Follow-up-Untersuchungen bei TAVI und MitraClip

Abstract

Interventional therapies in valvular heart disease address an increasing demand for minimal invasive strategies with good safety profile for an elderly patient population. These procedures are unique in their need for a multidisciplinary heart valve team with the help of a multimodality imaging approach. Imaging in interventional transcatheter valve implantations plays a pivotal role in the screening process of pre-procedural planning for optimal patient and device selection, the procedural guidance and optimization as well as the important short and long-term follow up evaluation of treatment success and complications. The goals of post-implantation imaging and assessment include the hemodynamic profile of the transcatheter prosthesis or edge-to-edge repair including gradients and quantification of valvular or paravalvular regurgitation and the positive remodeling effects of the therapy on cardiac chambers, clinical patient status as well as mortality and quality of life.

Kernaussagen

• Interventionelle Herzklappentherapien erfüllen einen steigenden Bedarf an minimal-invasiven Behandlungsstrategien mit einem hohen Sicherheitsstandard für eine alternde Bevölkerung.

• Das Besondere dieser Prozeduren besteht darin, dass sie ein interdisziplinäres Herzklappenteam und eine multimodale Bildgebung erfordern.

• Die Bildgebung spielt bei interventionellen katheterbasierten Klappenimplantationen eine Schlüsselrolle, um den Eingriff zu planen, Patienten und Devices auszuwählen, den Implantationsprozess zu steuern und zu optimieren und den Therapieverlauf – und mögliche Komplikationen – kurz- und langfristig zu kontrollieren.

• Der Patient bzw. seine Bilddaten wird beurteilt, indem der hämodynamische Effekt der kathetergestützten Klappenprothese oder perkutanen Mitralklappenrekonstruktion mit Klappengradienten erfasst und valvuläre und paravalvuläre Insuffizienzen bestimmt werden. Effekte dieser Therapie werden mit einer Normalisierung von Herzgröße, klinischem Patientenstatus, Lebensqualität und Reduktion der Mortalität dokumentiert.

• Literatur

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