Department of Cardiology and Invasive Electrophysiology, Campus Bad Neustadt, Bad Neustadt, Germany.
Departement of Cardiology and Angiology, Phillips University Clinic of Marburg, Marburg, Germany.
J Cardiovasc Electrophysiol. 2022 Jul;33(7):1596-1598. doi: 10.1111/jce.15561. Epub 2022 Jun 4.
It has been shown that endocardial occlusion of the left atrial appendage (LAA) is equally effective in preventing embolic events compared to oral anticoagulation in patients with nonvalvular atrial fibrillation. An 82-year-old female patient was admitted for LAA occlusion for repetitive GI bleeding. She had high CHADSVASC Score and HASBLED with long persistent atrial fibrillation with many comorbities. The preprocedural transesophageal echo revealed a great mass in the left atrium (Picture 1). Cardiac surgery was denied, we performed an epicardial only ligation for closing the LAA. For this approach we performed an epicardial puncture and contrast injection within the pericardial space to delineate the LAA. An epicardial wire with a suction mechanism at its distal end was attached to the anterior lobe of the LAA. Using this epicardial wire the snare could be advanced over the appendage and closed down. Complete exclusion of the LAA was achieved. There were no procedural complications and the patient is doing well after 3 months.
已经证明，与口服抗凝剂相比，在非瓣膜性心房颤动患者中，左心耳（LAA）的心内膜闭塞在预防栓塞事件方面同样有效。一名 82 岁女性患者因复发性胃肠道出血而入院接受 LAA 闭塞治疗。她的 CHADSVASC 评分和 HASBLED 评分均较高，且持续性心房颤动时间较长，合并多种合并症。术前经食管超声心动图显示左心房有一个大肿块（图 1）。心脏手术被拒绝，我们仅进行了心外膜结扎来关闭 LAA。为此，我们在心包腔内进行了心外膜穿刺和造影剂注射，以描绘 LAA。将带有远端抽吸机构的心外膜导丝连接到 LAA 的前叶。使用这条心外膜导丝，圈套器可以推进到附属物并关闭。完全排除了 LAA。没有出现操作相关并发症，患者在 3 个月后恢复良好。
