Prabhakar Bhat Sangeeta, Patel Neil R, Sethi Nishant
Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, USA.
Cardiology, The Wright Center for Graduate Medical Education, Scranton, USA.
Cureus. 2021 Feb 9;13(2):e13251. doi: 10.7759/cureus.13251.
The WATCHMAN (Boston Scientific, Marlborough, USA) is a device used to occlude the left atrial appendage (LAA) in patients of non-valvular atrial fibrillation (NVAF) with a high CHADS-VASc score who are poor candidates for oral anticoagulation. LAA perforation is a well-known complication of the WATCHMAN device placement. Here we present two cases of NVAF where oral anticoagulation was not advisable due to recurrent bleeding episodes. They underwent the WATCHMAN procedure for stroke prevention. During the placement of the WATCHMAN device into the left atrial appendage (LAA) in both cases, pericardial staining was noted that worsened over the next few minutes. It was decided to deploy the 27 mm WATCHMAN device into the LAA. In one case, satisfactory hemostasis was achieved with the device deployment eliminating the need for cardiothoracic surgery. However, the second case led to pericardial tamponade and was managed by the placement of a pericardial window. To our knowledge, this is the first case series describing the use of a WATCHMAN device upon detection of LAA perforation.
WATCHMAN（美国波士顿科学公司，马尔伯勒）是一种用于封堵非瓣膜性心房颤动（NVAF）且CHADS-VASc评分高、不适合口服抗凝治疗的患者左心耳（LAA）的装置。LAA穿孔是WATCHMAN装置置入术的一种已知并发症。在此，我们报告两例NVAF患者，由于反复出血事件，不适合口服抗凝治疗。他们接受了WATCHMAN手术以预防中风。在两例患者将WATCHMAN装置置入左心耳（LAA）的过程中，均发现心包染色，并在接下来的几分钟内加重。于是决定将27毫米的WATCHMAN装置置入LAA。其中一例，装置置入后实现了满意的止血，无需进行心胸外科手术。然而，第二例导致了心包填塞，通过心包开窗术进行处理。据我们所知，这是首例描述在检测到LAA穿孔后使用WATCHMAN装置的病例系列。
