Shamim Shariq, Magalski Anthony, Chhatriwalla Adnan K, Allen Keith B, Huber Kenneth C, Main Michael L
Saint Luke's Mid-America Heart Institute, Kansas City, MO, USA.
Echocardiography. 2017 Jan;34(1):128-130. doi: 10.1111/echo.13413. Epub 2016 Nov 16.
Left atrial appendage closure with the WATCHMAN device is an alternative to chronic oral anticoagulation for thromboembolic prophylaxis in atrial fibrillation patients. Left atrial device-related thrombus (DRT) has been described in the first year after implant with an incidence of ~6%. A 79-year-old man underwent WATCHMAN device placement in 2006. Routine protocol specified follow-up transesophageal echocardiograms (TEE) at 6 weeks, 6 months, and 1 year following implant showed no evidence for DRT or peri-device flow. A decade after device implant, the patient presented with severe symptomatic aortic stenosis and underwent repeat TEE, which revealed a 21 mm × 18 mm DRT on the LA aspect of the WATCHMAN device. He was prescribed apixaban 5 mg po BID. A TEE performed 111 days later demonstrated marked diminution in the DRT (9 mm in diameter). This case demonstrates that WATCHMAN DRT may occur late following implantation.
使用WATCHMAN装置进行左心耳封堵术是房颤患者预防血栓栓塞的一种替代长期口服抗凝治疗的方法。植入后第一年已发现左心耳装置相关血栓（DRT），发生率约为6%。一名79岁男性于2006年接受了WATCHMAN装置植入。常规方案规定在植入后6周、6个月和1年进行经食管超声心动图（TEE）随访，结果显示没有DRT或装置周围血流的证据。装置植入十年后，该患者出现严重症状性主动脉瓣狭窄并接受了再次TEE检查，结果显示在WATCHMAN装置的左心房侧有一个21mm×18mm的DRT。给他开了阿哌沙班，口服，5mg，每日两次。111天后进行的TEE显示DRT明显缩小（直径9mm）。该病例表明WATCHMAN DRT可能在植入后较晚发生。
