Il caso invece del paziente numero 32 è esemplificativo della situazione opposta. Si può notare una riduzione dei metri percorsi al 6MWT del follow-up, a cui è associato un evidente incremento del numero delle linee B, un incremento della frequenza cardiaca alla fine dell’esercizio. Sono quindi rilevabili i segni di aumentata congestione polmonare e di aumentato lavoro cardiaco, indicativi di un peggioramento della capacità di compenso, correlabile con un mancato miglioramento della patologia mitralica. Anche in questo caso questa indicazione è in linea con quanto rilevato con l’esame ecocardiografico, che ha dimostrato la persistenza di un’IM di grado moderato-severo (3+).
8. CONCLUSIONI
L’analisi della casistica dei pazienti reclutati mostra risultati in linea con quanto descritto da altri studi, tra cui l’EVEREST II72,73
e l’ACESS-EU74, da cui risulta che in pazienti ad elevato rischio
chirurgico tale tecnica sia un’opzione efficace e con un buon grado di sicurezza.
Per quanto riguarda la parte di questo studio relativa alla valutazione della ripresa delle capacità funzionali a seguito dell’intervento, non possono essere estrapolate indicazioni di carattere generale, in quanto si tratta di uno studio in fase iniziale con un numero di pazienti arruolati limitato.
Appare tuttavia interessante notare che, anche in pazienti compromessi come quelli reclutati per l’intervento di Mitraclip, una valutazione clinico-funzionale possa dare informazioni complementari ed aggiuntive che possano risultare di valido aiuto per l’inquadramento diagnostico e per il follow-up a medio termine di questa particolare tipologia di pazienti. Oltretutto le valutazioni proposte da questo studio possono, in prospettiva, essere facilmente eseguite anche in contesti clinici non specialistici, ed essere utilizzate sia in campo di ricerca che clinico per lo studio e l’inquadramento di popolazioni più ampie di pazienti.
9. RINGRAZIAMENTI
Desidero ringraziare la professoressa Anna Sonia Petronio per avermi proposto quest’argomento di tesi e per avermi guidato nei mesi di preparazione del lavoro.
Ringrazio in maniera particolare la dottoressa Cristina Giannini, per il suo concreto aiuto e supporto in tutte le fasi dello studio e la sua completa disponibilità; inoltre il dottor Paolo Spontoni e tutto il personale medico, tecnico ed infermieristico della S.D. di Emodinamica per la disponibilità dimostratami.
Un ringraziamento anche al professor Mario Marzilli ed ai medici ed infermieri della U.O. di Malattie Cardiovascolari 1, che mi hanno supportata e sopportato durante i mesi di preparazione della tesi.
Infine ringrazio la mia famiglia e i miei amici per avermi sostenuto in tutti i modi possibili affinchè io riuscissi a portare a termine questo studio, ma anche e soprattutto il mio percorso universitario.
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