经导管封堵房间隔交通：术后经食管超声心动图可及时检测和治疗心内血栓形成。
Transcathether occlusion of interatrial communications: postprocedural transoesophageal echocardiography allows timely detection and treatment of intracardiac thrombus formation.
作者信息
Pelliccia Francesco, Cianfrocca Cinzia, Pasceri Vincenzo, Granatelli Antonino, Speciale Giulio, Roncella Adriana, Turturo Maurizio, Richichi Giuseppe, Pristipino Christian
机构信息
Interventional Cardiology Unit, San Filippo Neri Hospital, Rome.
出版信息
Eur J Echocardiogr. 2009 May;10(3):439-41. doi: 10.1093/ejechocard/jen306. Epub 2008 Nov 25.
AIMS
Thrombus formation leading to ischaemic stroke is a major concern after transcathether occlusion of interatrial communications. The aim of our study was to verify if postprocedural transoesophageal echocardiography (TEE) might improve timely detection and management of thrombus formation.
METHODS AND RESULTS
We studied 65 patients with patent foramen ovale or atrial septal defect who received an atrial septal closure device. Transoesophageal echocardiography was used to guide the procedure, and was repeated <1 h after the end of the procedure, at 30 day and 6 month follow-up visits. Transoesophageal echocardiography <1 h after procedure revealed a left-sided thrombus attached to the device in three patients. All cases were successfully treated by thrombolytic therapy with full-dose tenecteplase (0.53 mg/kg in 5-10 s) with disappearance of thrombus in 15-60 min. No cerebrovascular event was recorded during a follow-up of 311 +/- 235 days.
CONCLUSION
Thrombus formation on interatrial closure devices can occur soon after device implantation and can be timely detected by postprocedural TEE.
目的
经导管封堵房间隔交通口后，血栓形成导致缺血性卒中是一个主要问题。我们研究的目的是验证术后经食管超声心动图（TEE）是否能改善血栓形成的及时检测和处理。
方法与结果
我们研究了65例患有卵圆孔未闭或房间隔缺损并接受房间隔封堵装置的患者。使用经食管超声心动图指导手术，并在术后<1小时、术后30天和6个月随访时重复检查。术后<1小时的经食管超声心动图显示3例患者的装置上附着有左侧血栓。所有病例均通过全剂量替奈普酶（0.53 mg/kg，5 - 10秒内给药）溶栓治疗成功治疗，血栓在15 - 60分钟内消失。在311±235天的随访期间未记录到脑血管事件。
结论
房间隔封堵装置上的血栓形成可在装置植入后不久发生，术后TEE可及时检测到。
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