Koermendy Dezsoe, Nietlispach Fabian, Shakir Samera, Gloekler Steffen, Wenaweser Peter, Windecker Stephan, Khattab Ahmed A, Meier Bernhard
Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Catheter Cardiovasc Interv. 2014 Dec 1;84(7):1190-6. doi: 10.1002/ccd.25354. Epub 2014 Feb 1.
To assess feasibility and outcomes of left atrial appendage (LAA) closure when using a patent foramen ovale (PFO) for left atrial access.
Because of the fear of entering the left atrium too high, using a PFO for left atrial access during LAA occlusion (LAAO) is generally discouraged. We report our single-center experience using a concomitant PFO for LAAO, thereby avoiding transseptal puncture.
LAAO was performed with local anesthesia and fluoroscopic guidance only (no echocardiography). The Amplatzer Cardiac Plug (ACP) was used in all patients. After LAAO, the PFO was closed at the same sitting, using an Amplatzer occluder through the ACP delivery sheath. Patients were discharged the same or the following day on dual antiplatelet therapy for 1-6 months, at which time a follow-up transesophageal echocardiogram (TEE) was performed.
In 49 (96%) of 51 patients (35 males, age 70.9 ± 11.9 years), LAAO was successful using the PFO for left atrial access. In one patient, a long tunnel PFO precluded LAAO, which was performed via a more caudal transseptal puncture. In a second patient, a previously inserted ASD occluder precluded LAAO, which was abandoned because of pericardial bleeding. PFO closure was successful in all patients. Follow-up TEE was performed in 43 patients 138 ± 34 days after the procedure. It showed proper sitting of both devices in all patients.
Using a PFO for LAAO had a high success rate and could be the default access in all patients with a PFO, potentially reducing procedural complications arising from transseptal puncture.
评估利用卵圆孔未闭（PFO）进入左心房进行左心耳（LAA）封堵的可行性及效果。
由于担心进入左心房位置过高，在LAA封堵术（LAAO）期间利用PFO进入左心房通常不被提倡。我们报告了我们单中心利用PFO进行LAAO的经验，从而避免了经房间隔穿刺。
仅在局部麻醉和荧光透视引导下进行LAAO（不使用超声心动图）。所有患者均使用Amplatzer心脏封堵器（ACP）。LAAO术后，通过ACP输送鞘管使用Amplatzer封堵器在同一次手术中封闭PFO。患者在术后当天或次日出院，接受1 - 6个月的双联抗血小板治疗，此时进行随访经食管超声心动图（TEE）检查。
51例患者（35例男性，年龄70.9±11.9岁）中有49例（96%）利用PFO进入左心房成功完成LAAO。1例患者因PFO为长隧道型而无法进行LAAO，通过更靠下的经房间隔穿刺完成手术。另1例患者因先前植入的房间隔缺损封堵器而无法进行LAAO，因心包出血而放弃手术。所有患者PFO封堵均成功。43例患者在术后138±34天进行了随访TEE检查。结果显示所有患者的两种装置位置均合适。
利用PFO进行LAAO成功率高，对于所有有PFO的患者可能是默认的进入途径，有可能减少经房间隔穿刺引起的手术并发症。
