Iatrogene Vorhofshunts: Therapieoption von der Geburt bis zur schweren Herzinsuffizienz

Zusammenfassung

Die moderne Medizin verwendet Kurzschlussverbindungen (Shunts) zur Therapie unterschiedlichster Krankheitsbilder (Beispiel: Dialyseshunt, portosystemische Shunts, ventrikuloperitoneale Shunts). In der Kardiologie hat sich die interventionelle Anlage eines Vorhofseptumdefekts innerhalb der letzten 50 Jahre von einem Notfalleingriff der Kinderkardiologie (Rashkind-Manöver) zu einem innovativen Therapiekonzept bei akuter und chronischer Herzinsuffizienz entwickelt. Im therapierefraktären akuten kardiogenen Schock bietet der Vorhofseptumdefekt die Option zur Entlastung des linken Herzens unter der erhöhten Nachlast bei effektiver ECLS-Unterstützung und so eine mögliche Alternative zu invasiveren Therapieverfahren wie der Impella®-Implantation oder einer chirurgischen LVAD-Implantation. Bei Herzinsuffizienz mit erhaltener LV-Funktion (HFpEF) könnte der Einsatz eines Interatrial septal Device Systems (IASD) eine innovative Therapieoption darstellen, die Lunge über einen Links-rechts-Shunt auf Vorhofebene zu entlasten und die Dyspnoe zu reduzieren.

Abstract

In contemporary medicine therapeutic shunts are placed for the treatment of a wide range of diseases (e.g. dialysis-access, portosystemic shunts, ventriculo-peritoneal shunts). Creation of an atrial septum defect has evolved over the last fifty years from a life-saving emergency intervention in the field of pediatric cardiology to an innovative therapeutic approach for advanced heart failure in the acute and chronic setting, respectively. In acute cardiogenic shock with progressing left ventricular failure under ECLS treatment, induction of an atrial septum defect may relieve pressure from the left ventricle via left to right shunting. Likewise, in the chronic setting of heart failure with preserved ejection fraction (HFpEF) creation of an atrial septum defect using an innovative device facilitating long-term shunt patency has shown to reduce left atrial filling pressures and to relief dyspnea in a first in man trial.

Schlüsselwörter

Septumdefekt - Rashkind-Manöver - ECLS - diastolische Herzinsuffizienz

Key words

heart failure with preserved ejection fraction - septal defect - Rashkind manoeuvre - ECLS - diastolic dysfunction

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