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Bedeutung des rechten Ventrikels bei Erwachsenen mit angeborenen Herzfehlern

Besonderheiten des chirurgischen und perioperativen Managements

Importance of the right ventricle in adults with congenital heart diseases

Special considerations for surgical and perioperative management

  • Perioperative Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Zahl der Erwachsenen mit angeborenen Herzfehlern (EMAH) übersteigt bereits jetzt die der Kinder mit angeborenen Herzfehlern, und ein weiterer Anstieg ist zu erwarten. Eine Besonderheit dieser Patienten ist der rechte Ventrikel (RV), da dieser häufig lange Zeit unphysiologischen Bedingungen ausgesetzt ist. Insbesondere Patienten mit dem RV in der Systemzirkulation nehmen eine Sonderstellung ein. Deren chirurgisches und perioperatives Management berücksichtigt die Besonderheiten des RV und bezieht individuelle patientenspezifische Faktoren ein. Operative Strategien versuchen, die RV-Funktion langfristig zu erhalten und assoziierte Vitien zu korrigieren. Die perioperative Betreuung dieser Patienten ist auf die Anpassung der Vor- und Nachlast fokussiert, häufig mit dem Ziel, die Vorlast zu erhöhen, die Nachlast zu senken und frühe Spontanatmung zu etablieren. Die Optimierung des Herzrhythmus und der Sauerstoffsättigung bilden zusätzliche Optionen. In einigen Fällen kann eine Stabilisierung lediglich durch mechanische Unterstützungssysteme oder durch eine Herztransplantation erreicht werden.

Abstract

Adults with congenital heart disease (ACHD) outnumber children with congenital heart disease and numbers are expected to increase further. A distinctive feature of these patients is the right ventricle (RV) as it is often exposed to non-physiological conditions for extended period of time. Especially patients with the RV in the systemic circulation form a unique subgroup. The respective surgical and perioperative management takes the characteristics of the RV into account and considers individual patient-specific aspects. Operative strategies aim to preserve RV function in the long term and to correct associated lesions. The perioperative care of these patients focuses on adequate adjustment of preload and afterload, often targeting an increase in preload, afterload reduction and transition to early spontaneous breathing. Other options are optimization of the heart rhythm and oxygen saturation. In some instances, stabilization can only be achieved with mechanical circulatory support or heart transplantation.

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Authors and Affiliations

  1. Kinderklinik für Kardiologie/Angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    P. Saur

  2. Division of Cardiovascular Surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, M5G 1X8, Toronto, Kanada

    C. Haller

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Correspondence to C. Haller.

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Interessenkonflikt

P. Saur und C. Haller geben an, dass kein Interessenkonflikt besteht.

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

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Saur, P., Haller, C. Bedeutung des rechten Ventrikels bei Erwachsenen mit angeborenen Herzfehlern. Z Herz- Thorax- Gefäßchir 33, 51–58 (2019). https://doi.org/10.1007/s00398-018-0276-0

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  • DOI: https://doi.org/10.1007/s00398-018-0276-0

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