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紧急手术取出迁移至左心室流出道并继发大量二尖瓣反流的左心耳封堵器:一例报告及文献综述

Emergent surgical retrieval of a left atrial appendage occluder migrated into the left ventricular outflow tract with secondary massive mitral regurgitation: A case report and literature review.

作者信息

Ye Wei, Zhou Wei, Zhao Weibing, Mao Jingjing, Wang Wei, Wei Liang, Zhao Linghui, Xu Yan, Yu Jing, Fu Zhi, Wang Qiang, Zhang Zhuan

机构信息

Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China.

Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China.

出版信息

Heliyon. 2024 Feb 29;10(5):e27112. doi: 10.1016/j.heliyon.2024.e27112. eCollection 2024 Mar 15.

Abstract

Thrombotic complications of atrial fibrillation continue to pose a significant challenge in clinical practice today. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative to oral anticoagulation for high-risk patients with atrial fibrillation. However, despite the potential benefits, there is still the possibility of life-threatening complications such as device dislocation. In this case study, we present a patient who experienced severe hemodynamic disturbances due to the embolization of LAAO device into the left ventricular outflow tract, resulting in a torn mitral valve and secondary massive mitral regurgitation, just 3 hours after the procedure. As a result, emergent surgical intervention was required to remove the device and repair the mitral valve. We also conducted a review of previous studies on the retrieval of dislodged left atrial appendage occluders through surgical procedures. It is crucial to maintain vigilance, foster interdisciplinary collaboration, and respond promptly to ensure the safety and efficacy of LAAO procedures.

摘要

心房颤动的血栓形成并发症在当今临床实践中仍然是一个重大挑战。对于高危心房颤动患者,左心耳封堵术(LAAO)已成为口服抗凝治疗的一种有前景的替代方法。然而,尽管有潜在益处,但仍有可能出现危及生命的并发症,如装置脱位。在本病例研究中,我们介绍了一名患者,该患者在手术后仅3小时就因LAAO装置栓塞至左心室流出道而出现严重血流动力学紊乱,导致二尖瓣撕裂和继发性大量二尖瓣反流。因此,需要紧急手术干预以取出装置并修复二尖瓣。我们还回顾了以往关于通过外科手术取出移位的左心耳封堵器的研究。保持警惕、促进跨学科合作并迅速做出反应对于确保LAAO手术的安全性和有效性至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8e8c/10915572/720aa14ab6b4/gr1.jpg

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