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Rofo 2022; 194(04): 373-383
DOI: 10.1055/a-1718-4182
Review

CT-Planung vor kathetergestütztem Mitralklappenersatz (TMVR)

Article in several languages: English | deutsch
Linda Heiser
1   Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
,
Robin F. Gohmann 
1   Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
,
Thilo Noack
2   Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
,
Katharina Renatus
1   Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
3   Medical Faculty, University of Leipzig, Leipzig, Germany
,
Philipp Lurz
4   Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
5   LHI, Leipzig Heart Institute, Leipzig, Germany
,
Holger Thiele
3   Medical Faculty, University of Leipzig, Leipzig, Germany
4   Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
5   LHI, Leipzig Heart Institute, Leipzig, Germany
,
Patrick Seitz‡
1   Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
,
Matthias Gutberlet  ‡
1   Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
3   Medical Faculty, University of Leipzig, Leipzig, Germany
5   LHI, Leipzig Heart Institute, Leipzig, Germany
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CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR)Rofo 2022; 194(04): e1-e1
DOI: 10.1055/a-1823-4613

Zusammenfassung

Hintergrund Der Transkatheter-Mitralklappenersatz (TMVR) ist ein interventionelles Verfahren zur Behandlung einer hochgradigen Mitralklappeninsuffizienz bei Patienten mit hohem operativen Risiko.

Während der Intervention ist keine direkte Sicht auf die Mitralklappe gegeben, wodurch beispielweise eine intraoperative Größenauswahl der Mitralklappenprothese nicht möglich ist. Daher sind im Vorfeld der Prozedur sowohl die Bestimmung und Ausmessung der individuellen Mitralklappenanatomie als auch eine Beurteilung hinsichtlich der morphologischen Eignung bezüglich Ausflusstraktanatomie und der voraussichtlichen Verankerung der geplanten Mitralklappenprothese mittels einer nicht invasiven Darstellung erforderlich.

Ziel dieses Review-Artikels ist es, die Rolle der Computertomografie (CT) im Rahmen der Planung für TMVR einzuordnen.

Methode Begutachtung und Einordnung der aktuellen Behandlungsleitlinien der entsprechenden Fachgesellschaften (European Society of Cardiology [ESC], American Heart Association [AHA/ACC]) sowie von Metaanalysen und Originalstudien, welche den Suchbegriffen „TMVR“ bzw. „TMVI“ und „CT“ enthielten. Ergänzend dazu wurden Erkenntnisse aus der eigenen klinischen Erfahrung der Autoren eingebracht.

Schlussfolgerung Mit der CT sind die Vermessung des Mitralklappenannulus mit hoher räumlicher und adäquater zeitlicher Auflösung und damit eine zuverlässige präinterventionelle Größenbestimmung der zu implantierenden Mitralklappenprothese möglich. Des Weiteren können mittels der CT Aussagen über die Klappen- und Ausflusstraktanatomie, Mitralklappenverkalkungen, die Konfiguration von Papillarmuskeln und des linken Ventrikels getroffen werden. Darüber hinaus können mittels der CT alle potenziellen Zugangswege für die Intervention dargestellt werden.

Kernaussagen: 

  • Die CT nimmt eine Schlüsselrolle in der Bildgebung vor TMVR ein.

  • Eine genaue Prothesen-Größenbestimmung ist anhand von Messwerten aus der CT zuverlässig möglich.

  • Mit der CT können zusätzlich LVOT-Anatomie, Mitralklappenverkalkungen und interventionelle Zugangswege beurteilt werden.

Zitierweise

  • Heiser L, Gohmann RF, Noack T et al. CT Planning prior to Transcatheter Mitral Valve Replacement (TMVR). Fortschr Röntgenstr 2022; 194: 373 – 383

Key words

TMVI - TMVR - transcatheter mitral valve implantation - transcatheter mitral valve replacement - computed tomography - CT


Publication History

Received: 30 July 2021

Accepted: 09 November 2021

Article published online:
10 March 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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