Die bikuspide Aortenklappe

Zusammenfassung

Die bikuspide Aortenklappe ist der häufigste kongenitale Herzfehler und gleichzeitig die häufigste angeborene Fehlbildung der Aortenklappe bei Erwachsenen. In dieser Übersichtsarbeit werden die verschiedenen Aspekte der bikuspiden Aortenklappe einschließlich ihrer Komplikationen unter klinischen Gesichtspunkten dargestellt.

Abstract

The bicuspid aortic valve is the most common congenital heart disease as also the most common congenital malformation of the aortic valve. Due to altered hemodynamics, anatomy and geometry of the valve apparatus there is a high risk of complications, with the most common of them the aortic valve stenosis. Echocardiography is primarily considered as the gold standard for the diagnosis. However computed tomography and magnetic resonance tomography belong to the diagnostic armamentarium for precise diagnosis, risk stratification and defining the therapeutic approaches. Operative aortic valve replacement has been ultimately the gold standard therapy for the bicuspid aortic valve, although in the last years, transaortic valve replacement emerge as an alternative option with excellent results.

Kernaussagen

• Die bikuspide Aortenklappe ist der häufigste kongenitale Herzfehler mit einer Inzidenz von 0,5 bis 2% und gleichzeitig die häufigste angeborene Fehlbildung der Aortenklappe bei Erwachsenen.

• Aufgrund des genetischen Hintergrunds ist ein echokardiografisches Screening wertvoll.

• Die Echokardiografie ist der diagnostische Goldstandard. CT und MRT gehören ebenfalls zum diagnostischen Armamentarium.

• Aufgrund der Pathogenität treten häufig Komplikationen auf, am häufigsten ist dabei die Aortenklappenstenose.

• Die Therapieoptionen sind die medikamentöse Behandlung, interventionelle und operative Behandlung, z. B. TAVI und der Aortenklappenersatz.

• Im Rahmen einer interventionellen Behandlung kann es zu Komplikationen kommen, die meist akut behandelt werden müssen, z. B. hochgradige AV-Blockierung oder schwere Blutung.

• Nicht nur der Klappenapparat, sondern auch Biomarker und insbesondere die Aorta müssen im Verlauf kontrolliert werden.

Schlüsselwörter

bikuspide Aortenklappe - Aortenklappenstenose - Aortenklappeninsuffizienz - Dilatation der Aorta - Aortendissektion

Key words

bicuspid aortic valve - aortic coarctation - aortopathy - surgical repair of bicuspidity

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