Katheter statt Skalpell

Zusammenfassung

Die Behandlung angeborener Herzfehler umfasst nicht mehr ausschließlich herzchirurgische Eingriffe, sondern wird ergänzend oder alternativ durch Herzkatheterinterventionen erweitert. Einige der Prozeduren haben sich inzwischen zum Goldstandard der Primärtherapie entwickelt. Für komplexe Morphologien, insbesondere bei sehr jungen Patienten, hat sich zusätzlich die Möglichkeit der kombinierten chirurgisch-interventionellen Strategie – die Hybridintervention – entwickelt. Die Eingriffe wie der Implantatverschluss von Ventrikelseptumdefekten, die intraoperative Stentimplantation, der transventrikuläre Pulmonalklappenersatz erfolgen idealerweise im Hybrid-OP. Dieser voll ausgestattete Operationssaal, ergänzt um eine biplane Herzkatheteranlage, erlaubt völlig neue therapeutische Strategien wie beispielsweise die Stentimplantation in den Ductus arteriosus in Kombination mit einem bilateralen Pulmonalarterienbanding beim hypoplastischen Linksherzsyndrom. In der Risikoabwägung zwischen einem rein chirurgischen bzw. perkutanen Kathetereingriff werden Hybridverfahren derzeit individualisiert angeboten. Ob künftig eine primäre Indikation hierfür gestellt wird, werden die Langzeitergebnisse zeigen.

Summary

The treatment of congenital heart disease is no longer subjected to heart surgery, but is extended to transcatheter interventions, that are offered additionally or alternatively to the standard surgical procedure. Some of the catheterization techniques are meanwhile the golden standard for primary treatment. In complex morphologies, especially in young patients, joined efforts of surgeons and pediatric cardiologists lead to the additional hybrid approach. The intraoperative device closure of ventricular septal defects, stent implantation and the transcatheter pulmonary valve implantation during surgery, are ideally performed in a hybrid suite. The latter is equipped not only as a fully functioning operating room but with a regular biplane angiography facility. This allowed the development of completely new therapeutical strategies, as is stent implantation in the arterial duct combined with bilateral banding of the pulmonary arteries to treat newborns with hypoplastic left heart syndrome. Actually hybrid interventions are offered on an individual basis, weighing the risk versus a solely surgical or percutaneous procedure. Long term results will show whether they can be indicated for primary standard.

Schlüsselwörter

Herzfehler - Hybridintervention - Stent - Ductus arteriosus

Keywords

Congenital heart disease - hybrid intervention - stent - arterial duct

• Literatur

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