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Proteze valvulare
Dr. Purcarea Florin
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
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
Aspect normal proteza mecanica bidisc
Aspect normal alte proteze mecanice
Proteza mecanica mitrala monodisc Proteza mecanica mitrala cu bila
Fenomen de cavitatie
Proteza biologica 2D
Proteze mecanice – mod M
“Stenoza fiziologica…”
Proteze mitrale bidisc
Proteza biologica tricuspidiana Proteza metalica aortica
Hemodinamica proteza bidisc
Hemodinamica proteza biologica
TEE – Proteza biologica aortica – orificiu triunghiular
Regurgitarea fiziologica
Doppler spectral
GRADIENTI TRANSVALVULARI
Proteza biologica tricuspida
Proteza metalica mitrala
Proteza mecanica aortica
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
Limite ETT
ELEMENTE MOBILE
2D
M MODE
DOPPLER
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
COLMATARE DE PROTEZA
LEAK PARAPROTETIC
Dezinsertia de proteza
Degenerescenta de proteza biologica
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