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Koronarsinus-Devices zur Behandlung der funktionellen Mitralklappeninsuffizienz

Ausweg oder Sackgasse?

Coronary sinus devices for treatment of functional mitral valve regurgitation

Solution or dead end?

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Zusammenfassung

In diesem Artikel geben wir einen Überblick über bisher verfügbare Techniken zur perkutanen Mitralklappenanuloraphie über den Koronarsinus bei Patienten mit funktioneller Mitralklappeninsuffizienz. Die größte klinische Erfahrung besteht für das Carillon™ Mitral Contour System™, das in den letzten beiden Jahren auch außerhalb von Studien eine zunehmende Anwendung gefunden hat. Es zeichnet sich durch eine relativ einfache Anwendung und eine effiziente Reduktion der funktionellen Mitralklappeninsuffizienz mit konsekutiver Verbesserung der echokardiographischen und klinischen Parameter aus. Limitierend sind Kompromittierungen des Koronarflusses vor allem bei Kreuzen des Koronarsinus mit dem Ramus circumflexus. Zukünftige Untersuchungen müssen den Stellenwert dieser Technologie im Vergleich zum Mitralklappen-Clipping in der Therapie der funktionellen Mitralklappeninsuffizenz untersuchen.

Abstract

In this article we review the currently available data on percutaneous mitral valve annulorrhaphy devices using the coronary sinus in patients with functional mitral valve regurgitation (MR). Of these devices the greatest clinical experience exists for the Carillon mitral contour system which has gained increasing application also outside trials in the last 2 years. The advantages include the ease of use with an effective reduction in functional MR and a subsequent improvement of echocardiographic and clinical parameters. A limitation is the compromise of flow in the circumflex artery in some patients especially with a crossing of the coronary sinus with this artery. Future investigations need to focus on the evaluation of this coronary sinus-based technology versus mitral valve clipping technology for the treatment of functional MR.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: HD und MH sind Mitarbeiter (Aufsichtsführende) bei Cardiac Dimensions™.

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  1. Medizinische Klinik 1 – Kardiologie, internistische Intensivmedizin, Nephrologie, Städtische Kliniken Neuss – Lukaskrankenhaus GmbH, Preussenstr. 84, 41464, Neuss, Deutschland

    H. Degen, T. Schneider, J. Wilke & M. Haude

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  1. H. Degen
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  2. T. Schneider
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  3. J. Wilke
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  4. M. Haude
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Correspondence to H. Degen.

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Degen, H., Schneider, T., Wilke, J. et al. Koronarsinus-Devices zur Behandlung der funktionellen Mitralklappeninsuffizienz. Herz 38, 490–500 (2013). https://doi.org/10.1007/s00059-013-3866-3

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