proteze valvulare
TRANSCRIPT
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Proteze valvulare
Dr. Purcarea Florin
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Tipuri de proteze
• Mecanice• cu bila – Starr Edwards
• cu disc :• monodisc: Bjork-Shiley, Medtronic-Hall, Omnicarbon, Lillehei-Kaster• bidisc: St.Jude Medical, CarboMedics, Duramedics Jyros
• Biologice• Heterograft
• Porcine • cu stent: Carpentier-Edwards, Hancock • fara stent: St. Jude Medical, Medtronic Freestyle, Edwards Prima
• Bovine (pericardice) Hancock
• Homograft: allografturi aortice
• Autograft: pericardic, pulmonar
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Evaluare proteza – 2D/mod M
Detectarea tipului proteza Mecanica
bidisc/monodisc Biologica
Mişcarea elementelor mobile : deschidere/închidere
Aspectul elementelor mobile/prezenta mase
Integritatea şi mişcarea inelului de sutură
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Aspect normal proteza mecanica bidisc
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Aspect normal alte proteze mecanice
Proteza mecanica mitrala monodisc Proteza mecanica mitrala cu bila
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Fenomen de cavitatie
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Proteza biologica 2D
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Proteze mecanice – mod M
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“Stenoza fiziologica…”
Proteze mitrale bidisc
Proteza biologica tricuspidiana Proteza metalica aortica
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Hemodinamica proteza bidisc
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Hemodinamica proteza biologica
TEE – Proteza biologica aortica – orificiu triunghiular
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Regurgitarea fiziologica
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Doppler spectral
GRADIENTI TRANSVALVULARI
Proteza biologica tricuspida
Proteza metalica mitrala
Proteza mecanica aortica
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Click deschidere/inchidere
B. 78 aniProteza bidisc mitrala – leak paraprotetic
B. 65 ani Proteza biologica aortica disfunctionala
Regurgitare aortica
Stenoza mitrala
Regurgitare holosistolica paraprotetica
Proteze mecanice – semnal intens
Proteze biologice – semnal slab
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Limite ETT
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ELEMENTE MOBILE
2D
M MODE
DOPPLER
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FENOMENUL DE MISMATCH
B. 30 ani, proteza aortica montata la 22 ani
Aria functionala a protezei aortice index = 0.5 cm2/Sc
π d2/4 x VTI LVOT VTI Proteza Ao
MISMATCH SEVER = Aria functionala aortica index < 0.65cm2/Sc
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COLMATARE DE PROTEZA
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LEAK PARAPROTETIC
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Dezinsertia de proteza
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Degenerescenta de proteza biologica