La stenosi della valvola aortica va trattata una volta fatta la diagnosi oppure si può scegliere di tenerla sotto controllo se alle fase iniziali, il tutto per scongiurare rischi per la salute. I farmaci che si utilizzano per questa condizione servono ad alleviare i sintomi della stenosi aortica, ma l’unico modo per eliminare il restringimento è l’intervento chirurgico. Vediamo insieme quali sono tutti i possibili trattamenti del caso e quando sono utili gli uni o gli altri.
Farmaci
I farmaci a volte possono alleviare i sintomi della stenosi valvolare aortica. La chirurgia non è sempre necessaria e non sull’immediato. Per questo motivo è importante eseguire dei follow –up e seguire la cura farmacologica del caso che il cardiologo potrà prescrivere. I medicinali sono quelli per controllare i sintomi dovuti a tale condizione: per ridurre l’accumulo di liquidi, per rallentare la frequenza cardiaca o per stabilizzare le aritmie. Ridurre la pressione sanguigna con farmaci anti –ipertensivi può rallentare il peggioramento della stenosi.
Chirurgia
In taluni casi, quando la malattia è avanzata è necessario riparare o sostituire la valvola aortica (co una meccanica o con una biologica). Sono possibili anche approcci meno invasivi, ma la chirurgia in tal caso è la terapia d’elezione. Tra le metodiche per riparare o sostituire la valvola aortica troviamo le seguenti:
Valvuloplastica
Si utilizza un catetere con un palloncino sulla punta. Il catetere viene guidato da un vaso sanguigno (nell’inguine) fino al cuore. Arrivato all’altezza della valvola il palloncino viene gonfiato per riparare la stenosi. Poi sgonfiato ed il catetere estratto. La valvuloplastica può alleviare la stenosi della valvola aortica ed i suoi sintomi, soprattutto nei neonati e nei bambini. Negli adulti, la valvola tende a restringersi di nuovo, per questo motivo non si tratta su questi pazienti di una metodica utilizzata di frequente.
Sostituzione della valvola aortica
E’ il trattamento chirurgico primario per la stenosi della valvola aortica. Il chirurgo rimuove la valvola aortica ristretta e la sostituisce con una meccanica o con una biologica a seconda dei casi. In genere è un intervento molto invasivo che si fa a “cuore aperto”.
Le valvole meccaniche (in metallo) hanno una lunga durata, ma comportano un rischio di coaguli di sangue, per cui il paziente sarà costretto a vita ad una terapia con farmaco anticoagulante come il warfarin (Coumadin). Le valvole biologiche invece hanno spesso una durata più breve, possono quindi condurre nell’arco della vita ad un secondo intervento chirurgico, ma non hanno necessità di terapie con anticoagulanti.
Sostituzione della valvola aortica transcatetere (TAVR)
Di recente ed in taluni casi, la sostituzione della valvola viene eseguita anche con un metodo meno invasivo del tradizionale intervento a cuore aperto: si introduce dall’arteria femorale un catetere che ha sulla sua punta un palloncino e la valvola sostitutiva che viene quindi inserita. Tale procedura viene utilizzata essenzialmente nei pazienti con alto rischio in caso di chirurgia, ma può aumentare il pericolo di ictus ed altre complicanze cardiovascolari.
Valvuloplastica chirurgica
In casi rari, la riparazione chirurgica della valvola può essere una soluzione più efficace.
Dopo un intervento chirurgico di sostituzione valvolare diventa necessario prestare maggiore attenzione alle infezioni e prendere antibiotici anche prima di alcune procedure dentistiche o mediche a causa del rischio di infezione nel tessuto cardiaco (endocardite).
Leggi anche:
Soffio al cuore, cause e sintomi
I benefici dell’olio d’oliva per il cuore
Le dieci regole per proteggere il cuore
Fonte: Mayo Clinic
Foto: Thinkstock
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