Medikamentöse und interventionelle Therapie der Rechtsherzinsuffizienz

 

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Zusammenfassung

In der Therapie der chronischen Rechtsherzinsuffizienz führen die aktuellen Leitlinien der European Society of Cardiology zur Therapie der pulmonalen Hypertonie medikamentöse Ansätze ein, die erstmalig auf eine Reduktion der Mortalität abzielen. Zudem steht mit Riociguat ein neues Medikament für die Therapie der chronisch thrombembolischen pulmonalen Hypertonie (CTEPH) zur Verfügung. Perkutane Interventionen an den Klappen des rechten Ventrikels sind für die Pulmonalklappe in der Therapie etabliert, für die Trikuspidalklappe vielversprechend im experimentellen Stadium.

In der Therapie der akuten Rechtsherzinsuffizienz eröffnet die Miniaturisierung der mechanischen extrakorporalen Unterstützungssysteme sowie die Verwendung von perkutan eingebrachte Perfusionskanülen neue Therapieoptionen auf dem Sektor „Bridge to Recovery“ und „Bridge to Decision“ hin zu längerfristiger Unterstützung von Herz- und Lungenfunktion.

Abstract

New pharmacological approaches are introduced for the treatment of chronic right heart failure which aim at reduced mortality. Riociguat is a new drug for the treatment of chronic thrombembolic pulmonary hypertension. Transcatheter valve interventions are established for treatment of pulmonary valve diseases and introduced as promising upcoming therapeutic options for tricuspid regurgitation.

The management of acute right heart failure is supported by the miniaturization of mechanical circulatory support systems with percutaneous cannulation applicable in terms of “Bridge to Recovery” and “Bridge to Decision” concepts and effective long-term support, respectively.

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