Fontos Géza, Andréka Péter, Temesvári András, Wéber Dóra, Szatmári András
Gottsegen György Országos, Kardiológiai Intézet, Budapest.
Orv Hetil. 2010 May 2;151(18):725-34. doi: 10.1556/OH.2010.28870.
In patients with non-valvular atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. Despite their high risk for thromboembolic events, there are substantial numbers of patients who are not candidates for long-term oral anticoagulant therapy, therefore the interest in alternative treatment strategies are in focus these days. The most common place within the heart for thrombus formation in patients with non-valvular atrial fibrillation is the left atrial appendage. Two devices specifically designed for percutaneous left atrial appendage closure are currently available in Europe: the WATCHMAN LAA system (Atritech, Inc) and the AMPLATZER Cardiac Plug (AGA Medical Corporation). Although present trial results (PLAATO, PROTECT AF) suggest that LAA closure may be performed at acceptable safety and it may reduce the long-term stroke risk, available data are still very limited. At present these procedures may be an acceptable alternative in selected high-risk patients with non-valvular atrial fibrillation who are not or suboptimal candidates for oral anticoagulant therapy. On 28. January, 2010 we performed the first three successful percutaneous left atrial appendage closure procedures in Gottsegen György Hungarian Institute of Cardiology in Hungary.
在非瓣膜性心房颤动患者中，口服抗凝治疗预防中风的疗效已得到证实。尽管这些患者发生血栓栓塞事件的风险很高，但仍有相当数量的患者不适合长期口服抗凝治疗，因此，目前人们对替代治疗策略十分关注。非瓣膜性心房颤动患者心脏内血栓形成最常见的部位是左心耳。目前在欧洲有两种专门设计用于经皮左心耳封堵的装置：WATCHMAN左心耳系统（Atritech公司）和AMPLATZER心脏封堵器（AGA医疗公司）。尽管目前的试验结果（PLAATO、PROTECT AF）表明左心耳封堵术可以在可接受的安全性下进行，并且可能降低长期中风风险，但现有数据仍然非常有限。目前，对于不适合或口服抗凝治疗效果欠佳的特定高危非瓣膜性心房颤动患者，这些手术可能是一种可接受的替代方案。2010年1月28日，我们在匈牙利的戈特塞根·久尔吉匈牙利心脏病学研究所成功实施了前三例经皮左心耳封堵手术。
