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Echtzeit-3-D-Echokardiographie zur Schweregradbeurteilung von Herzklappenvitien

Einfluss auf aktuelle Leitlinien

Real-time 3D echocardiography for estimation of severity in valvular heart disease

Impact on current guidelines

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Zusammenfassung

Neben der räumlich-anatomischen Darstellung von Herzklappen verspricht die Echtzeit-3-D-Echokardiographie mit Hilfe des Farbdopplers eine genauere Klappenflussquantifizierung als herkömmliche 2‑D-Methoden. Insbesondere wurde die Quantifizierung des Regurgitationsflusses bei Mitralklappeninsuffizienz mittels der PISA („proximal isovelocity surface area“)-Methode und der VCA („vena contracta area“)-Methode in verschiedenen Studien validiert. Speziell die Beurteilung der VCA mittels Farbdoppler-Echtzeit-3-D-Echokardiographie (FD-3DE) führte zu einem Paradigmenwechsel im Verständnis der VCA, da sich die VCA in der Mehrzahl der Fälle als stark asymmetrisch zeigte. In der vorliegenden Arbeit werden der aktuelle Stellenwert und die klinische Anwendbarkeit der unterschiedlichen FD-3DE-basierten Methoden zur Schwergradbeurteilung von Herzklappenvitien, insbesondere von Klappeninsuffizienzen, ausführlich beschrieben.

Abstract

Besides providing spatial anatomic information on heart valves, real-time three-dimensional echocardiography (3DE) combined with color Doppler has the potential to overcome the limitations of flow quantification inherent to conventional 2D color Doppler methods. Recent studies validated the application of color Doppler 3DE (cD-3DE) for the quantification of regurgitation flow based on the vena contracta area (VCA) and the proximal isovelocity surface area (PISA) methods. Particularly the assessment of VCA by cD-3DE led to a change of paradigm by understanding of the VCA as being strongly asymmetric in the majority of patients and etiologies. This review provides a comprehensive description of the different concepts of cD-3DE-based flow quantification in the setting of different valvular heart diseases and their presentation in recent guidelines.

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Authors and Affiliations

  1. Medizinische Klinik III, Klinik für Kardiologie, Klinikum Westfalen, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Deutschland

    T. Buck FESC, FACC & B. Plicht

  2. Medizinische Universitätsklinik II – Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland

    L. Bösche

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  1. T. Buck FESC, FACC
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Correspondence to T. Buck FESC, FACC.

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T. Buck, L. Bösche und B. Plicht geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Buck, T., Bösche, L. & Plicht, B. Echtzeit-3-D-Echokardiographie zur Schweregradbeurteilung von Herzklappenvitien. Herz 42, 241–254 (2017). https://doi.org/10.1007/s00059-017-4540-y

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