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Proteze valvulare

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Proteze valvulare Dr. Purcarea Florin
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Page 1: Proteze valvulare

Proteze valvulare

Dr. Purcarea Florin

Page 2: Proteze valvulare

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

Page 3: Proteze valvulare

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

Page 4: Proteze valvulare

Aspect normal proteza mecanica bidisc

Page 5: Proteze valvulare

Aspect normal alte proteze mecanice

Proteza mecanica mitrala monodisc Proteza mecanica mitrala cu bila

Page 6: Proteze valvulare

Fenomen de cavitatie

Page 7: Proteze valvulare

Proteza biologica 2D

Page 8: Proteze valvulare

Proteze mecanice – mod M

Page 9: Proteze valvulare

“Stenoza fiziologica…”

Proteze mitrale bidisc

Proteza biologica tricuspidiana Proteza metalica aortica

Page 10: Proteze valvulare

Hemodinamica proteza bidisc

Page 11: Proteze valvulare

Hemodinamica proteza biologica

TEE – Proteza biologica aortica – orificiu triunghiular

Page 12: Proteze valvulare

Regurgitarea fiziologica

Page 13: Proteze valvulare

Doppler spectral

GRADIENTI TRANSVALVULARI

Proteza biologica tricuspida

Proteza metalica mitrala

Proteza mecanica aortica

Page 14: Proteze valvulare

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

Page 15: Proteze valvulare

Limite ETT

Page 16: Proteze valvulare

ELEMENTE MOBILE

2D

M MODE

DOPPLER

Page 17: Proteze valvulare

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

Page 18: Proteze valvulare

COLMATARE DE PROTEZA

Page 19: Proteze valvulare

LEAK PARAPROTETIC

Page 20: Proteze valvulare

Dezinsertia de proteza

Page 21: Proteze valvulare

Degenerescenta de proteza biologica


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