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在荧光透视和经食管超声心动图引导下经皮圈套器取出心内血栓:病例报告及系统评价

Percutaneous snare-retrieval of intracardiac thrombus under fluoroscopic and transesophageal echocardiography guidance: case report and systematic review.

作者信息

Zhou Huaji, Wang Bing, Pan Jun, Qiu Chenyang, Yu Xinyu, He Yangyan, Zhu Qianqian, Yu Lei, Wu Ziheng, Li Donglin, Zhang Hongkun

机构信息

Department of Vascular Surgery, The NO.1 People's Hospital of Pinghu, Jiaxing, China.

Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

出版信息

Front Cardiovasc Med. 2023 May 9;10:1127131. doi: 10.3389/fcvm.2023.1127131. eCollection 2023.

Abstract

Intracardiac foreign bodies (IFB) are rare clinical conditions. There are now several reports on the percutaneous retrieval of IFB under fluoroscopy. However, some IFB are not radiopaque, and retrieval requires combined fluoroscopic and ultrasound guidance. We report the case of a bedridden 23-year-old male patient with T-lymphoblastic lymphoma treated with long-term chemotherapy. Ultrasound examination diagnosed a huge thrombus in the right atrium near the opening of the inferior vena cava which affected the patency of his PICC line. Ten days of anticoagulant therapy did not modify the thrombus size. Open heart surgery was not feasible because of the patient clinical condition. Snare-capture of the non-opaque thrombus was done from the femoral vein under fluoroscopic and ultrasound guidance with excellent outcomes. We also present a systematic review of IFB. We found out that percutaneous removal of IFBs is a safe and effective procedure. The youngest patient who received percutaneous IFB retrieval was 10 days old and weighed only 800 g, while the oldest patient was 70 years old. Port catheters (43.5%) and PICC lines (42.3%) were the most commonly found IFBs. Snare catheters and forceps were the most commonly used instruments.

摘要

心内异物(IFB)是罕见的临床情况。目前有几篇关于在荧光透视引导下经皮取出心内异物的报告。然而,一些心内异物不透射线,取出需要荧光透视和超声引导相结合。我们报告一例长期接受化疗的23岁卧床男性T淋巴细胞母细胞淋巴瘤患者。超声检查诊断下腔静脉开口附近右心房有巨大血栓,影响了其经外周静脉穿刺中心静脉置管(PICC)的通畅性。抗凝治疗10天并未改变血栓大小。由于患者的临床状况,心脏直视手术不可行。在荧光透视和超声引导下经股静脉用圈套器捕获不透射线的血栓,效果良好。我们还对心内异物进行了系统评价。我们发现经皮取出心内异物是一种安全有效的方法。接受经皮心内异物取出术的最年轻患者为10日龄,体重仅800克,最年长患者为70岁。端口导管(43.5%)和PICC(42.3%)是最常见的心内异物。圈套导管和镊子是最常用的器械。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7e5c/10203901/42aa7a1a2626/fcvm-10-1127131-g001.jpg

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