Escribano Subias P, Gómez-Sánchez M A, Fernández Casares S, Lombera Romero F, Delgado Jiménez J F, García Pascual J, Pérez De La Sota E, Rufilanchas J J, Sáenz De La Calzada C
Servicios de Cardiología Hospital 12 de Octubre, Madrid, Spain.
Rev Esp Cardiol. 2001 Sep;54(9):1055-60. doi: 10.1016/s0300-8932(01)76452-4.
Standard orthotopic heart transplantation produces important anatomic and functional atrial alterations with subsequent thrombotic risk. Therefore the aim of this study was to analyze the prevalence and evolution of spontaneous echocardiography, atrial thrombi and embolic events.
52 consecutive transplanted patients were analyzed with transesophageal echocardiography and hemodynamic studies performed at 15 days and one year after transplantation.
Spontaneous echocardiography contrast was present in 27 patients (52%). Ten atrial thrombi were observed (19.2%), 9 with spontaneous echocardiography contrast. Six atrial thrombi appeared on day 15 and 4 after one year (with spontaneous echocardiography contrast on the previous study). Using multiple logistic regression analysis left atrial size was the only independent predictor factor for spontaneous echocardiography contrast (OR = 1.27; 95% CI, 1.09-1.54) and was an important predictor factor of atrial thrombi formation (OR = 1.19; 95% CI, 1.04-1.42). Likewise, the main predictor of atrial thrombi was the presence of spontaneous echocardiography contrast (OR = 116; 95% CI, 8.4-999). The hemodynamic pattern did not predict either the presence of spontaneous echocardiography contrast or atrial thrombi. The global incidence of embolic events was 4% less than previously described.
The incidence of atrial thrombi and spontaneous echocardiographic contrast after standard orthotopic heart transplantation was 19.2% and 52%, respectively. An enlarged atrium and/or spontaneous echocardiography contrast was found to increase the risk of atrial thrombi. Considering the dynamic nature of atrial thrombi formation, periodical transesophageal echocardiography studies are recommended after heart transplantation.
标准原位心脏移植会产生重要的解剖学和功能性心房改变，继而带来血栓形成风险。因此，本研究旨在分析经食管超声心动图检查发现的自发显影、心房血栓及栓塞事件的发生率和演变情况。
对52例连续接受心脏移植的患者进行经食管超声心动图检查，并在移植后15天和1年进行血流动力学研究。
27例患者（52%）出现经食管超声心动图检查自发显影。观察到10例心房血栓（19.2%），其中9例伴有经食管超声心动图检查自发显影。6例心房血栓出现在第15天，4例出现在1年后（前次检查伴有经食管超声心动图检查自发显影）。采用多因素logistic回归分析，左心房大小是经食管超声心动图检查自发显影的唯一独立预测因素（比值比[OR]=1.27；95%置信区间[CI]，1.09 - 1.54），也是心房血栓形成的重要预测因素（OR = 1.19；95% CI，1.04 - 1.42）。同样，心房血栓的主要预测因素是经食管超声心动图检查自发显影（OR = 116；95% CI，8.4 - 999）。血流动力学模式既不能预测经食管超声心动图检查自发显影的存在，也不能预测心房血栓的存在。栓塞事件的总体发生率比先前报道的低4%。
标准原位心脏移植术后心房血栓和经食管超声心动图检查自发显影的发生率分别为19.2%和52%。发现心房扩大和/或经食管超声心动图检查自发显影会增加心房血栓形成的风险。考虑到心房血栓形成的动态特性，建议心脏移植术后定期进行经食管超声心动图检查。
