Operative Verfahren auf dem Rückzug - Kathetertechniken zur Therapie der Herzinsuffizienz

Zusammenfassung

In den letzten Jahren wurden in der Katheterbehandlung nicht nur bei der koronaren Herzkrankheit, sondern auch bei vielen anderen Erkrankungen, die zu einer Herzinsuffizienz führen, erhebliche Fortschritte erzielt. Die größte Bedeutung hat momentan sicherlich die Ballondilatation der Koronararterien, es können aber auch stenosierte Herzklappen aufgedehnt werden. Gute Akut- und Langzeitergebnisse werden mit der Dilatation von Pulmonalstenosen erreicht - ein risikoarmes Verfahren. Dies gilt auch für die Dilatation der angeborenen Aortenstenose. Werden verkalkte Aortenstenosen dilatiert, sind Rezidive relativ häufig, sodass wiederholte Eingriffe erforderlich sind. Hier wird in Zukunft die kathetergesteuerte Implantation von Herzklappen eine neue Perspektive eröffnen. Die Akut- und Langzeitergebnisse der Mitralklappendilatation sind mit denen der operativen Kommissurotomie zu vergleichen. Sind bestimmte morphologische Kriterien der Klappen gegeben, ist wegen der geringeren Invasivität die Dilatation der Operation vorzuziehen. Shuntvitien werden heute wenn irgend möglich primär kathetertechnisch behandelt. Bei der Aortenisthmusstenose kann in den meisten Fällen eine Dilatation und/oder eine Stentimplantation erfolgen. In naher Zukunft wird auch die kathetertechnische Behandlung der Mitralinsuffizienz möglich sein.

Summary

Cardiac catheterization is not only a diagnostic but also an interventional therapeutic tool. Mainly used for treating coronary stenosis, cardiac catheterization can also be performed for therapeutic dilatation of calcified stenotic heart valves. The short- as well as the long-term results of dilatation in pulmonary valve stenosis are good, and can be done with low risk, as in congenital aortic valve stenosis. Recurrence of stenosis is common in dilatation of calcified aortic valves. Thus, repeated procedures are necessary. The development of catheter-based implantation of heart valves promises favorable prospects for the near future. Short- and long-term results of mitral valve dilatation are similar to surgical commissurotomy. If special morphologic criteria are present, the interventional therapy is preferred because it is less invasive. Today, in atrial septum and ventricular septum defects, cardiac catheterization techniques are first-line therapy. In aortic coarctation, dilatation with or without stent implantation can be performed in most cases. The near future will bring catheterization techniques for treatment of mitral regurgitation. In summary, much progress has been made not only in coronary interventional therapy but also in many other diseases which are associated with heart failure.

Key Words

dilatation - pulmonary stenosis - aortic stenosis - mitral valve stenosis - shunt vitium

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