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Dekompensiertes Klappenvitium: das Revival der Ballonvalvuloplastie – perkutane Klappeninterventionen

Decompensated Valve Failure: the Revival of Balloon Valvuloplasty – Percutaneous Valve Intervention

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Zusammenfassung

Die kalzifizierte Aortenklappenstenose ist der häufigste Herzklappenfehler. Betroffen sind ältere Menschen, die häufig zusätzlich Komorbiditäten wie linksventrikuläre Dysfunktion, eingeschränkte Nierenfunktion und pulmonale Hypertonie aufweisen. Das operative Risiko ist erhöht. Mit der perkutanen Valvuloplastie der Aortenklappe können eine Symptomreduktion und Zunahme der Leistungsfähigkeit und damit eine bessere Lebensqualität erreicht werden. Neuere Ergebnisse zeigen sogar eine verbesserte Überlebensrate. Neue Techniken haben zu einem „Revival“ dieser vor gut 20 Jahren implementierten Methode geführt. Im akuten Notfall mit kardialer Dekompensation ist die Letalität weiterhin hoch. Eine Stabilisierung zur Vermeidung von ventrikulären Arrhythmien oder elektromechanischer Entkoppelung kann durch die Anwendung von Amiodaron erreicht werden. Eine intensivmedizinische Stabilisierung des Patienten vor Durchführung der Valvuloplastie ist ratsam. Bei Restenosen von Bioprothesen lässt sich mit der Valvuloplastie nur kurzfristig eine Verbesserung der Hämodynamik erzielen. Ein chirurgischer Aortenklappenersatz oder eine perkutane Prothesenimplantation („valve-in-valve“) muss rasch durchgeführt werden.

Abstract

Calcified aortic stenosis is the dominating valve disease. Patients affected are most commonly elderly people, who often show associated comorbidities like reduced left ventricular function, impaired renal function, and pulmonary hypertension. The risk of open heart surgery is elevated. Balloon aortic valvuloplasty enables a reduction of symptoms, an increase in physical performance, and, therefore, an improved quality of life. Recent data also demonstrated an improved survival of patients after valvuloplasty. New techniques and improved equipment induced a “revival” of balloon aortic valvuloplasty, which has been introduced more than 20 years ago. In acute emergencies, however, mortality is high. Hemodynamic stabilization in the intensive care unit prior to valvuloplasty is recommended. If restenosis in aortic bioprosthesis has occurred, hemodynamic improvement is very limited. Surgical valve replacement or percutaneous transcatheter valve implantation as valve-in-valve must be considered in the short term.

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Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, München, Germany

    Werner Zwehl

  2. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, Kölner Platz 1, 80804, München, Germany

    Stefan Sack

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  1. Stefan Sack
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  2. Jochen Menne
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  3. Thomas Krüger
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  4. Michael Weber
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  5. Dieter Müller
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  6. Werner Zwehl
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Correspondence to Stefan Sack.

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Sack, S., Menne, J., Krüger, T. et al. Dekompensiertes Klappenvitium: das Revival der Ballonvalvuloplastie – perkutane Klappeninterventionen. Herz 34, 206–210 (2009). https://doi.org/10.1007/s00059-009-3233-6

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