T7.3 - Patologia da Válvula Tricúspide

Question 1

Algoritmo de TR?

Answer 1

Need for left-sided valve surgery?
Kind o tricuspid regurgitation?
Symptomatic?
Dysfunction o RV or LF?

Question 2

Próteses Valvulares?

Answer 2

Mecânica:
- Anticoagulante para toda a vida (anti vitK)
- Risco de hemorragia
- Risco de tromboembolismo
- Controlo da terapêutica, INR alvo, AAS, FR para hemorragia
Biológica:
- Deterioração valvular ao longo do tempo
- Risco de disfunção estrutural
- Risco de reoperação

Question 3

Mechanical vs Biological?

Answer 3

Mechanical is recommended:
- According to the desire of the informed patient
- In patients at risk of accelerated structural valve deterioration
- Patients already on anticoagulation because of mechanical prosthesis
- <60y for aortic position and <65y in mitral
- Reasonable life expectancy, for whom future redo would be at high-risk
- Already on long term anticoagulant
Bioprsothesis is recommended:
- Desire o finformed patient
- Good-quality anticoagulation is unlikely
- Reoperation for mechanical valve thrombosis despite good long-term anticoagulant control
- Low likelihood of redo surgery
- Pregnancy
- >65y in aortic and >70y in mitral

Question 4

Recommendation for mechanical prosthesis?

Answer 4

Oral anticoagulation using Anti VitK
Low dose aspirin if thromboembolism or concomitant atherosclerotic disease
INR self-management
Use of NOACs is contraindicated

Question 5

Recommendation for biological prosthesis?

Answer 5

Anti VitK for the first 3 months
Low dose aspirin if aortic bioprosthesis for 3 months
Dual antiplatelet therapy for 3-6 months after TAVI

Question 6

Seguimento após Cirurgia?

Answer 6

• 6 – 12 semanas após intervenção: avaliação clínica, ECG, ETT, Raio-X tórax, análises.
• Educação do paciente acerca da profilaxia para endocardite infeciosa, terapêutica anticoagulante, relato de novos sintomas.
• Seguimento médico durante toda a vida do doente, com avaliações anuais.
• Valores de gradientes transprotésicos devem ser comparados com os valores de base e não com os fornecidos pelos fabricantes.