Herz

, Volume 40, Issue 5, pp 759–764 | Cite as

Trikuspidalklappeninterventionen

Was ist machbar?
Schwerpunkt

Zusammenfassung

Aufgrund der steigenden Lebenserwartung und der immer besseren kardiologischen Behandlungsmöglichkeiten werden auch Erkrankungen der Trikuspidalklappe – insbesondere die Trikuspidalinsuffizienz – häufiger und rücken in den Fokus der interventionellen Kardiologie. Die Entwicklung interventioneller Verfahren zum Trikuspidalklappenersatz steht dabei noch viel mehr als bei anderen Klappenerkrankungen vor der Herausforderung, dass es sich bei dieser Erkrankung nicht um einen isolierten strukturellen Klappendefekt handelt, sondern dass die Funktion der Trikuspidalklappe und damit die Entwicklung der Insuffizienz wesentlich an die myokardiale Funktion und Dilatation des rechten Ventrikels geknüpft sind. In den letzten Jahren konnten durch erste klinische Erfahrungen sowohl mit dem kavalen Klappenersatz (CAVI) als perkutanem Ersatzverfahren als auch mit kathetergeführten Rekonstruktionsverfahren wie dem Mitralign™- oder TriCinch™-System wesentliche Fortschritte in der interventionellen Therapie dieser Erkrankung erzielt werden. Mittelfristig ist davon auszugehen, dass perkutane Systeme und Therapieoptionen für diese Indikation verfügbar sein werden, wobei dann in entsprechenden Studien der funktionelle oder prognostische Effekt dieser Behandlungsverfahren in den jeweiligen Patientengruppen zu belegen sein wird.

Schlüsselwörter

Trikuspidalinsuffizienz Trikuspidalstenose Klappenersatz Rekonstruktion Kardiologie 

Interventions at the tricuspid valve

What is possible?

Abstract

Due to the increased life expectancy and continual improvements in cardiological treatment options, diseases of the tricuspid valve, in particular tricuspid valve insufficiency will become increasingly more recognized as an interventional target. While tricuspid stenosis is rare and can be effectively treated with balloon valvuloplasty, no effective transcatheter approach to tricuspid regurgitation (TR) has yet been established. As the tricuspid annulus is a complex and highly dynamic structure that offers little resistance, orthotopic long-term fixation of transcatheter valves with the current techniques is challenging and has not yet been performed in human patients. Alternative treatment concepts include transcatheter caval valve implantation (CAVI) to address the regurgitation of blood into the caval veins, which has resulted in hemodynamic improvement and is currently undergoing further clinical investigation. Other interventional treatment concepts are aimed at tricuspid valve repair, e.g. by annular plication with the Mitralign™ device or the TriCinch™ system. In the medium-term it can be assumed that percutaneous systems and therapy options will become available for these indications whereby the functional and prognostic effects of these treatment procedures will be corroborated in the appropriate patient groups by corresponding studies.

Keywords

Tricuspid valve regurgitation Triscupid valve stenosis Valve replacement Reconstruction Cardiology 

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Copyright information

© Urban & Vogel 2015

Authors and Affiliations

  1. 1.Medizinische Klinik für KardiologieCharité – Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland
  2. 2.Klinik für Innere Medizin I/KardiologieUniversitäts-Herzzentrum JenaJenaDeutschland

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