Loading...
Publication
Terapêutica com anticoagulantes orais em crianças com substituição de válvula aórtica
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 6.48 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
A válvula aórtica é normalmente constituída por três cúspides semilunares em formato
de bolsa, onde as extremidades interiores livres se encontram no centro da artéria permitindo
a passagem do sangue aquando da sua abertura. A estenose aórtica bicúspide, é uma doença
cardíaca maioritariamente de natureza congénita e pertencente ao grupo das valvulopatias.
Surge quando a válvula apresenta duas cúspides ao invés de três originando uma disfunção
valvular que se caracteriza pelo seu estreitamento e obstrução ao fluxo sanguíneo
proveniente do ventrículo esquerdo para a aorta.
Atualmente, as doenças cardiovasculares constituem uma elevada causa de
morbilidade em todo o mundo, no entanto, quando se trata de uma valvulopatia – doença
que afeta as válvulas cardíacas, impedindo a sua abertura e/ou fecho apropriados e que pode
ocorrer numa ou mais válvulas (aórtica, mitral, tricúspide e pulmonar) – a taxa de morbilidade
diminui pelo recurso à implantação de próteses.
A utilização de anticoagulantes orais aumentou devido ao desenvolvimento de
procedimentos cirúrgicos cardíacos, uma vez que, após a cirurgia, os doentes necessitam de
terapia anticoagulante por norma para o resto da vida, com o objetivo de evitar eventos
trombóticos futuros. Apesar dos avanços notórios nos últimos anos, o controlo subjacente a
este tipo de terapia em crianças ainda é um desafio. A causa disso pode ter como base a
particularidade da farmacocinética infantil, doenças e medicação crónica concomitante.
Posto isto, a presente monografia pretende apresentar uma revisão bibliográfica
acerca do tratamento convencional de valvulopatias, começando pela abordagem cirúrgica,
seguida da abordagem terapêutica, explicitando os antivitamínicos K e os novos
anticoagulantes orais. Serão também abordadas as principais características deste tipo de
terapia na faixa etária infantil e os desafios que a mesma envolve. Por fim, será descrito um
estudo de caso acerca da monitorização da terapêutica com varfarina numa jovem
adolescente que foi submetida a uma substituição de válvula aórtica na infância.
The aortic valve has normally three semilunar cusps in the shape of a pouch, where the free inner extremities meet in the center of the artery allowing the passage of blood at the time of opening. Bicuspid aortic stenosis is a major congenital heart disease that belongs to the group of Valvular heart disease. This happens when the aorta has two cusps instead of three, causing a valve dysfunction that is characterized by its narrowing and obstruction of blood flow from the left ventricle to the aorta. Nowadays cardiovascular diseases are one of the main causes of morbidity worldwide, however, when it comes to valvulopathy - a disease that affects the heart valves, preventing their proper opening and / or closing, that can occur in one or more valves (aortic, mitral, tricuspid and pulmonary) - the morbidity rate decreases due to the use of prosthetic implants. The use of oral anticoagulants has increased as a result of the development of cardiac surgical procedures, since, after surgery, patients usually require anticoagulant therapy for the rest of their lives, in order to prevent future thrombotic events. Despite notable advances in recent years, the control behind this type of therapy in children is remaining a clinical challenge. The cause of this may be based on the particularity of children's pharmacokinetics, diseases and concomitant chronic medication. Therefore, the present thesis intends to present a bibliographic review about the conventional treatment of valvulopathies, starting with the surgical approach, followed by the therapeutic approach, explaining the vitamin K antagonists and the new oral anticoagulants. The main characteristics underlying the implementation of this type of therapy in children and the challenges that it involves will also be presented. Finally, a case study on monitoring warfarin therapy in a young teenager who underwent aortic valve replacement in childhood will be described.
The aortic valve has normally three semilunar cusps in the shape of a pouch, where the free inner extremities meet in the center of the artery allowing the passage of blood at the time of opening. Bicuspid aortic stenosis is a major congenital heart disease that belongs to the group of Valvular heart disease. This happens when the aorta has two cusps instead of three, causing a valve dysfunction that is characterized by its narrowing and obstruction of blood flow from the left ventricle to the aorta. Nowadays cardiovascular diseases are one of the main causes of morbidity worldwide, however, when it comes to valvulopathy - a disease that affects the heart valves, preventing their proper opening and / or closing, that can occur in one or more valves (aortic, mitral, tricuspid and pulmonary) - the morbidity rate decreases due to the use of prosthetic implants. The use of oral anticoagulants has increased as a result of the development of cardiac surgical procedures, since, after surgery, patients usually require anticoagulant therapy for the rest of their lives, in order to prevent future thrombotic events. Despite notable advances in recent years, the control behind this type of therapy in children is remaining a clinical challenge. The cause of this may be based on the particularity of children's pharmacokinetics, diseases and concomitant chronic medication. Therefore, the present thesis intends to present a bibliographic review about the conventional treatment of valvulopathies, starting with the surgical approach, followed by the therapeutic approach, explaining the vitamin K antagonists and the new oral anticoagulants. The main characteristics underlying the implementation of this type of therapy in children and the challenges that it involves will also be presented. Finally, a case study on monitoring warfarin therapy in a young teenager who underwent aortic valve replacement in childhood will be described.
Description
Keywords
Valvulopatias Estenose aortica bicuspide Cirurgia estenose aortica Anticoagulantes orais Terapia anticoagulante infantil.