Mitral valve-in-valve implantation: A case report.

INTRODUCTION: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. CASE DESCRIPTION: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. ASSESSMENT: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern 2: bilateral malleolar oedema without pitting; pattern 3: urinary catheter and intravenous diuretic use; pattern 4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern 5: need for pharmacological assistance for a good night's rest. DIAGNOSES: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; ineffective breathing pattern; Activity intolerance and problem collaborating: Hypotension and anaemia secondary to deep thigh haematoma. PLANNING: The following objectives were set based on the NOC taxonomy: Fluid balance; Respiratory status: ventilation; Cardiopulmonary status and the following NIC interventions: Hypervolaemia management; Respiratory monitoring and oxygen therapy; Vital sign monitoring and heart care. DISCUSSION: Nursing interventions aimed at monitoring haemodynamic status, fluid restriction together with the efficacy of diuretic treatment achieved a negative water balance which contributed to fluid depletion improving respiratory symptoms, enabling implantation under better conditions. CONCLUSIONS: Technological progress in the health sciences, and in the field of acute cardiology in particular, directly calls for training, revision and updating of critical care nursing. Given this dynamic and continually evolving process, the specialist intensive care nurse, the inclusion of the cardiovascular nurse specialist in multidisciplinary teams such as the heart team, and expanding the consultation of the haemodynamic nurse are urgently required to ensure optimal nursing care, safety, and care quality.

Valve in valve mitral: a propósito de un caso / Mitral valve-in-valve implantation: A case report

Introducción: El implante valve in valve mitral es una nueva herramienta terapéutica que ha surgido recientemente en el campo del intervencionismo estructural en cardiología para pacientes con disfunción bioprotésica por insuficiencia mitral severa y alto riesgo quirúrgico. El objetivo es elaborar un plan de cuidados enfermero individualizado destinado a una paciente que se somete a este procedimiento, siendo el primer caso en nuestro centro. Descripción del caso: Mujer de 75años, independiente para las actividades de la vida diaria, con antecedentes de insuficiencia renal crónica y recambio valvular mitral biológico por valvulopatía reumática. Ingresada en la unidad de cuidados cardiológicos agudos por insuficiencia mitral severa sintomática secundaria a disfunción de la bioprótesis mitral. Descartada para cirugía cardíaca por comorbilidades y alto riesgo quirúrgico, se procedió al valve in valve mitral percutáneo, siendo exitoso su implante. Valoración: La valoración enfermera se realizó siguiendo el modelo conceptual de Marjory Gordon, donde se identificaron los siguientes patrones alterados: patrón2: edemas maleolares bilaterales sin fovea; patrón3: sondaje vesical y uso de diurético intravenoso; patrón4: disnea a moderados esfuerzos, tos seca nocturna, ortopnea y alteraciones respiratorias e intolerancia a la actividad; patrón5: necesidad de ayuda farmacológica para el buen descanso nocturno. Diagnósticos: Mediante la taxonomía NANDA se establecieron los diagnósticos enfermeros: Exceso de volumen de líquidos; Patrón respiratorio ineficaz; Intolerancia a la actividad y el problema de colaboración: Hipotensión y anemización secundaria al hematoma profundo en muslo.(AU)

Introduction: Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. Case description: A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. Assessment: The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern2: bilateral malleolar oedema without pitting; pattern3: urinary catheter and intravenous diuretic use; pattern4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern5: need for pharmacological assistance for a good night's rest.Diagnoses: The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; Ineffective breathing pattern; Activity intolerance and problem collaborating; Hypotension and anaemia secondary to deep thigh haematoma.(AU)