Kaczmarek Krzysztof, Cygankiewicz Iwona, Streb Witold, Plaksej Rafal, Jakubowski Piotr, Kalarus Zbigniew, Ptaszynski Pawel, Wranicz Jerzy Krzysztof, Babicz-Sadowska Anna, Markiewicz Agata, Grygier Marek
Department of Electrocardiology, Medical University of Lodz, Pomorska Str 251, 92-213 Lodz, Poland.
Silesian Center for Heart Disease, 1st Department of Cardiology and Angiology, 41-800 Zabrze, Poland.
J Clin Med. 2021 Feb 12;10(4):726. doi: 10.3390/jcm10040726.
We analyzed clinical experience with percutaneous closure of instances of left atrial appendage with thrombus (LAAT) irresponsive to antithrombotic therapy in patients treated in three high-volume cardiology centers. Clinical and procedural data regarding consecutive patients who underwent percutaneous left atrial appendage closure (PLAAC) due to LAAT were retrospectively analyzed. The study population consisted of 17 patients (11 men; 68 ± 14 years; CHADSVASC 4.7 ± 1.9; HASBLED 3 (0-5)) with LAAT confirmed by transesophageal echocardiography, and included 5 patients with mechanical heart valves. Most of the patients (94.1%) received anticoagulation therapy before PLAAC. All LAATs were located in distal portions of the appendage and occupied less than 30% of its volume. Occluding-device implantation was successful in 17 patients; in one, a residual leak was disclosed. Appropriate positioning of occluders required more than 1 attempt in 6 individuals (35.3%); in 3 others (17.6%), the subjects' devices had contact with thrombi. No procedural complications were noted. Midterm follow-up (median: 10 months) revealed no procedure-related complications or clinically diagnosed thromboembolism. Transesophageal echocardiography (TEE) performed after six months revealed device-related thrombus in one patient. We concluded that LAAT irresponsive to antithrombotic therapy might be effectively treated with PLAAC, even in patients with mechanical-valve prostheses.
我们分析了在三个大型心脏病中心接受治疗的患者中，经皮闭合对抗血栓治疗无反应的左心耳血栓形成（LAAT）的临床经验。对因LAAT接受经皮左心耳闭合术（PLAAC）的连续患者的临床和手术数据进行了回顾性分析。研究人群包括17例经食管超声心动图证实为LAAT的患者（11例男性；年龄68±14岁；CHADSVASC评分为4.7±1.9；HASBLED评分为3（0 - 5）），其中包括5例使用机械心脏瓣膜的患者。大多数患者（94.1%）在PLAAC之前接受了抗凝治疗。所有LAAT均位于心耳远端，占据其容积不到30%。17例患者封堵器植入成功；1例发现有残余分流。6例患者（35.3%）封堵器的合适定位需要不止1次尝试；另外3例患者（17.6%）的装置与血栓有接触。未观察到手术并发症。中期随访（中位数：10个月）未发现与手术相关的并发症或临床诊断的血栓栓塞。6个月后进行的经食管超声心动图（TEE）检查发现1例患者有与装置相关的血栓形成。我们得出结论，即使是使用机械瓣膜假体的患者，对抗血栓治疗无反应的LAAT也可以通过PLAAC有效治疗。
