Chiusura Difetto interatriale con patch dacron sauvage in toracotomia anterolaterale destra.

Il difetto interatriale (DIA), o meglio conosciuto come forame ovale pervio, consiste in una comunicazione nella parete che separa gli atri, il setto interatriale. Prima della nascita, questa apertura è importante perché́ consente al sangue ossigenato, proveniente dalla madre, di circolare nel feto. Dopo la nascita, il forame ovale si chiude formando una parete solida (setto), perché́ il flusso sanguigno da destra a sinistra non è più̀ necessario. Quindi in questo tipo di difetto una quota di sangue, che dipende dalla grandezza del difetto, passa dall’atrio sinistro all’atrio destro e va ad ossigenarsi (inutilmente in quanto già ossigenato) ai polmoni, i quali ricevono un quantitativo di sangue superiore al normale.

Nella grandissima maggioranza dei casi il DIA non da sintomi durante l’infanzia. Sebbene il DIA sia una malformazione congenita, e come tale presente dalla nascita, esso di solito viene scoperto successivamente, poiché i reperti ascoltatori cardiaci sono poco appariscenti. A volte anche difetti interatriali di piccole dimensioni (4-5 mm) possono chiudersi spontaneamente in qualche mese. Un DIA che non sia piccolissimo deve di regola essere chiuso in età prescolare (può comportare rischio di ictus, ipertensioni polmonari).

La chiusura è effettuata per mezzo di un intervento chirurgico a cuore aperto in circolazione extracorporea. L’atrio destro viene aperto ed il DIA viene chiuso o con una sutura diretta o, se è molto grande, con un patch di materiale sintetico.

Negli ultimi 10 anni il progresso medico ha consentito di perfezionare materiali e metodi capaci di sostituirsi alla chirurgia.

Trattamento chirurgico Forame ovale pervioL’Amplatzer Septal Occluder (occlusore settale di Amplatz, che è il nome del cardiologo che lo ha ideato) è l’ultimo di questi ed ha guadagnato ampi consensi per le caratteristiche innovative del materiale e per la sua sicurezza. Il dispositivo viene inserito nel forame ovale pervio (PFO) durante la procedura percutanea e rimarrà̀ per sempre impiantato. L’AMPLATZER PFO Occluder è realizzato con fili intrecciati di nitinol, un metallo con caratteristiche di memoria di forma. Ciò̀ significa che il dispositivo recupererà̀ la sua forma originaria anche dopo essere stato manipolato per poter passare attraverso il catetere. Il dispositivo è formato da due dischi tenuti insieme da una parte centrale ristretta. Per migliorare la capacità di chiusura del dispositivo, i dischi contengono un sottile tessuto di poliestere. Il tessuto è saldamente cucito ad ogni disco con un filo di poliestere. Tuttavia non sempre è possibile impiantare l’Amplatzer, in quanto esso richiede la presenza di lembi della membrana, dove andrà ad ancorarsi, ben solidi e ampi.

Fonti | Articolo e foto di Maria Russo

Domenico Posa
Amministratore e Facebook Manager | Frequento Scuola di Medicina e Chirurgia presso l'Università degli Studi di Bari "Aldo Moro." Fondatore ed ideatore del progetto "La medicina in uno scatto" | email - domenico.posa@gmail.com

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