Beurteilung und akutes Management der dekompensierten Klappenvitien auf der Intensivstation – eine aktuelle Übersicht

Zusammenfassung

Die akute valvuläre Dysfunktion ist eine zunehmend häufigere und kritische Ursache einer intensivmedizinischen Behandlung einer dekompensierten Herzinsuffizienz mit dem Auftreten eines kardiogenen Schocks als der schwerwiegendsten Form. Während es definierte Leitlinien sowohl für die Diagnostik und Therapie der Herzinsuffizienz als auch für stabile Patienten mit Herzklappenfehlern gibt, ist die Datenlage bei akut valvulär dekompensierten Patienten begrenzt. Bei drohender oder bestehender Organdysfunktion trotz Ausschöpfung aller medikamentösen Therapieoptionen stehen neben den chirurgischen Klappenoperationen verschiedene Katheter-interventionelle Therapieoptionen wie das TAVI- und das MitraClip-Verfahren zur Verfügung. Darüber hinaus haben zuletzt die Ballonvalvuloplastie bei der Aortenklappenstenose sowie perkutane Kreislaufunterstützungssysteme einen wachsenden Stellenwert bei der Behandlung und hämodynamischen Stabilisierung von dekompensierten Klappenpatienten auf der Intensivstation erlangt.

Abstract

The acute valvular dysfunction is a rapidly growing and critical condition in the intensive care unit with a cardiogenic shock as the most serious clinical entity. There are clearly defined guidelines for the diagnosis and treatment of heart failure and for stable patients with valvular heart disease. However, data regarding acutely valvular decompensated patients are currently limited. In case of secondary organ dysfunction despite optimal medical treatment, various percutaneous interventional procedures such as TAVI and MitraClip are now available besides surgical valvular repair. Moreover, balloon valvuloplasty for aortic stenosis and percutaneous mechanical circulatory support devices are emerging tools for the treatment and stabilization of valvular decompensated patients in the intensive care unit.

Schlüsselwörter

Valvuläre Dekompensation - kardiogener Schock - Ballonvalvuloplastie - MitraClip - TAVI - kardiale Kreislaufunterstützungssysteme

Key words

valvular decompensation - cardiogenic shock - balloon valvuloplasty - MitraClip - TAVI - cardiac circulatory assist devices

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