Thrombosen künstlicher Herzklappen

Abstract

Thrombosis of prosthetic valves is the most threatening complication in patients after valve replacement. Due to the high morbidity and mortality of this event rapid diagnostic evaluation is crucial for the prognosis. The diagnosis is mainly based on auscultation, TTE and TEE. These methods also allow the thrombus size and the presence of outflow obstruction to be measured, which is essential for the further therapeutic decision. Moreover, the location (left versus right heart) and the clinical presentation (NYHA I-IV) need to be taken into account. The available therapeutic options are conservative therapy, surgery, and thrombolysis. This CME-article allows the reader to obtain the necessary knowledge about diagnostic and therapeutic pathways for patients with suspected prosthetic valve thrombosis.

Kernaussagen

• Klinik: Die Symptome können plötzlich oder schleichend auftreten. Vom kardiogenen Schock über Synkope bis hin zur Herzinsuffizienz oder zu Thromboembolien kann das klinische Bild sehr unterschiedlich sein.

• Auskultation: Charakteristisch ist der fehlende Klick. Herzgeräusche können auftreten.

• Labor: D-Dimere, Entzündungswerte, Hämolysezeichen und Gerinnung sollten bestimmt werden.

• Echokardiografie: In der TTE kann der transvalvuläre Gradient, in der TEE können Thrombusgröße und Klappenmobilität bestimmt werden.

• Therapie: Bei nicht obstruierenden Thrombosen wird konservativ, bei obstruierenden linksventrikulären und insbesondere großen Thromben operativ vorgegangen. Bei rechtsventrikulären Thrombosen oder wenn eine OP unmöglich ist, ist eine Thrombolyse indiziert.

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