vegetaţii marivegetaţii mari, cor triatriatum, cor triatriatum
.+.+ omplicaţii ale sindromului malign carcinoidomplicaţii ale sindromului malign carcinoid, lupus, lupus
er er iit&ematosus st&ematosus siistemic, artritstemic, artrităă reumatoidreumatoidăă
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/izio)atologie/izio)atologie
- aria orificiului mitral* 0-1 cm2
- 2 cm2
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FiziopatologieFiziopatologie
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Ta$lou %lini%Ta$lou %lini%
dispnee,dispnee, ortopnee, dispnee paroxisticortopnee, dispnee paroxisticăă nocturnnocturnăă,,
edemedem pulmonar acutpulmonar acut &emoptizii&emoptizii disfagiedisfagie distoniedistonie
durere precordială3 durere interscapulovertebrală stg4durere precordială3 durere interscapulovertebrală stg4 tablou de insuficienţă cardiacă dreaptătablou de insuficienţă cardiacă dreaptă palpitaţiipalpitaţii astenieastenie
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E&a(en o$ie%tivE&a(en o$ie%tiv
a4a4 5eneral*5eneral*
facies mitralfacies mitral 6ugulare turgescente 6ugulare turgescente insuficienţă dreaptă* &epatomegalie, edeme,insuficienţă dreaptă* &epatomegalie, edeme,
ascită, revărsat pleuralascită, revărsat pleural
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Examen obiectiv Examen obiectiv
b4b4 +parat cardiovascular +parat cardiovascular 7alpare7alpare* pulsaţiile 89, freamăt diastolic mitral* pulsaţiile 89, freamăt diastolic mitral
+scultaţie +scultaţie** accentuare accentuare "" : 9) : uruitura diastolică: 9) : uruitura diastolică
mitrală : suflu presistolicmitrală : suflu presistolic- ;<7* accentuare - ;<7* accentuare 22p, clic de e6ecţie pulmonar p, clic de e6ecţie pulmonar
- suflul 5ra&am-teel (7!- suflul 5ra&am-teel (7!
- insuficienţă dreaptă* <- insuficienţă dreaptă* <
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
*+ ECG
,+ R& tora%i%ă
-+ E%o%ar'iografie
.+ Cateteris( %ar'ia%
0+ Stu'ii ra'ioizoto)i%e
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
*+ ECG1
>7 mitral? (@$,"2 sec, bifidă n 9 ..! forţe terminale ale undei 7 n 8" fibrilaţie atrială
;<7* ;89 şi deviaţia la dreapta a axului electricA
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
,+ R& tora%i%ă*
dialatare + şi +7* contur cardiac stâng rectiliniu proeminenţa trunc&iurilor arterelor pulmonare cefalizarea circulaţiei venoase pulmonare dilatare +* aspect de dublu contur drept
dilatarea 89 liniile BerleC D edem pulmonar alveolar examenul baritat de profil sau E+9* deplasarea
posterioară a esofagului
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
,+ R& tora%i%ă1
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
,+ R& tora%i%ă1
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
,+ R& tora%i%ă1E+9 : Da
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
,+ R& tora%i%ă1
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
-+ E%o%ar'iografie1
metoda neinvazivă de elecţie<< : <
)odul )299oppler spectral şi color
8izualizarea valvelor mitrale)asurarea ariei orificiului mitral
)asurarea &ipertensiunii pulmonare
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E%o%ar'iografie 2 ,DE%o%ar'iografie 2 ,D
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E%o%ar'iografie 2 ,DE%o%ar'iografie 2 ,D
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E%o%ar'iografie 2 ,DE%o%ar'iografie 2 ,D
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E%o%ar'iografie 2 (o'ul "E%o%ar'iografie 2 (o'ul "
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E%o%ar'iografie 2E%o%ar'iografie 2 Do))ler %olor Do))ler %olor
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E%o%ar'iografie 2E%o%ar'iografie 2 Do))ler s)e%tralDo))ler s)e%tral
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E%o%ar'iografie 2E%o%ar'iografie 2 severitate S"severitate S"
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E%o%ar'iografie 2E%o%ar'iografie 2 severitate S"severitate S"
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S" u3oară S" (e'ie S" severă
P(e'iu 4((5g6 7 0 8 2 *9 4*,6 :*94*,6
P5T 4(s6 *99 2 *09 *09 2 ,99 :,,9
Sorif+(itr+4%(,6 *;0 2 , * 2 *;0 7*
cocardiografie F severitate )
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
4+ Cateteris( %ar'ia%
- nainte de intervenţia c&irurgicală*coronarografie) asociată
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
4+ Cateteris( %ar'ia%
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E&a(ene )ara%lini%eE&a(ene )ara%lini%e
0+ Stu'ii ra'ioizoto)i%e1
funcţia 89 şi 8
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Diagnosti% )ozitivDiagnosti% )ozitiv
E&a(en o$ie%tiv
<
Investigaţii )ara%lini%e
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Diagnosti% 'iferenţialDiagnosti% 'iferenţial
)ixomul atrial3 tenoza tricuspidiană3 9efectul septal atrial3 or triatriatum sinister3 uflul +ustin Glint din regurgitareaaortică3
;ipertensiunea pulmonară primarăsau consecutivă afecţiunilorrespiratorii cronice4
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Evoluţie; %o()li%aţii; )rognosti%Evoluţie; %o()li%aţii; )rognosti%
. semne la 2$ ani de la ++3
. simptome n decada 0 de viaţă
voluţia naturală H
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Evoluţie; %o()li%aţii; )rognosti%Evoluţie; %o()li%aţii; )rognosti%
Co()li%aţiile S" * aritmiile atriale (fibrilaţia atrială! insuficienţa cardiacă congestivă3 edemul pulmonar acut &emoptizia tromboza + tromboembolismul sistemic (2$I!* cerebral,
renal, splenic, la nivelul extremitatilor3 tromboembolismul pulmonar infecţii pulmonare recurente endocardita infecţioasă
recurenţa reumatismală
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Trata(entTrata(ent
A+Trata(ent (e'i%a(entos=+Valvulo)lastia )er%utanătransvenoasă %u $alona3
C+Trata(ent %>irurgi%alD+Profila&ia EI
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Trata(entTrata(ent
A+Trata(ent (e'i%a(entos1- pacienţi asimptomatici- pacienţi simptomatici* ↓Ja, diuretice, βblocante
adrenergice, blocante ale canalelor de a3- fibrilaţie atrială- tratament anticoagulant
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Trata(entTrata(ent
=+ Valvulo)lastia )er%utanătransvenoasă %u $alona3
)etodăcor eco.ndicaţii*- scor eco K L,
- fără tromb intraatrial- risc c&irurgical crescut* embolie cerebrală,mic 9+ rezidual
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Trata(entTrata(ent
C+ Trata(ent %>irurgi%al
.ndicaţii* arie valvulară mitrală " cmM
)etode* valvuloplastia mitrală pe cord nc&is
valvuloplastia mitrală pe cord desc&isprotezarea valvulară mitrală
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Trata(entTrata(ent
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Trata(entTrata(ent
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