Präinterventionelle Klappenbildgebung in der CT: TAVR, TMVR und mehr

Zusammenfassung

Klappenerkrankungen zählen zu den häufigsten Herzerkrankungen, werden häufiger und können immer besser behandelt werden. Zwar benötigt nicht jede Klappenerkrankung zwingend eine radiologische Bildgebung, doch insbesondere für die Aorten- und Mitralklappe spielt die radiologische Beurteilung eine wichtige Rolle. In diesem Beitrag steht vor allem die CT vor Klappeneingriffen im Vordergrund.

Abstract

Valvular heart diseases (VHD) are among the most common cardiac diseases and are associated with increased mortality. While becoming more and more frequent in the clinical practice, the therapeutic options offer effective treatment in a broader variety of patients. Not every VHD necessarily requires radiological imaging, but especially for VHD of the aortic and mitral valves, radiographic evaluation plays an important role pre- and sometimes post-interventional. This article focuses primarily on computed tomography (CT) prior to valve interventions and provides insights into other radiological modalities and post-interventional valve imaging.

Kernaussagen

• Die Anzahl der Klappeninterventionen und der damit verbundenen präinterventionellen Bildgebungen nimmt stetig zu, auch aufgrund der zunehmenden Ausweitung der Indikation auf Patienten mit einem niedrigem Risikoprofil, besonders im Rahmen einer TAVR.

• Die Klappenintervention sollte in einem interdisziplinären Herzteam indiziert und geplant werden, hier sollte neben der Kardiologie und der Herzchirurgie auch die Radiologie vertreten sein.

• Die CT-Bildgebung zur Planung einer TAVR nimmt den größten Anteil der präinterventionellen Klappenbildgebungen ein und ist daher von besonderer Relevanz für den klinischen Alltag.

• Für die unterschiedlichen Herzklappenerkrankungen und Fragestellungen sind dedizierte CT-Protokolle notwendig, die – angepasst an die lokalen Gegebenheiten – in enger Zusammenarbeit mit den klinischen Kollegen erstellt werden sollten.

• Die adäquate metrische Analyse, ausgerichtet auf die klinische Fragestellung, sollte im Rahmen der Bildgebung vor Klappeninterventionen durchgeführt werden und Bestandteil des Befundes sein.

Schlüsselwörter

Herzklappenerkrankung - Computertomografie - Transkatheter-Aortenklappenersatz - Herzklappe

Key words

Valvular heart disease - computed tomography - transcatheter aortic valve replacement - cardiac valve

Publikationsverlauf

Artikel online veröffentlicht:
08. Juni 2023

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