When they don’t perform their function well, it can not only be the heart but the whole body that suffers. How to intervene today on strictures or insufficiencies
heart valves they play a fundamental role for the correct functioning of the heart: they open to allow the passage of blood from the atria to the ventricles and from the ventricles to the pulmonary or systemic circulation; they close to prevent blood from flowing back. If they have structural abnormalities or don’t work well, they can give rise to various diseases that can compromise not only heart health, but also that of the whole organism. To avoid dangerous consequences therefore very important diagnose any valvular disease and take targeted action. In the last 10-15 years the way of treating some of these conditions has radically changed and the way has been paved for increasingly less invasive intervention strategies.
What are the most common valve pathologies?
There are four heart valves: tricuspid, pulmonary, mitral and aortic,” he explains Francesco Maisano, director of the cardiac surgery unit and of the Heart Valve Center of the Irccs San Raffaele Hospital in Milan and professor of cardiac surgery at the Vita-Salute San Raffaele University -. The most frequent valvular pathologies are the
aortic stenosis elmitral insufficiency
. In recent years, however, thetricuspid insufficiency, hitherto underestimated, while pulmonary valve stenosis is generally a congenital condition (present at birth) which therefore affects children. In general, stenotic valves are valves that open little, while insufficient ones are valves that “do not hold” and therefore can cause blood to flow backwards.
What is aortic stenosis and how can it be treated?
Aortic stenosis due to a narrowing of the aortic valve, the exit port of the heart that connects the left ventricle to the aorta, which distributes oxygenated blood to the whole body. It is estimated that about one in 10 people over the age of 65 suffer from it. In most cases linked to a progressive degenerative process, a form of atherosclerosis that affects the elderly more. At the beginning the progression is slow, but when the first symptoms start to appear it becomes exponential. Typical of this valve disease is a triad of symptoms such as shortness of breath; chest pain (angina pectoris) and finally, in the most advanced cases, the syncope for which the patient may even pass out because the flow of oxygenated blood to the brain is very reduced. If nothing is done, the stenosis progresses to become fatal.
The only curative treatment the replacement of the diseased valve. Until 15 years ago, open heart surgery was the only viable way to implant a prosthetic valve. Today the paradigm has changed, thanks to a decidedly less invasive procedure,
la Tavi (Transcatheter aortic valve implant)
which can be used in many cases. With Tavi, the new valve is “brought” to the heart thanks to a catheter that is inserted in the groin into the femoral artery or directly into the aorta through a small incision in the chest. Thanks to this less invasive approach, open surgery is reserved for selected cases.
What does mitral regurgitation mean?
Mitral regurgitation occurs when the mitral valve does not close properly and “leaks”. The consequence that the blood that should be pushed from the left ventricle to the aorta, and from there to the rest of the body, flows back into the atrium. Over time, if the loss is significant enough, the heart, forced to work harder, wears out and begins to show signs of fatigue. Mitral regurgitation can be primary, if the valve has an anomaly (prolapse) or has had a disease, or secondary, when it becomes incontinent because the left ventricle is dilated.
The mitral becomes silently insufficient and when the symptoms arrive it means that it is already late. In advanced stages the left ventricle dilates and generates lo heart failure or the left atrium dilates, resulting in chronic atrial fibrillation, both very important diseases. Lbreathlessness it is the most frequent symptom together with palpitations of atrial origin (atrial fibrillation) or ventricular (more dangerous arrhythmias which can lead to sudden death).
More attention to the tricuspid
Tricuspid regurgitation is a condition to which, until a few years ago, little attention was paid. However, it has been seen that when the tricuspid, located between the right atrium and ventricle, does not work well, in the long run, it can lead to right ventricular dilatation. As the mitral valve protects the lungs, the tricuspid protects the body (brain, liver, kidney, etc.): when very compromised, all the organs are subjected to an overload, initially well tolerated, but which can lead to multiple organ failure. This is why we try to give more attention and propose, when appropriate, minimally invasive interventions.
June 6, 2023 (change June 6, 2023 | 12:34)
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