Miljak Tomislav, Kunze Markus, Birkemeyer Ralf, Jung Werner
Klinik für Innere Medizin III (Kardiologie), Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Germany.
Med Klin (Munich). 2009 Nov 15;104(11):875-7. doi: 10.1007/s00063-009-1184-6. Epub 2009 Nov 17.
A 69-year-old woman was admitted to hospital for cardioversion of persistent atrial fibrillation. She was on anticoagulation with a vitamin K antagonist for several weeks. Transesophageal echocardiography revealed a left atrial appendage aneurysm with a floating thrombus. None of the risk factors for thromboembolism mentioned in the guidelines for the management of patients with atrial fibrillation were present. As the patient refused surgical resection, long-term anticoagulation was recommended.
Due to their scarcity, patients with left atrial appendage aneurysms are not considered in current management guidelines. Since this anomaly is associated with a potential risk of systemic embolization, surgical resection should be recommended even in asymptomatic patients.
一名69岁女性因持续性心房颤动入院接受心脏复律治疗。她已使用维生素K拮抗剂进行抗凝治疗数周。经食管超声心动图显示左心耳动脉瘤伴有漂浮血栓。房颤患者管理指南中提及的血栓栓塞危险因素均不存在。由于患者拒绝手术切除,建议进行长期抗凝治疗。
由于左心耳动脉瘤患者较为罕见,当前的管理指南未将其纳入考虑。鉴于这种异常情况与全身性栓塞的潜在风险相关,即使是无症状患者也应建议进行手术切除。