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Trattamento percutaneo della valvulopatia mitralica

ABSTRACT Riassunto La valvuloplastica mitralica percutanea è diventata la migliore opzione terapeutica per la stenosi mitralica, con buoni risultati sia a breve che a lungo termine. Essa è comparabile col classico intervento chirurgico di commissurotomia mitra-lica a cielo chiuso per quanto riguarda l'incremento dell'area valvolare. Per l'insufficienza mitralica, al contrario, fino a poco tempo fa l'unico trattamento disponibile era quello chirurgico, sem-pre più volto alla riparazione valvolare più che alla sostituzione. Alcuni anni fa è stata introdotta una tecnica percutanea di riparazione "edge-to-edge" della valvola mitrale, basata sull'operazione di Alfieri, che crea una valvola a doppio orifi-cio con una migliore coaptazione delle cuspidi. Completato lo studio in fase 1 EVEREST I con incoraggianti risultati, è seguito lo studio EVEREST II. Più recentemente una annuloplastica mitralica percutanea è stata tentata in alcuni pazien-ti; essa consiste nell'impianto di un sistema accorciante nel seno coronarico in considerazione della sua stretta relazione anatomica con l'annulus mitralico. In ogni caso allo stato attuale il trattamento chirurgico conserva il suo ruolo dominante. Summary Percutaneous mitral valvuloplasty has become the primary therapeutic option for mitral stenosis, with good short-and long-term results. It is comparable to surgical closed mitral commissurotomy in terms of valve area increase. For mitral insufficiency, on the contrary, until recently the only treatment available was surgical, with an increasing ten-dency to valve repair instead of replacement. A few years ago a percutaneous "edge-to-edge" mitral valve repair was introduced, based on Alfieri's operation, which creates a double-orifice valve with better cuspid coaptation. The phase I study EVEREST I has been completed with incouraging results, followed by EVEREST II. More recently a percutaneous transvenous mitral annuloplasty has been reported in a few patients, consisting in the implantation of a shortening devi-ce in the coronary sinus in consideration of its proximity to the mitral annulus. However for mitral regurgitation the sur-gical treatment definitely plays the dominant role.

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