Vol. 12. Núm. 40.
Páginas 2370-2379 (Octubre 2017)

Actualización
Lesiones de las válvulas tricúspide y pulmonar

Pulmonary and tricuspid valve lesions

V. Bonilla JiménezaO. González LorenzobE.J. García Pérez Velascoa
Doi : https://10.1016/j.med.2017.09.003
Opciones
Resumen
Introducción

Las enfermedades que afectan a las válvulas del lado derecho del corazón reciben menos atención que las valvulopatías izquierdas. Sin embargo, es frecuente encontrar disfunción de las mismas, ya sea en forma de válvulas insuficientes, estenóticas o una mezcla de ambas.

Etiología y manifestaciones clínicas

En el caso de la insuficiencia tricúspide e insuficiencia pulmonar, la etiología más frecuente es la secundaria a la dilatación del ventrículo derecho y la arteria pulmonar, respectivamente. La causa más frecuente de estenosis tricúspide es la reumática y, en el caso de la estenosis pulmonar, la afectación congénita. Las valvulopatías derechas provocan síntomas de congestión sistémica como hepatomegalia, ascitis, edemas en los miembros inferiores y síntomas debidos a bajo gasto (disnea, dolor torácico, síncope) que en ausencia de valvulopatía izquierda no suele asociarse a congestión pulmonar.

Diagnóstico y tratamiento

El ecocardiograma es la base de la evaluación diagnóstica y el estudio Doppler es útil para la cuantificación de las mismas. Aunque la restricción hidrosalina y los diuréticos constituyen la base del tratamiento médico, en los casos más graves puede ser necesario el intervencionismo, ya sea en forma de cirugía o de procedimientos percutáneos.

Palabras clave
Insuficiencia
Estenosis
Pulmonar
Tricúspide
Abstract
Introduction

Diseases affecting right-sided heart valves receive less attention than left-sided valvular heart disease. However, it is common to find dysfunction of the same, either in the form of insufficient valves, stenotic or a mixture of both.

Etiology and clinical manifestations

In the case of tricuspid insufficiency and pulmonary insufficiency, the most frequent etiology is secondary to dilation of the right ventricle and pulmonary artery, respectively. The most frequent cause of tricuspid stenosis is rheumatic and in the case of pulmonary stenosis, the congenital affectation. Right valvulopathy causes symptoms of systemic congestion such as hepatomegaly, ascites, edema in the lower limbs and symptoms due to low expenditure (dyspnea, chest pain, syncope), which in the absence of left valvulopathy is not usually associated with pulmonary congestion.

Diagnosis and treatment

The echocardiogram is the basis of the diagnostic evaluation and the Doppler study is useful for the quantification of the same. Although hydrosaline restriction and diuretics are the basis of medical treatment, in the most severe cases interventional intervention may be necessary, either in the form of surgery or percutaneous procedures.

Keywords
Insufficiency
Stenosis
Pulmonary
Tricuspid

Identifíquese

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