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Neonatologie Scan 2012; 01(01): 61-78
DOI: 10.1055/s-0032-1310079
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© Georg Thieme Verlag KG Stuttgart · New York

Dopplersonografische Diagnostik der Hämodynamik in der Neonatologie

Eva Robel-Tillig
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Publication Date:
23 August 2012 (online)

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Einleitung

Im letzten Jahrzehnt haben sich dopplersonografische und funktionell echokardiografische Untersuchungen zur Beurteilung der hämodynamischen Situation von Frühgeborenen und anpassungsgestörten Reifgeborenen in der Neonatologie etabliert.

Wesentlich zur Bewertung der erhobenen Befunde ist die Kenntnis der physiologischen peri- und postnatalen Abläufe. Jedes Neugeborene muss neben der Anpassung der Ventilation (u. a. gekennzeichnet durch raschen Anstieg des Lungenvolumens und Veränderung der Compliance) eine Vielzahl von hämodynamischen Adaptationsvorgängen bewältigen. So verändern sich innerhalb kürzester Zeit links- und rechtsventrikuläre Vor- und Nachlast sowie intra- und extrakardiale Shunts.

Frühgeborene haben zusätzlich das Problem, dass ihr Herz strukturell wie das fetale Herz noch durch folgende Eigenschaften gekennzeichnet ist:

  • morphologisch kleine Myozyten

  • geringe Sarkomerenzahl

  • höherer Wasseranteil des Myokards

  • verringerte Anzahl von Mitochondrien

Das so in seiner Compliance eingeschränkte Herz ist durch den häufig noch instabilen Thorax in seiner Funktion negativ beeinflusst. Die noch nicht ausgereifte Struktur der pulmonalen Gefäße führt zu einem höheren vaskulären Widerstand.

Diese physiologischen Abläufe können durch unterschiedliche prä- und perinatale Stresssituationen gestört werden und die Anpassungsvorgänge des Neugeborenen pathologisch verlaufen.

Jede funktionell echokardiografische Beurteilung der neonatalen Hämodynamik sollte immer dem Ausschluss eines Herzklappenfehlers durch klinische und sonografische Untersuchung erfolgen. Bei morphologischen Auffälligkeiten und Arrhythmien mit persistierenden hämodynamischen Einschränkungen ist eine enge Zusammenarbeit mit der Kinderkardiologie erforderlich [1].

 

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