Différences entre versions de « Valvulopathies »

Version du 19 juin 2020 à 18:27

In patients with symptoms of aortic stenosis and discrepancies between the physical examination and echocardiographic findings, the severity of stenosis should be established with cardiac catheterization before aortic valve replacement is performed.

Chirurgie de remplacement de la valve aortique
TAVI
Traitement médicamenteux: diminution de la post-charge. Vasodilators should be used with caution in patients with aortic stenosis and heart failure symptoms.

In cases of chronic aortic regurgitation, surgery with traditional open aortic valve replacement is advised for patients with symptoms (typically, dyspnea or angina), those with LV dysfunction (ejection fraction <50%), or patients undergoing other cardiac surgery.
In the absence of these findings, surveillance echocardiography every 6 to 12 months is recommended.

CAVE rechercher une fibrillation auriculaire (présente dans 50% des cas si sténose mitrale) car risque thrombo-embolique 20-25% → on parle de fibrillation auriculaire valvulaire, anticoagulation d'office
- Anti-vitamine K si sténose modérée à sévère (INR cible 2−3)
- NACO si sténose légère
Traitement médicamenteux: Medical therapy for mitral stenosis consists of diuretics or long-acting nitrates, which may help alleviate symptoms such as dyspnea. In addition, β-blockers or nondihydropyridine calcium channel blockers can lower heart rate and improve left ventricular diastolic filling time.

Synonyme: régurgitation mitrale

Chronic primary mitral regurgitation relates to processes involving any portion of the mitral annulus. Common causes of primary mitral regurgitation are mitral valve prolapse (also known as myxomatous or degenerative mitral valve disease), radiation therapy, rheumatic disease, and cleft mitral valve.^[1]

Chronic secondary mitral regurgitation involves causes other than the annulus, such as ventricular dysfunction.^[1]

Mitral valve repair is strongly recommended for chronic severe primary mitral regurgitation in
- symptomatic patients with left ventricular ejection fraction greater than 30%
- asymptomatic patients with left ventricular dysfunction
- and patients undergoing another cardiac surgical procedure.
Insuffisance mitrale aiguë: ballonnet intra-aortique à contrepulsion

Causes of tricuspid regurgitation include rheumatic disease, radiation, endocarditis, myxomatous degeneration (prolapse), congenital abnormalities (Ebstein anomaly), carcinoid disease, and trauma (for example, chest wall impact or right ventricular biopsy). Placement of internal device leads for pacemakers and cardioverter-defibrillators is also a common cause of tricuspid regurgitation.

Cardiomyopathie hypertrophique et obstruction dynamique intraventriculaire: https://www.revmed.ch/RMS/2002/RMS-2393/22223

@@ Ligne 17 : / Ligne 17 : @@
 === Sténose mitrale ===
 * '''CAVE''' rechercher une [[fibrillation auriculaire]] (présente dans 50% des cas si sténose mitrale) car risque thrombo-embolique 20-25% → on parle de '''fibrillation auriculaire valvulaire''', anticoagulation d'office
-** '''Anti-vitamine K''' si sténose modérée à sévère
+** '''Anti-vitamine K''' si sténose modérée à sévère (INR cible 2−3)
 ** '''NACO''' si sténose légère
 * <u>Traitement médicamenteux:</u> Medical therapy for mitral stenosis consists of diuretics or long-acting nitrates, which may help alleviate symptoms such as dyspnea. In addition, β-blockers or nondihydropyridine calcium channel blockers can lower heart rate and improve left ventricular diastolic filling time.