Sack Stefan, Menne Jochen, Krüger Thomas, Weber Michael, Müller Dieter, Zwehl Werner
Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, Kölner Platz 1, 80804 München.
Herz. 2009 May;34(3):206-10. doi: 10.1007/s00059-009-3233-6.
Calcified aortic stenosis is the dominating valve disease. Patients affected are most commonly elderly people, who often show associated comorbidities like reduced left ventricular function, impaired renal function, and pulmonary hypertension. The risk of open heart surgery is elevated. Balloon aortic valvuloplasty enables a reduction of symptoms, an increase in physical performance, and, therefore, an improved quality of life. Recent data also demonstrated an improved survival of patients after valvuloplasty. New techniques and improved equipment induced a "revival" of balloon aortic valvuloplasty, which has been introduced more than 20 years ago. In acute emergencies, however, mortality is high. Hemodynamic stabilization in the intensive care unit prior to valvuloplasty is recommended. If restenosis in aortic bioprosthesis has occurred, hemodynamic improvement is very limited. Surgical valve replacement or percutaneous transcatheter valve implantation as valve-in-valve must be considered in the short term.
钙化性主动脉瓣狭窄是主要的瓣膜疾病。受影响的患者大多为老年人，他们常伴有诸如左心室功能减退、肾功能受损和肺动脉高压等合并症。心脏直视手术的风险升高。球囊主动脉瓣成形术可减轻症状、提高身体机能，从而改善生活质量。近期数据还表明瓣膜成形术后患者的生存率有所提高。新技术和改良设备促使球囊主动脉瓣成形术“复兴”，该技术早在20多年前就已问世。然而，在急性紧急情况下，死亡率很高。建议在瓣膜成形术前在重症监护病房进行血流动力学稳定处理。如果主动脉生物瓣膜发生再狭窄，血流动力学改善非常有限。短期内必须考虑进行外科瓣膜置换或经皮经导管瓣膜植入术（瓣中瓣）。
