| Abstract | Pojedine kongenitalne srčane bolesti zahtijevaju kiruršku rekonstrukciju izlaznog trakta desne klijetke. To je slučaj u gotovo 20 % novorođenčadi s prirođenim srčanim bolestima (PSB) koja predstavljaju složene anomalije kao što su tetralogija po Fallotu, plućna atrezija sa ili bez ventrikularnog septalnog defekta (VSD), transpozicija velikih krvnih žila, neki oblici dvostrukog izlaza desne klijetke (RV). Nakon kirurški popravljene disfunkcije izlaznog trakta desne klijetke, bioproteza i valvule s vremenom, najčešće nakon deset godina, dožive degenerativne promjene ili kalcificiraju što na kraju dovodi do moguće plućne stenoze (PS) ili plućne regurgitacije (PR), a posljedično tome izvolijeva ponovnu intervenciju i zamjenu plućne valvule. Do 2000. godine, kirurška zamjena plućnog zaliska predstavljala je zlatni standard, no nakon što su Bonhoeffer i suradnici opisali prvu transkatetersku zamjenu plućnog zaliska na čovjeku, od tada se re – intervencijskoj zamjeni plućne valvule pristupa većinom i kad god je to moguće, transkateterskim, odnosno perkutanim putem. Indikaciju za perkutanu zamjenu plućne valvule postavlja tim za intervencijsku kardiologiju, bolesnik obavlja neinvazivnu i invazivnu kardiološku obradu što uključuje ehokardiogram (ECHO), elektrokardiogram (EKG), RTG srca i pluća, CT, MRI, koronarografiju, kateterizaciju desne strane srca te laboratorijske pretrage. U Republici Hrvatskoj je do sada u KBC – u Zagreb transkateterskim putem ugrađeno 7 plućnih valvula, dok je taj broj na svjetskoj razini veći od 10 000 intervencija. U samom procesu implantacije sudjeluju najmanje dva liječnika internista koji ugrađuju zalistak, anesteziološki tim, rendgen tehničar i medicinska sestra / tehničar koji asistira tijekom zahvata, brine za sterilnost područja i opreme te obavještava liječnika o svakoj promjeni i odstupanju kojeg primijeti u bolesnikovom stanju ili stanju opreme ili aparata. Nakon zahvata, sestrinska skrb za bolesnika nastavlja se na bolesničkom odjelu gdje medicinska sestra / tehničar prati stanje bolesnika, stanje svijesti, izlučevine, opservira ubodna mjesta bolesnika i moguća krvarenja. Od neupitne su važnosti kompetencije, stručnost, spretnost, ali i empatija medicinskog osoblja u procesu implantacije kao i u post – intervencijskom razdoblju na odjelu. |
| Abstract (english) | Certain congenital heart diseases require surgical reconstruction of the right ventricular outflow tract. This is the case in almost 20% of newborns with congenital heart disease (CHD) presenting complex anomalies such as tetralogy of Fallot, pulmonary atresia with or without ventricular septal defect (VSD), transposition of great vessels, some forms of double outlet of the right ventricle ( RV). After surgically repaired dysfunction of the right ventricular outflow tract, bioprostheses and valves over time, usually after ten years, undergo degenerative changes or become calcified, which ultimately leads to possible pulmonary stenosis (PS) or pulmonary regurgitation (PR), and as a result requires repeated intervention and pulmonary valve replacement. Until 2000, surgical pulmonary valve replacement was the gold standard, but after Bonhoeffer et al described the first transcatheter pulmonary valve replacement in humans, since then re-interventional pulmonary valve replacement has been approached mostly and whenever possible, transcatheter, that is, percutaneously. The indication for percutaneous pulmonary valve replacement is set by the interventional cardiology team, the patient undergoes non-invasive and invasive cardiac treatment, which includes echocardiogram (ECHO), electrocardiogram (ECG), X-ray of the heart and lungs, CT, MRI, coronary angiography, catheterization of the right side of the heart and laboratory tests. In the Republic of Croatia, 7 pulmonary valves have been implanted transcatheterically in KBC - Zagreb, while this number exceeds 10,000 interventions worldwide. At least two internists who install the valve, an anesthesiology team, an X-ray technician and a nurse/technician who assists during the procedure, cares for the sterility of the area and equipment and informs the doctor of any changes and deviations he notices in the patient's condition or the condition of the equipment are involved in the implantation process itself. or device. After the procedure, nursing care for the patient continues in the patient ward, where the nurse / technician monitors the patient's condition, state of consciousness, secretions, observes the patient's puncture sites and possible bleeding. The competence, expertise, dexterity, and empathy of the medical staff are of unquestionable importance in the implantation process as well as in the post-intervention period in the department. |
