Zusammenfassung
Zur Beurteilung des Schweregrades einer Aortenstenose ist die transthorakale Echokardiographie mit der Bestimmung von mittlerem Druckgradienten und Aortenöffnungsfläche unbestritten das Standardverfahren. Bei klinisch eindeutig gelagerten Fällen bereitet sie oft keinerlei Probleme. Ergänzende Untersuchungen sind häufiger notwendig bei einer Diskrepanz zu klinischen Befunden, bei schwer beeinträchtiger linksventrikulärer Funktion, Obstruktion im linksventrikulären Ausflusstrakt und inkonsistenter Schweregradbeurteilung anhand von Aortenöffnungsfläche und mittlerem Druckgradienten trotz erhaltener Ejektionsfraktion. Als ergänzende Untersuchung kommt in erster Linie die transösophageale Echokardiographie, in zweiter Linie auch eine Magnetresonanztomographie in Betracht. Mit beiden Verfahren ist eine direkte Planimetrie der Aortenöffnungsfläche möglich. Die Katheteruntersuchung aus hämodynamischen Gründen ist aufgrund des Embolierisikos bei der Klappenpassage ein Reserveverfahren in unklaren Fällen.
Abstract
The assessment of the severity of aortic stenosis is routinely performed by transthoracic echocardiography based on the measurement of mean pressure gradient and aortic valve area. In general it can be done without any problem especially if the measurements are concordant with clinical symptoms. Additional testing may be required if the measurements are at odds with clinical findings, in cases with severely depressed left ventricular function, obstruction in the left ventricular outflow tract or discrepancy in grading according to mean pressure gradient and aortic valve area despite preserved left ventricular function. Transesophageal echocardiography will often be the next step allowing direct planimetry of the aortic valve area or alternatively magnetic resonance imaging can be performed. Catheterization for hemodynamic reasons must be restricted to rare cases because of the risk of embolic events when crossing a calcified valve.
Abbreviations
- TTE:
-
transthorakale Echokardiographie
- TEE:
-
transösophageale Echokardiographie
- MRT:
-
Magnetresonanztomographie
- MPG:
-
mittlerer Druckgradient
- AÖF (A2):
-
Aortenöffnungsfläche
- A1 :
-
(berechnete) Fläche des linksventrikulären Ausflusstraktes
- V1 :
-
Doppler-Flussgeschwindigkeit im linksventrikulären Ausflusstrakt
- V2 :
-
Doppler-Flussgeschwindigkeit in der Aortenklappe
- VTI:
-
Geschwindigkeitszeitintegral
- CW:
-
Continuous-wave-Doppler
- PW:
-
Pulsed-wave-Doppler
- LVOT:
-
Linksventrikulärer Ausflusstrakt
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Der korrespondierende Autor weist auf folgende Beziehungen hin: Der korrespondierende Autor erhält Vorlesungshonorare von den Firmen Merck, Medtronic und AstraZeneca.
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Jander, N. Schweregradbeurteilung der Aortenklappenstenose. Kardiologe 3, 523–534 (2009). https://doi.org/10.1007/s12181-009-0220-3
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DOI: https://doi.org/10.1007/s12181-009-0220-3