经皮左心耳封堵术后的远程心包填塞
Remote Tamponade After Percutaneous Left Atrial Appendage Closure.
作者信息
Au Magdalene, Bobrowski David, Altin Eslem, Fam Neil, Angaran Paul, Ong Geraldine, Leong-Poi Howard, Yanagawa Bobby, Bagai Akshay
机构信息
Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
出版信息
JACC Case Rep. 2025 Apr 2;30(7):103388. doi: 10.1016/j.jaccas.2025.103388.
BACKGROUND
The use of percutaneous left atrial appendage closure (LAAC) among patients with nonvalvular atrial fibrillation at high thromboembolic risk and contraindication to or high risk for bleeding with oral anticoagulation is increasing.
CASE SUMMARY
The authors present a case of acute hemorrhagic tamponade 7 months after LAAC. Intraoperative findings showed device-related microperforation of the LAA and erosion of the adjacent pulmonary artery.
DISCUSSION
Remote tamponade after LAAC has been reported with an incidence <1%, occurring more frequently in nitinol plug devices than in nitinol cage devices. Management ranges from conservative with cessation of antithrombotic agents to invasive with surgical repair.
TAKE-HOME MESSAGES: Remote tamponade after LAAC is a rare but potentially fatal complication. Routine use of cardiac computed tomography in addition to transesophageal echocardiography for preprocedural planning, especially for nitinol plug devices, can identify patients at risk of delayed tamponade and can guide device selection, modified implantation technique, or alternative management strategies.
背景
在具有高血栓栓塞风险且口服抗凝治疗存在禁忌或出血风险高的非瓣膜性心房颤动患者中，经皮左心耳封堵术（LAAC）的应用正在增加。
病例摘要
作者报告了1例LAAC术后7个月发生急性出血性心包填塞的病例。术中发现显示与器械相关的左心耳微穿孔及邻近肺动脉侵蚀。
讨论
LAAC术后迟发性心包填塞的发生率<1%，镍钛合金塞式器械比镍钛合金笼式器械更常发生。处理方法从停用抗血栓药物的保守治疗到手术修复的侵入性治疗不等。
经验教训
LAAC术后迟发性心包填塞是一种罕见但可能致命的并发症。除经食管超声心动图外，术前常规使用心脏计算机断层扫描进行术前规划，特别是对于镍钛合金塞式器械，可以识别有延迟心包填塞风险的患者，并可指导器械选择、改良植入技术或替代管理策略。
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