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Patología de la Válvula Aórtica Ricardo Poveda Jaramillo Fellow Anestesia Cardiovascular Universidad CES

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Patologa de la Vlvula Artica

Patologa de la Vlvula ArticaRicardo Poveda JaramilloFellow Anestesia CardiovascularUniversidad CES

AnatomaComponentes:AnilloCspides (unin sinotubular)Comisuras

Otras caractersticas:Ndulos de ArancioZonas/fenestraciones lunulares

Adquisicin de imgenes

Adquisicin de imgenesVista medioesofgicaEje corto de vlvula a 45-60Eje largo a 120Multilatido (4-6)Eje largo + eje corto = planimetraExhibir con cspide coronaria derecha a las 6:00

Adquisicin de imgenesPerspectiva artica: morfologa valvularPerspectiva ventricular: tumores articos, vegetaciones, obstrucciones subvalvulares

Estenosis

Etiologa

Mtodos de valoracinBaumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiones M; EAE/ASE.Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.Eur J Echocardiogr. 2009 Jan;10(1):1-25. doi: 10.1093/ejechocard/jen303. Epub 2008 Dec 8. Review. Erratum in: Eur J Echocardiogr. 2009 May;10(3):479 Severidad

SeveridadBaumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiones M; EAE/ASE.Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice.Eur J Echocardiogr. 2009 Jan;10(1):1-25. doi: 10.1093/ejechocard/jen303. Epub 2008 Dec 8. Review. Erratum in: Eur J Echocardiogr. 2009 May;10(3):479

Estadios clnicosNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.

Estadios

Estadios

Recomendaciones de manejo en estenosis articaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.Reemplazo de vlvula artica se recomienda para pacientes sintomticos graves con estenosis y gradiente alto que tienen sntomas por historia clnica o en la prueba de esfuerzo (etapa D1) Reemplazo de vlvula artica se recomienda para pacientes asintomticos con estenosis artica severa (nivel C2) y FEVI 12 meses

Intervencin transcatter o cirugaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.TAVR es una alternativa razonable a reemplazo quirrgico en pacientes que cumplen una indicacin para reemplazo y que tienen alto riesgo quirrgicoLa dilatacin percutnea con baln puede ser considerado como un puente para reemplazo valvular quirrgico o transcatter en pacientes gravemente sintomticos con severa estenosis artica

Intervencin transcatter o cirugaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.TAVR no se recomienda en pacientes en los que las comorbilidades existentes impedirn ver el beneficio esperado de la correccin de la estenosis

Indicaciones TAVREst indicado para uso en pacientes con enfermedad cardiaca sintomtica ya sea debido a una estenosis grave nativa calcificada artica o el fracaso (estenosis, insuficientes o combinado) de una vlvula bioprtesica quirrgica en posicin aortica que son juzgados como de alto o de mayor riesgo para la terapia quirrgica abierta (es decir, puntuacin de riesgo operativo Society of Thoracic Surgeons 8% o riesgo de mortalidad 15% a los 30 das).

Contraindicaciones TAVRPacientes que no pueden tolerar un rgimen de anticoagulacin/antiagregacin o que tienen endocarditis bacteriana activa u otras infecciones activas.

Insuficiencia

Mtodos de evaluacinZoghbi WA, et al. American Society of Echocardiography.Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr. 2003 Jul;16(7):777-802

Severidad Zoghbi WA, et al. American Society of Echocardiography.Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr. 2003 Jul;16(7):777-802

Estadios de la insuficiencia artica crnicaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.

Estadios de la insuficiencia artica crnica

Recomendaciones de intervencin en insuficiencia articaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.Reemplazo de vlvula artica est indicado para pacientes sintomticos con insuficiencia severa, independientemente de la funcin sistlica del VI (etapa D) Reemplazo de vlvula artica est indicado para pacientes asintomticos con disfuncin sistlica del VI e insuficiencia crnica grave (FEVI < 50 %) (nivel C2) Reemplazo de vlvula artica est indicado para pacientes con insuficiencia grave (estadio C o D) mientras se somete a una ciruga cardaca por otras indicaciones

Recomendaciones de intervencin en insuficiencia articaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.Reemplazo de vlvula artica es razonable para pacientes con IA severa con funcin sistlica del VI normal (FEVI 50 %), pero con dilatacin severa del VI (LVESD >50 mm, nivel C2) Reemplazo de vlvula artica es razonable en pacientes con insuficiencia moderada (fase B) que se someten a otra ciruga cardiaca

Recomendaciones de intervencin en insuficiencia articaNishimura RA, et al. American College of Cardiology; American College of Cardiology/American Heart Association; American Heart Association.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Thorac Cardiovasc Surg. 2014 Jul;148(1):e1-e132. doi: 10.1016/j.jtcvs.2014.05.014. Epub 2014 May 9. Review. Erratum in: J Thorac Cardiovasc Surg. 2014 Oct 21;64(16):1763.Reemplazo de vlvula artica puede ser considerada para pacientes asintomticos con funcin ventricular izquierda sistlica normal e insuficiencia severa ( FEVI 50%, etapa C1) pero con la dilatacin VI progresiva y severa (LVEDD > 65 mm) en caso de riesgo quirrgico bajo

Grazie


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