Geppert A
3. Medizinische Abteilung mit Kardiologie, Wilhelminenspital der Stadt Wien, Montlearstr. 37, 1160, Wien, Österreich,
Med Klin Intensivmed Notfmed. 2013 Oct;108(7):555-60. doi: 10.1007/s00063-012-0140-z. Epub 2013 Sep 15.
Valvular dysfunction is as frequent as acute coronary syndromes in the pathogenesis of acute decompensated heart failure. The prevalence of relevant valvular dysfunction increases with age and reaches more than 10 % in patients over 75 years old. Guidelines and studies on the treatment of these patients, especially in an intensive care unit (ICU) setting are, however, scarce despite excellent guidelines for treatment of valvular heart disease in the general population. In the last decade a number of therapeutic alternatives became available when standard inotrope and vasopressor therapy fails to stabilize patients. These include balloon valvuloplasty in patients with severe aortic valve stenosis and assist devices, extracorporeal membrane oxygenation (ECMO) as well as mitral clipping. These therapeutic alternatives are to be considered as bridge to operation procedures in cases of shock due to valvular dysfunction, as hemodynamic stabilization and stabilization of organ function are essential to allow valve repair/replacement which is still considered to be the gold standard in this situation but is not always possible in the acute setting.
在急性失代偿性心力衰竭的发病机制中，瓣膜功能障碍与急性冠状动脉综合征一样常见。相关瓣膜功能障碍的患病率随年龄增长而增加，在75岁以上的患者中超过10%。然而，尽管有针对一般人群瓣膜性心脏病的优秀治疗指南，但关于这些患者治疗的指南和研究却很少，尤其是在重症监护病房（ICU）环境中。在过去十年中，当标准的正性肌力药和血管加压药治疗无法使患者病情稳定时，出现了一些治疗选择。这些包括对严重主动脉瓣狭窄患者进行球囊瓣膜成形术以及辅助装置、体外膜肺氧合（ECMO）和二尖瓣夹合术。在因瓣膜功能障碍导致休克的情况下，这些治疗选择应被视为手术的桥梁，因为血流动力学稳定和器官功能稳定对于进行瓣膜修复/置换至关重要，瓣膜修复/置换在这种情况下仍被视为金标准，但在急性情况下并不总是可行。
