Wu Yu-Cheng, Wang Mei-Xiang, Chen Ge-Cai, Ruan Zhong-Bao, Zhang Qing-Qing
Department of Cardiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
Department of Endocrinology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
World J Clin Cases. 2022 Apr 26;10(12):3872-3878. doi: 10.12998/wjcc.v10.i12.3872.
In patients who suffer from both atrial fibrillation (AF) and atrial septal defect (ASD), cryoballoon pulmonary vein isolation (PVI), sequential left atrial appendage (LAA) occlusion and ASD closure could be a strategy for effective prevention of stroke and right heart failure.
A 65-year-old man was admitted to our institution due to recurrent episodes of palpitations and shortness of breath for 2 years, which had been worsening over the last 48 h. He had a history of AF, ASD, coronary heart disease with stent implantation and diabetes. Physical and laboratory examinations showed no abnormalities. The score of CHA2DS2VASc was 3, and HAS-BLED was 1. Echocardiography revealed a 25-mm secundum ASD. Pulmonary vein (PV) and LAA anatomy were assessed by cardiac computed tomography. PV mapping with 10-pole Lasso catheter was performed following ablation of all four PVs with complete PVI. Following the cryoballoon PVI, the patient underwent LAA occlusion under transesophageal echocardiographic monitoring. Lastly, a 34-mm JIYI ASD occlude device was implanted. A follow-up transesophageal echocardiography at 3 mo showed proper position of both devices and neither thrombi nor leakage was found.
Sequential cryoballoon PVI and LAA occlusion prior to ASD closure can be performed safely in AF patients with ASD.
在同时患有心房颤动（AF）和房间隔缺损（ASD）的患者中，冷冻球囊肺静脉隔离术（PVI）、序贯性左心耳（LAA）封堵和ASD封堵可能是有效预防中风和右心衰竭的一种策略。
一名65岁男性因心悸和气短反复发作2年入院，在过去48小时内症状加重。他有房颤、ASD、冠心病支架植入史和糖尿病史。体格检查和实验室检查均无异常。CHA2DS2VASc评分为3分，HAS-BLED评分为1分。超声心动图显示继发孔型ASD大小为25mm。通过心脏计算机断层扫描评估肺静脉（PV）和LAA解剖结构。在对所有四根肺静脉进行完全PVI消融后，使用10极Lasso导管进行PV标测。在冷冻球囊PVI术后，患者在经食管超声心动图监测下进行LAA封堵。最后，植入一枚34mm的吉易ASD封堵器。术后3个月的经食管超声心动图随访显示，两个装置位置恰当，未发现血栓和渗漏。
在患有ASD的房颤患者中，可在ASD封堵术前安全地序贯进行冷冻球囊PVI和LAA封堵。
