Murdoch Dale, McAulay Laura, Walters Darren L
The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
The Prince Charles Hospital, Brisbane, Australia.
Cardiovasc Revasc Med. 2014 Nov-Dec;15(8):428-31. doi: 10.1016/j.carrev.2014.04.007. Epub 2014 Apr 26.
Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.
风湿性心脏病是全球心血管疾病发病和死亡的常见原因，在发展中国家尤为常见。二尖瓣狭窄和心房颤动常同时存在，与二尖瓣和左心房的结构及炎症变化有关。二者均易导致左心房血栓形成，常见于左心耳。可发生血栓栓塞，后果严重。我们报告一例62岁患有风湿性心脏病导致二尖瓣狭窄和心房颤动的女性病例。先前使用华法林治疗导致危及生命的胃肠道出血，她拒绝进一步抗凝治疗。实施了一项联合手术，包括经皮气球二尖瓣成形术和使用Atritech® Watchman®装置植入左心耳封堵器。随访一年未出现血栓栓塞或出血并发症。需要对一组患者进行长期随访以评估该策略的安全性和有效性。
