Kernaussagen
Ein hämodynamisch relevanter Vorhofseptumdefekt sollte unabhängig vom Alter prinzipiell verschlossen werden. Aufgrund ihrer dezentralen und randständigen Lage im interatrialen Septum sind der ASD-Typ I und der Sinus-venosus-Defekt i. d. R. nur chirurgisch zu behandeln, wobei beim ASD-Typ II v. a. der Katheterverschluss mittels Implantat (Schirm) als Alternative zur Chirurgie zuerst in Betracht gezogen werden sollte. Die wesentlichen anatomischen Voraussetzungen für das erfolgreiche Einbringen eines solchen Verschlusssystems sind Faktoren, wie eine durch das Ballonsizing gemessene Defektgröße < 38 mm, ein ausreichender aortaler Randsaum von 4-5 mm und ein suffizienter Abstand des zu implantierenden Schirmchens zur atrioventrikulären Klappenebene. Die Indikation zum primären medikamentösen Therapieansatz liegt vor bei asymptomatischen Patienten ohne rechtsventrikuläre Belastungszeichen und kleinem ASD oder bei Patienten mit großem ASD und vorliegender Shuntumkehr im Rahmen einer Eisenmenger-Reaktion, bei denen eine Kontraindikation zum ASD-Verschluss besteht.
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Dr. med. habil. Martin Braun
Medizinische Klinik/Kardiologie
Technische Universität Dresden
Fetscherstraße 76
01309 Dresden
Email: Martin.Braun@mailbox.tu-dresden.de
