Valve in valve mitral: a propósito de un caso

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.