atresia tricuspidea expo
DESCRIPTION
TRANSCRIPT
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ATRESIA TRICUSPIDEA
DAVIDE MAGNANI2009
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Generalidades
Cianotica Frecuencia 1 - 3% Mortalidad 38% 1a Discontinuidad AD / VD VD hipoplasico RVS via Defecto septal atrial Sobrecarga VI
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ClasificacionEdwards Burchell
Tipo : Grandes vasos Normoposicion Tipo I Transposicion Tipo II
Grupo : Flujo pulmonar Disminuido
Atresia Pulmonar + PDA : subgrupo “a” Estenosis Pulmonar + CIV : subgrup “b”
Aumentado : subgrupo “c”
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TIPOS
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Clasificacion Anatomica Funcional
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CLASIFICACION Y FRECUENCIA
MAS FRECUENTE NORMOPOSICION 70% TIPO IB 40%
ESTENOSIS PULMONAR 75% SIN ESTENOSIS PULMONAR 25%
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TIPO 1 69% ATRESIA PULMONAR 9% ESTENOSIS PULMONAR + CIV 51% SIN EP + CIV GRANDE 9%
TIPO 2 28% ATRESIA PULMONAR 2% ESTENOSIS PULMONAR 8% SIN EP 18%
TIPO 3 L TRANSPOSICION 3%
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Clinica : Segun QP
ATRESIA PULMONAR CIANOSIS PRECOZ CRISIS HIPOXICAS
ESTENOSIS PULMONAR CIANOSIS MENOS SEVERA
SIN ESTENOSIS PULMONAR SOBRECARGA DISFUNCION VI HTP
CONVULSION D/C ABSCESO CEREBRAL
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RX
CON/SIN CARDIOMEGALIA
OLIGOHEMIA CONGESTION CRECIMIENTO AD CRECIMIENTO VI AP CONCAVA
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AT + EP
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AT - EP
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E K G
P ACUMINADA EJE IZQUIERDO CRECIMIENTO VI
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E K G
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E K G
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E C O
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E C O
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E C O
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ANGIOGRAFIA
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ANGIOGRAFIA
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ANGIOGRAFIA
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BANDING ENDOLUMINAL
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MANEJO
MANTENER DUCTUS PATENTE : PGE1
CONTROL CRISIS HIPOXICAS
ACIDOSIS
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MANEJO : SEGUN MORFOLOGIA
TAMAÑO CIV Y ESTENOSIS PULM PEQUEÑO : HIPOFLUJO PULMONAR
BLALOCK TAUSSIG PARA INCREMENTAR QP (BTS)
MEDIANO
GRANDE : HIPERFLUJO PULMONAR BANDING ARTERIA PULMONAR
SIN ESTENOSIS PULMONAR BANDING ARTERIA PULMONAR
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CIV PEQUEÑO + EP
SHUNT SISTEMICO PULMONAR INCREMENTA FLUJO PULMONAR
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CIV MEDIANO
CIV MEDIANO PERMITE ADECUADO VOL VD SIN SOBRECARGA VD NI HIPERFLUJO PULMONAR
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CIV GRANDE SIN EP
HIPERFLUJO PULMONAR QUE REQUIERE BANDING
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MANEJO DSA
NEONATAL PRIMERO : TECNICA DE RASHKIND LUEGO : SHUNT SISTEMICO BTS FINAL : SHUNT BIDIRECCIONAL GLENN 3 – 4 A : DERIVACION ATRIOPULM
FONTAN
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MANEJO DSA
NEONATAL PRIMERO : TECNICA DE RASHKIND
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MANEJO DSA
NEONATAL PRIMERO : TECNICA DE RASHKIND LUEGO : SHUNT SISTEMICO BTS
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MANEJO DSA
NEONATAL FINAL : SHUNT BIDIRECCIONAL GLENN
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MANEJO DSA
NEONATAL 3 – 4 A : DERIVACION ATRIOPULM FONTAN
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MANEJO DSA
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MANEJO DSA
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MANEJO DSA
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FONTAN
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TRATAMIENTO QX
FISTULA SISTEMICA PULMONAR (BTS)
ANTES DE 2 MESES ASEGURA QP NO EN AUSENCIA DE EP : BANDING
SHUNT BIDIRECCIONAL ( GLENN )
ANTES DE LOS 4-6MESES VCI CON AP
CIRUGIA DE FONTAN
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TRATAMIENTO QX
CIRUGIA DE FONTAN
INTRACARDIACA EXTRACARDIACA CONECTA VCI CON AP A LOS 3A / 13KG
AUSENCIA DE EP
BANDING PREVIO A BTS, GLENN Y FONTAN
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CONCLUSIONES
CIANOTICA RARA GRAVE VD HIPOPLASICO, SOBRECARGA VI, DSA CIRUGIA EN TRES TIEMPOS
BTS GLENN FONTAN
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G R A C I A S .