Herz

, Volume 40, Issue 5, pp 765–770 | Cite as

Interventioneller Verschluss von Vorhofseptumdefekt, persistierendem Foramen ovale und Ventrikelseptumdefekt

  • Marius Hornung
  • Jennifer Franke
  • Dani Id
  • Horst Sievert
Schwerpunkt

Zusammenfassung

Der interventionelle Verschluss kongenitaler Shunt-Vitien ist zu einem in der klinischen Routine etablierten Verfahren herangereift. So stellt der Katheterverschluss mittlerweile die Therapie der Wahl in der Behandlung des ASD dar. Er ist in fast allen Fällen der Defekte vom Sekundumtyp anatomisch möglich und mit einer Erfolgsrate von über 99 % technisch durchführbar. Der Eingriff kann in der Regel ohne Vollnarkose durchgeführt werden und erfordert nur einen kurzen Krankenhausaufenthalt. Das PFO ist eine potenzielle Durchtrittspforte für paradoxe Embolien. Diese können zu embolischen Schlaganfällen bzw. peripheren Embolien führen. Der Katheterverschluss hat im Vergleich zu einer lebenslangen Antikoagulation viele Vorteile und ist für manche Patienten die einzige therapeutische Option. Randomisierte Studien haben gezeigt, dass der interventionelle Verschluss zu Ergebnissen führt, die der medikamentösen Therapie vergleichbar sind. Bei einigen Okkludertypen gelang sogar der Nachweis signifikanter Vorteile gegenüber der medikamentösen Behandlung. Auch VSD einschließlich perimembranöser Defekte können in vielen Fällen kathetertechnisch verschlossen werden. Dies gilt sogar für VSD, die durch eine Ruptur des Septums infolge eines Myokardinfarkts entstanden sind.

Schlüsselwörter

Kongenitale Herzfehler Myokardinfarkt Embolien Shunt Katheter 

Interventional closure of atrial septal defects, patent oval foramen and ventricular septal defects

Abstract

Percutaneous transcatheter closure techniques and devices for congenital intracardiac shunts have considerably improved; therefore, catheter closure is now the treatment of choice for atrial septal defects (ASD). This is technically feasible in more than 80 % of patients with a secundum ASD and the success rate is higher than 99 %. General anesthesia is as a rule unnecessary and the hospital stay is very short. A patent oval foramen (POF) is a potential cause of cryptogenic stroke and peripheral embolisms. The catheter occlusion has many advantages in comparison to lifelong anticoagulation therapy and for some patients it is the only therapeutic option. Randomized trials have shown that interventional closure leads to results which are comparable to drug therapy and for some occlusion systems even evidence of significant advantages compared to drug therapy was found. Even ventricular septal defects (VSD), including perimembraneous and post-myocardial infarction VSDs can be closed by catheter techniques with a high success rate.

Keywords

Congenital heart defects Myocardial infarction Embolisms Shunt Catheter 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Das Zentrum der Autoren erhielt Studienhonorare, Beratungs- oder Reisekosten von oder hält Beteiligungen an folgenden Firmen: Abbott, Access Closure, AGA, Angiomed, Arstasis, Atritech, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Cardiac Dimensions, CardioKinetix, CardioMEMS, Coherex, Contego, CSI, EndoCross, EndoTex, Epitek, Evalve, ev3, FlowCardia, Gore, Guidant, Guided Delivery Systems Inc., InSeal Medical, Lumen Biomedical, HLT, Kensey Nash, Kyoto Medical, Lifetech, Lutonix, Medinol, Medtronic, NDC, NMT, OAS, Occlutech, Osprey, Ovalis, Pathway, PendraCare, Percardia, pfm Medical, Rox Medical, Sadra, SJM, Sorin, Spectranetics, SquareOne, Trireme, Trivascular, Velocimed, Veryan.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Urban & Vogel 2015

Authors and Affiliations

  • Marius Hornung
    • 1
  • Jennifer Franke
    • 1
  • Dani Id
    • 1
  • Horst Sievert
    • 1
  1. 1.CardioVasculäres Centrum CVCFrankfurtDeutschland

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