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Geburtshilfe Frauenheilkd 2009; 69(1): R1-R19
DOI: 10.1055/s-2008-1039297
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© Georg Thieme Verlag KG Stuttgart · New York

Kongenitale Herzfehler – Teil 1

B. Meurer1 , 2 , S. Dittrich3 , T. W. Goecke1 , R. L. Schild1 , 4
  • 1Universitätsklinikum Erlangen, Frauenklinik
  • 2Hôpitaux Universitaires de Genève, Département de Gynécologie et d'Obstétrique
  • 3Universitätsklinikum Erlangen, Kinderkardiologie
  • 4Diakonische Dienste Hannover, Frauenklinik
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Publication Date:
26 January 2009 (online)

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Überblick

Herzfehler

In Deutschland beträgt die Prävalenz kongenitaler Herzfehler bei Neugeborenen 7,6 %.

Bei hohem Risiko für angeborene Herzfehler sollten Feten frühzeitig einem erfahrenen Untersucher zur Echokardiografie vorgestellt werden.
sind mit einer Inzidenz von 5–8 auf 1000 Neugeborene relativ häufig [1], [2]. In Deutschland liegt die Prävalenz angeborener Herzfehler bei Lebendgeborenen in einer aktuellen Erhebung des Kompetenznetzes angeborener Herzfehler bei 7,6 %. Die häufigsten Herzfehler sind dabei der Ventrikelseptumdefekt, der Vorhofseptumdefekt und die Pulmonalklappenstenose, die zusammen ca. 70 % der Vitien ausmachen (PAN-Studie, Kompetenznetz angeborene Herzfehler: http://www.kompetenznetz-ahf.de). Da ca. 15–20 % aller Schwangerschaften im 2. Trimenon als Spontanabort enden und zu einem großen Teil mit Herzfehlbildungen assoziiert sind, begegnet dem Pränataldiagnostiker somit eine noch höhere Rate an kongenitalen Herzvitien als bei Geburt. In ca. 50 % der Fälle handelt es sich um schwere Herzfehler, die einer operativen Behandlung bedürfen [1], [3]. Ca. 20 % der Behandlungen angeborener Herzfehler müssen bereits in der Neonatalperiode erfolgen. Unter heutigen optimierten Therapiemöglichkeiten liegt die Mortalität bei Herzoperationen im Neonatalalter in der aktuellen Qualitätssicherungsdatenbank der europäischen Gesellschaft für Herzchirurgie bei 11 % (EACTS Congenital Database, http://www.eacts.org/index.html). Die Mortalität korreliert eng mit dem Schweregrad des Herzfehlers und dem Zeitpunkt der klinischen Manifestation [1]. Die Detektionsrate der angeborenen Herzfehler bei der pränatalen Ultraschalluntersuchung ist vom Untersuchungszeitpunkt, der persönlichen Kompetenz des Pränataldiagnostikers und der apparativen Ausstattung abhängig und schwankt nach Literaturangaben zwischen 5 und 85 % [1]. Im Rahmen der Pränataldiagnostik ist es wichtig, zwischen einem High- (Risiko ca. 10 %) und einem Low-Risk-Kollektiv (Risiko) < 0,5 %) für angeborene Herzfehler zu differenzieren. Feten mit einem hohen Risiko für eine kongenitale Herzfehlbildung sollten frühzeitig einem in der fetalen Echokardiografie erfahrenen Untersucher vorgestellt werden. Unglücklicherweise werden jedoch ca. 90 % aller angeborenen Herzvitien postpartal im Niedrigrisikokollektiv diagnostiziert [6].

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Dr. med. Britta Meurer

Hôpitaux Universitaires de Genève
Département de Gynécologie et d'Obstétrique
Maternité de Genève

Bd. de la Cluse 30

CH-1211 Genève 14

Email: britta.meurer@huge.ch

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