Angeborene Shuntvitien

Zusammenfassung

Angeborene Shuntvitien sind mit einer Häufigkeit von etwa 60 % aller angeborenen Herzfehler die größte Gruppe der angeborenen Vitien. Die Defekte können auf der Ebene der großen Venen, der Vorhöfe, Ventrikel und der großen Arterien lokalisiert sein. Die Defektgröße und das Widerstandsverhältnis zwischen Lungen- und Körperkreislauf bestimmen die hämodynamischen Folgen: Herzinsuffizienz und pulmonale Druckerhöhung. Letztere erfordern eine frühzeitige operative Korrektur im Säuglingsalter, um einen irreversiblen pulmonalen Hypertonus zu vermeiden. Mittelgroße Defekte werden bei entsprechender Symptomatik und nach Diagnostik (Echokardiografie, MRT, Herzkatheter) operativ oder häufiger katheterinterventionell behandelt. Vorhofseptumdefekte und/oder Lungenvenenfehlmündungen können bis zum Erwachsenenalter unentdeckt bleiben. Daher sollte eine echokardiografische Vergrößerung des rechten Vorhofs und Ventrikels den Verdacht auf ein Vitium cordis lenken.

Abstract

Congenital heart defects with left-to-right-shunting constitute about 60 % of congenital heart defects. These defects may be located at the level of the great veins, the atria and ventricles and the great arteries. The hemodynamic effects depend on defect size and the ratio of resistance in pulmonary vs. systemic circulation: the development of heart failure und pulmonary hypertension. Heart failure and pulmonary hypertension should indicate surgical correction in infancy preventing fixed pulmonary hypertension. Midsize defects should be corrected according to symptoms and findings of echocardiography, MRT and cardiac catheterization surgically or by catheter interventions. Atrial septal defects and partial anomalous pulmonary venous connections may be missed until adulthood. Right atrial or ventricular dilatation detected by echocardiography should raise suspicion for these congenital heart defects.

Schlüsselwörter

angeborene Herzfehler - pulmonale Hypertension - Operation - Katheterintervention

Key words

congenital cardiac defects - pulmonary hypertension - surgical defect closure - percutaneous interventions

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