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Minimal-invasiver Pulmonalklappenersatz bei pädiatrischen Patienten

Stellenwert der Bildgebung

Minimally invasive pulmonary valve replacement in pediatric patients

Importance of imaging

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Zusammenfassung

Klinisches/methodisches Problem

Pulmonale Regurgitation oder Strenosen sind nicht selten Folgen operativ korrigierter rechtsventrikulärer Ausflusstrakte (RVOT) bei angeborenen Herzfehlern.

Radiologische Standardverfahren

Die radiologische Bildgebung, insbesondere die MRT, ist ein zentrales Verfahren, das einen großen Stellenwert in der Diagnostik und Verlaufskontrolle angeborener Herzfehler hat.

Methodische Innovationen

Mit der perkutanen Pulmonalklappenimplantation (PPVI) steht seit einiger Zeit ein minimal-invasives Verfahren zur Verfügung, das bei ausgewählten Patienten eine Alternative zur Operation der meist voroperierter RVOTs darstellt.

Leistungsfähigkeit

Darstellung der anatomischen Verhältnisse, Berechnung der rechtsventrikulen Volumina und Funktion sowie Flussmessungen sind zentrale Bestandteile der Untersuchungen zur Beurteilung von Problematiken des RVOT.

Bewertung

Die Bildgebung leistet einen wichtigen Beitrag zur Auswahl der für einen Pulmonalklappenersatz geeigneten Patienten und kann in Follow-up-Untersuchungen den Erfolg der Intervention belegen bzw. Komplikationen entdecken.

Empfehlung für die Praxis

Unterschiedliche Bildgebungsmodalitäten stehen für die Bildgebung vor und nach PPVI zur Verfügung. Nach Möglichkeit und in Abhängigkeit von der Fragestellung sollte die MRT zum Einsatz kommen, da sie ohne Strahlenbelastung die meisten relevanten Informationen liefern kann.

Abstract

Clinical/methodical issue

Right ventricular outflow tract (RVOT) dysfunction with pulmonary regurgitation or obstruction is a common postsurgical consequence in congenital heart disease.

Standard radiological methods

Magnetic resonance imaging (MRI) is widely accepted as standard method of imaging in congenital heart disease. It provides anatomical and functional information without radiation exposure and is therefore well suited for serial examinations.

Methodical innovations

Percutaneous pulmonary valve implantation (PPVI) has been shown to be a safe and effective treatment option for patients with pulmonary valve insufficiency or stenosis. Correct patient selection for PPVI is crucial. It is important to be familiar with the indications and anatomical requirements for stent placement and to tailor imaging protocols.

Performance

Imaging the RVOT, assessment of right ventricular volumes and function and calculation of pulmonary flow and regurgitation are core elements of the MRI examination prior to PPVI. Low interobserver and intraobserver variation allows even small changes to be detected.

Achievements

Imaging provides relevant information for correct patient selection for PPVI and is part of postinterventional follow-up. Imaging is an important tool for documentation of success and for detection of complications.

Practical recommendations

Several imaging modalities are used for evaluation of RVOTs; however, MRI can provide answers to most questions without radiation exposure.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. Bauner und K. Kozlik-Feldmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    K. Bauner

  2. Abteilung für Kinderkardiologie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    R. Kozlik-Feldmann

Authors
  1. K. Bauner
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Correspondence to K. Bauner.

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Bauner, K., Kozlik-Feldmann, R. Minimal-invasiver Pulmonalklappenersatz bei pädiatrischen Patienten. Radiologe 53, 880–885 (2013). https://doi.org/10.1007/s00117-012-2471-4

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  • DOI: https://doi.org/10.1007/s00117-012-2471-4

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