Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany.
Med. Klinik III, Cardioangiologisches Centrum Bethanien, Markus Krankenhaus, Wilhelm-Epstein-Str. 4, 60431 Frankfurt am Main, Germany
Europace. 2015 Jan;17(1):64-8. doi: 10.1093/europace/euu164. Epub 2014 Aug 6.
Patients undergoing heart surgery and with history of atrial fibrillation are often treated with intraoperative left atrial appendage (LAA) ligation. Incomplete LAA ligation is often described and can be associated with thrombo-embolic complications. To describe a case series of percutaneous LAA occlusion in patients previously treated with surgical LAA ligation.
Over 179 patients treated with implantation of an LAA-occluder system at our centre, 3 (1.6%) were previously treated with a surgical LAA suture exclusion (2 males, age 74 ± 3 years). Patients 1 and 3 presented a 'hammerhead' LAA morphology with an open neck and were successfully treated with an AGA Cardiac Plug (ACP-St Jude Medical) Device. Patient 2 had a conic monolobar LAA with a small neck, and the occlusion could be performed using a Watchman (Boston Scientific) device. After discharge on dual antiplatelet therapy, all the patients could be switched to single aspirin (ASA) therapy after a 6-week transoesophageal echocardiography control.
Left atrial appendage occlusion in patient with incomplete surgical ligation using percutaneous LAA occluder devices appears to be feasible, and studies including a larger number of patients are needed.
接受心脏手术且有房颤病史的患者常需术中行左心耳（LAA）结扎。常描述结扎不完全，并可能与血栓栓塞并发症相关。本文旨在介绍既往行外科 LAA 结扎术的患者行经皮 LAA 封堵术的病例系列。
在本中心接受 LAA 封堵器系统植入治疗的 179 例患者中，3 例（1.6%）既往行外科 LAA 缝线结扎术（2 例男性，年龄 74 ± 3 岁）。患者 1 和 3 的 LAA 呈“锤头”状形态，有开放的颈部，成功地使用 AGA 心脏塞（圣犹达医疗）装置进行了治疗。患者 2 的 LAA 呈锥形单叶状，颈部较小，使用 Watchman（波士顿科学）装置可以进行封堵。在双联抗血小板治疗出院后，所有患者在 6 周经食管超声心动图检查后均可以转为单一阿司匹林（ASA）治疗。
使用经皮 LAA 封堵装置对不完全外科结扎的患者行左心耳封堵似乎是可行的，需要进行包括更多患者的研究。
