Kernaussagen
Bei Patientinnen mit Herzklappenfehlern ist vor der Schwangerschaft eine klinische und echokardiografische Untersuchung zu empfehlen, um die LV-Funktion und das Ausmaß des Herzfehlers zu bestimmen. Das mütterliche Risiko ist in den folgenden Fällen deutlich erhöht:
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eingeschränkte LV-Funktion
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obstruktives Vitium
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vorangegangene kardiale Dekompensationen
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thromboembolische Ereignisse
Treffen mehrere dieser Risikofaktoren zu, sollte von einer Schwangerschaft abgeraten werden. Patientinnen mit Herzfehlern sollten in jedem Trimenon kardiologisch untersucht werden.
Bei mechanischen Herzklappen sollte zwischen der 6. und 12. Woche sowie nach der 36. Woche eine Antikoagulation von Phenprocoumon auf unfraktioniertes oder niedermolekulares Heparin umgestellt werden. Dabei ist die engmaschige Kontrolle und sorgfältige Gerinnungseinstellung von entscheidender Bedeutung. Die Anwendung von niedermolekularem Heparin zur Antikoagulation ist umstritten, da niedermolekulares Heparin bei Patienten mit Herzklappenersatz bisher nicht zugelassen ist und es keine randomisierte Studie gibt, in der geprüft wurde, ob ein niedermolekulares Heparin für Herzklappenpatienten anzuwenden ist.
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Prof. Dr. I. Ott
Deutsches Herzzentrum
Lazarettstr. 36
80636 München
Email: ott@dhm.mhn.de
