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Kardiologie up2date 2010; 6(1): 59-74
DOI: 10.1055/s-0029-1243921
Aortenerkrankungen

© Georg Thieme Verlag KG Stuttgart · New York

Die asymptomatische Aortenklappenstenose

Edda  Bahlmann, Karl-Heinz  Kuck, Christoph  A.  Nienaber
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Publication History

Publication Date:
23 March 2010 (online)

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Abstract

Aortic stenosis is the most frequent type of valvular heart disease in Europe and North America. Calcific aortic valve disease is the leading etiology in industrialized countries. Doppler echocardiography plays a key role in the grading of aortic valve stenosis. Symptomatic patients with severe aortic stenosis have a very poor prognosis and indication for valve replacement. It is often difficult, particularly in older patients with comorbidities to be confident about the origin of symptoms which might lead to operation in a patient with a low chance of symptomatic and prognostic improvement. Management of asymptomatic severe aortic stenosis is controversial and challenging. Reliable risk stratification is helpful for identification of asymptomatic patients at high risk who would benefit from early aortic valve replacement with the goal to reduce mortaility. Assessment of valve calcification, hemodynamic progression and LV function, clinical parameters, exercise testing and cardiac biomarkers have been reported as major predictors of clinical outcome.

Kernaussagen

  • Bei asymptomatischen Patienten mit hochgradiger Aortenklappenstenose ist das perioperative Mortalitätsrisiko und das jährliche Risiko der Prothesenkomplikation größer als das Risiko der wachsamen Verlaufsbeobachtung. Dennoch müssen diese Patienten engmaschig durch klinische und echokardiografische Nachsorge überwacht werden und über die Symptome aufgeklärt werden. Belastungstests sollten bei unklarem Symptomstatus hinzugezogen werden.

  • Ein frühzeitiger Aortenklappenersatz erscheint bei Patienten mit höherem Risikoprofil (ausgeprägte Aortenklappenkalzifizierung, schnelle Aorten-Jet-Progression in Verlaufskontrollen, gleichzeitige KHK, LV-Dsyfunktion, erhöhte BNP-Spiegel und in einzelnen Fällen vor Zuweisung großer elektiver nicht kardialer chirurgischer Eingriffe) vernünftig.

  • Ein präventiver Aortenklappenersatz könnte sich bei reduziertem Operations- oder Interventionsrisiko als das Verfahren der Wahl herausstellen. Eine solche Strategie setzt allerdings die verbesserte Beurteilbarkeit der Prognose durch nicht invasive Testverfahren und Fortschritte bei prothetischen Aortenklappen und perkutanen Klappen voraus.

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Dr. med. Edda Bahlmann

II. Medizinische Klinik – Kardiologie
Asklepios-Klinik St. Georg

Lohmühlenstraße 5
20099 Hamburg

Email: Doc_Edda@hotmail.com

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