Bildgebung bei angeborenen Vitien im Erwachsenenalter – Grundlagen

Abstract

The population of patients with congenital heart disease is growing. Major improvements in screening, diagnostics as well as interventional, surgical and medical treatment led to an improved life expectancy. Eventually the majority of newborns with congenital heart disease reach adulthood. Non invasive sceening by prenatal ultrasound as well as imaging by 2 D and 3 D echocardiography, cardiac MRI and cardiac CT are developing rapidly and became important tools for paediatric and adult cardiologist as well as surgeons for the diagnosis, treatment guiding, planning of surgical interventions as well as longtime follow ups. This article gives a brief introduction in the actual imaging modalities, their indications as well as advantages and disadvantages for patients with congenital heart disease.

Kernaussagen

• Etwa 1 % aller lebend geborenen Kinder kommen mit einem Herzfehler zur Welt. Die Prognose dieser Patienten hat sich in den vergangenen 2 – 3 Dekaden deutlich verbessert. Daher nimmt die Anzahl der Erwachsenen mit angeborenem Herzfehler ständig zu.

• Im Rahmen der initialen Diagnosestellung und der Planung von Operationen, aber auch im Follow-up der Patienten ergibt sich die Notwendigkeit serieller bildgebender Untersuchungen.

• Die Echokardiografie ist nahezu ubiquitär verfügbar, kostengünstig, mobil einsetzbar, nebenwirkungs- und strahlungsfrei. Sie ermöglicht Follow-up-Untersuchungen in kurzen Zeitintervallen und kann auch bei Patienten mit eingeschränkter Kooperationsbereitschaft eingesetzt werden.

• Mit der MRT sind beliebige Angulationen der Schnittbildebenen im Raum und die Abbildung des gesamten Herzens und der umliegenden Gefäße möglich. Damit lassen sich auch komplexe Morphologien und deren Funktion gut darstellen. Sie ist der Goldstandard bei Patienten mit Kardiomyopathien und mit angeborenen Herzfehlern.

• Mit der CT lassen sich in der MRT nicht oder schlechter darstellbare sehr kleine anatomische Strukturen mit sehr kurzen Untersuchungszeiten visualisieren. Außerdem kann sie das Lungenparenchym besser darstellen als die MRT.

• Diagnostische Herzkatheteruntersuchungen sind zunehmend nur noch bei spezifischen, hämodynamischen Fragestellungen notwendig, interventionelle, katheterbasierte Therapien werden dagegen immer häufiger durchgeführt.

• In der Zukunft bietet die Kombination der Daten verschiedener Verfahren möglicherweise viel Potenzial, um die Diagnostik zu optimieren und interventionelle Eingriffe genauer zu planen.

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