Prolasso della valvola mitralica
Table of Contents
Definizione
Ilprolasso della valvola mitraleè una protrusione di uno o entrambi i lembi valvolari verso l’atrio sinistro durante la sistole ventricolare. E’ più frequente il prolasso del lembo posteriore. Si può associare alla presenza di insufficienza mitralica e, di fatto, è la causa più frequente diinsufficienza mitralicaisolata. Il prolasso della valvola mitralica viene anche denominato sindrome di Barlow o sindrome del click sistolico.
Eziologia
- Congenita: il prolasso della valvola mitralica può essere trasmesso in modo autosomico dominante; è talvolta associato allasindrome di Marfano allacomunicazione interatriale.
- Degenerazione mixomatosa.
- Interessamento del miocardio:miocardite, ischemia miocardica.
- Sequela di valvulotomia mitralica.
Sintomi
Segni funzionali
La malattia si osserva soprattutto nelle donne di 30-40 anni; è diagnosticata spesso conecocardiografia.
E’ scoperta fortuitamente o a causa dei sintomi seguenti:
- Dispneada sforzo
- Palpitazioni
- Tachicardiaparossistica
- Lipotimia
- Sincope
- Precordialgieindipendenti dallo sforzo.
Segni fisici
Il torace presenta spesso deformazioni (torace a imbuto, scoliosi e lordosi dorsale). L’auscultazione all’apice di uno o piu’click mesosistoliciè caratteristica. Questo click è variabile: tende a diventareprotosistolico in posizione eretta otelesistolicoin posizione seduta o accovacciata. E’spesso seguito da un soffio telesistolico egualmente variabile secondo la posizione del malato, che tende a divenireolosistolico in posizione eretta.
Esami complementari
ECG
Generalmente normale. Si possono osservareonde T appiattite o negativenelle derivazioni inferiori. Provoca frequentemente la comparsa di falsi positivi alla prova da sforzo.
Radiografia toracica
Normale. In caso di insufficienza mitralica grave associata, si osserveranno i reperti dovuti a tali condizione.
Ecocardiografia
Il reperto più caratteristico è l’osservazione con ilmodo Mdi un movimento brusco all’indietro del lembo posteriore o di entrambi i lembi valvolari durante lemesosistole.
Trattamento
Medico
Sintomatico e volto a prevenire complicanze.
- Evitare la deplezione di volumee tutti i fattori che possano stimolare l’attività del sistema nervoso simpatico.
- Attività fisica aerobica regolare.
- Ibeta-bloccantia basse dosi costituiscono la terapia di prima scelta per i casi sintomatici.
Chirurgico
Si effettua nei pazienti che presentano un’ insufficienza mitralica con criteri di intervento chirurgico. Se è possibile dire si raccomanda la riparazione della valvola.
Complicanze
- Insufficienza mitralicaprogressiva.
- Rottura delle corde tendinee.
- Aritmie.
- Morte improvvisa: rara, tranne nei casi di grave insufficienza mitralica e funzione depressa del ventricolo sinistro.
- Embolizzazione sistemica,inclusoictus.
- Endocardite infettiva.
Prognosi
- Nella maggior parte dei casi laprognosi è buona.
- Gli uomini, le persone di età > 45 anni e i pazienti con evidenza ecocardiografica di ispessimento dei lembi mitralici sono a maggiore rischio di insufficienza mitralica significativa.
- L’ insufficienza mitralica è il fattore di rischio più significativo per altre complicanze.
- Morte improvvisa
- Ictus
- Endocardite
Prevenzione
- Il controllo della pressione arteriosa può ridurre il rischio di evoluzione verso l’insufficienza mitralica significativa.
- Profilassi dell’endocardite per i pazienti con soffio sistolico e ispessimento dei lembi valvolari mitralici.
Ti potrebbero interessare:
- Stenosi mitralica
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- Insufficienza aortica
- Insufficienza mitralica
- La sindrome del prolasso dellamitrale (SPM) idiopaticaA proposito di una casistica di 80 pazienti
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