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
