Indikationen zur Operation bei kardialen Vitien

Zusammenfassung

Im Zuge der demografischen Entwicklung gewinnen erworbene Erkrankungen der Herzklappen zunehmend an Bedeutung. Dies gilt insbesondere für meist altersbedingte, primäre Veränderungen der Aorten- und Mitralklappe. Es betrifft aber auch sekundäre Veränderungen der Mitral- und Trikuspidalklappe im Rahmen anderer mit dem Alter zunehmender Herzerkrankungen. Die medikamentöse Therapie beschränkt sich auf eine ausreichende diuretische Therapie, um die Symptome zu verbessern. Spezifische medikamentöse Therapien oder solche mit nachgewiesenem prognostischem Nutzen stehen nicht zur Verfügung. Bei relevanten Vitien ist daher eine Rekonstruktion oder ein Ersatz der defekten Herzklappe die wichtigste Therapieoption. Während dies lange Zeit nur mithilfe einer konventionellen Operation möglich war, spielen im vergangenen Jahrzehnt zusehends interventionelle, d. h. kathetergestützte Therapieformen eine Rolle. Die vorliegende Arbeit beschreibt die aktuell geltenden Empfehlungen zur Indikationsstellung für eine Operation der wichtigsten chronischen Klappenvitien bei Erwachsenen – die Aortenklappenstenose und –insuffizienz sowie die Mitral- und Trikuspidalklappeninsuffizienz.

Abstract

Due to the demographic change, chronic valvular heart disease becomes increasingly important – especially age-related primary diseases of the aortic and mitral valve as well as secondary diseases of the mitral and tricuspid valve caused by other age-related cardiac disorders. Medical treatment is limited to symptom relief by use of diuretics. Specific drugs or drugs with a prognostic benefit are not available. Thus, valve repair or replacement are the key options for treatment of relevant valvular heart disease. While open heart surgery was the only approach for a long time, interventional, catheter-based therapies have evolved in the last decade. This article describes up-to-date recommendations on indications for surgery for the most prevalent valvular heart diseases in adults – aortic stenosis, and aortic, mitral and tricuspid regurgitation).

Schlüsselwörter

Vitien - Herzklappen - Operationsindikation - Empfehlungen

Keywords

Valvular heart disease - indications for surgery - recommendations

• Literatur

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