Enfermedad de la válvula cardíaca

Las válvulas cardiacas pueden volverse rígidas y estrecharse, dificultando el paso de la sangre. Esta afección, denominada estenosis valvular, impide que la válvula se abra completamente y limita el flujo sanguíneo. En casos graves, la abertura de la válvula puede llegar a ser tan pequeña que el organismo no reciba suficiente sangre.

• Pulmonary valve stenosis: A narrowed pulmonary valve restricts blood flow from the right ventricle to the lungs, making it harder for blood to pick up oxygen and increasing pressure in the heart. This is typically found in people with congenital heart conditions, which are usually present since birth.
• Mitral valve stenosis: A narrowed mitral valve limits blood flow from the left atrium to the left ventricle, leading to fatigue, shortness of breath and fluid buildup in the lungs. This usually occurs when young people have had a history of rheumatic fever or in older people with severe calcification.
• Aortic valve stenosis: A narrowed aortic valve restricts blood flow from the heart to the body, causing the left ventricle to work harder and eventually weaken.

Cuando las válvulas cardiacas no cierran correctamente, la sangre puede retroceder en lugar de avanzar. Este flujo retrógrado, denominado regurgitación, interrumpe el sistema de flujo sanguíneo unidireccional del corazón. Supone un esfuerzo adicional para su corazón, dificultando su bombeo eficaz y reduciendo la sangre rica en oxígeno que su cuerpo necesita.

• Tricuspid valve regurgitation: If the tricuspid valve doesn't close fully, blood that's supposed to move from the right ventricle to the lungs leaks backward into the right atrium, causing the atrium to enlarge over time and fluid to build up in the liver, abdomen and legs.
• Pulmonary valve regurgitation: When the pulmonary valve doesn't close properly, blood pumped from the heart to the lungs can leak back into the heart. This mix of oxygen-poor and oxygen-rich blood reduces the amount of oxygen circulating in your body.
• Mitral valve regurgitation: In this condition, some blood leaks backward into the left atrium and then the lungs instead of flowing out to the body, increasing pressure and blood volume in the atrium, potentially causing it to enlarge and leading to fluid buildup in the lungs.
• Aortic valve regurgitation: If the aortic valve doesn't close completely, oxygen-rich blood flows backward into the left ventricle, making the heart work harder to compensate, which, over time, can lead to the left ventricle becoming enlarged, weakened, and increase the risk of heart failure.

El prolapso se produce cuando las aletas (valvas) de una válvula cardiaca se salen de su sitio o se abomban, impidiendo que la válvula se cierre correctamente. Esto puede hacer que la sangre fluya hacia atrás a través de la válvula, interrumpiendo el flujo sanguíneo unidireccional normal del corazón.

• Mitral valve prolapse: In mitral valve prolapse, the mitral valve doesn’t close evenly. Instead, part or all of the valve bulges upward into the left atrium when the heart pumps blood. This may allow a small amount of blood to flow backward (called regurgitation). Mitral valve prolapse is also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome. In most cases, mitral valve prolapse has favorable outcomes and rarely progresses into a more serious condition.
• Other valve prolapses: Prolapse of the tricuspid, pulmonary or aortic valves is much less common than mitral valve prolapse. However, they can also cause the valve leaflets to fail to close tightly, leading to a similar issue with blood flow.

La mayoría de las afecciones valvulares no pueden tratarse sólo con medicación. Sin embargo, si la afección no es tan grave como para necesitar cirugía pero sigue causando síntomas molestos o riesgos, la medicación puede ayudar a controlarla durante un tiempo.

Pueden prescribirse medicamentos para:

• Aliviar los molestos síntomas de los problemas valvulares más leves. Los diuréticos pueden reducir el exceso de líquido en su cuerpo, disminuyendo la cantidad de sangre que el corazón tiene que bombear. Esto reduce su presión arterial y mejora su estado de volumen.
• Ayudar a mantener un ritmo cardiaco estable si existe una arritmia (latido irregular)
• Reducir el riesgo de coágulos sanguíneos e ictus

Si su valvulopatía cardiaca tiene un impacto significativo en su calidad de vida, es posible que su cardiólogo le recomiende someterse a una intervención o cirugía de reparación o sustitución de la válvula cardiaca. Además de la cirugía a corazón abierto, los avances tecnológicos y la innovación han introducido como opciones los procedimientos robóticos y transcatéteres mínimamente invasivos.

Su médico le explicará sus opciones quirúrgicas, que tienen en cuenta la válvula o válvulas que necesitan cuidados, su edad, la gravedad de su valvulopatía cardiaca y otros factores de salud.

• Balloon valvuloplasty: During a balloon valvuloplasty, your surgeon uses a narrow, flexible catheter to guide a balloon to your heart valve, where the balloon is expanded to help open the flaps of the heart valve. This procedure is not common for aortic valve stenosis, but may be used if you are living with mitral valve regurgitation.
• Annuloplasty: An annuloplasty can be performed through open-heart surgery or minimally invasive surgery. During the procedure, your surgeon sews a band designed to reshape or reinforce the existing ring around your valve to improve its functionality and correct blood flow. This procedure is not used for aortic valve stenosis.
• Transcatheter aortic valve replacement (TAVR): TAVR is a minimally invasive surgery that allows your heart surgeon to repair a damaged aortic valve. Using a catheter, the surgeon guides a new valve to the site of the damaged valve and expands it, pushing the old valve out of the way.
• Transcatheter edge to edge repair (TEER): This procedure uses a similar approach to TAVR but serves to repair damage to the mitral valve. During the procedure, a catheter is used to guide a device that clips mitral valve leaflets together to improve valve closure and reduce leaking.
• Transcatheter tricuspid valve replacement (TTVR): TTVR is a minimally invasive procedure used to treat a damaged tricuspid valve in the heart. Instead of open-heart surgery, a catheter is inserted through a blood vessel (usually the vein in the upper area of your leg/hip) and guided to the right side of the heart to replace the valve.