Ruperti-Repilado Francisco Javier, Wals-Rodriguez Amadeo, Japon Miguel Angel, Gonzalez-Calle Antonio, Gallego Pastora
Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Avenida Manuel Siurot s/n., 41013 Sevilla, Spain.
European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Eur Heart J Case Rep. 2025 Mar 27;9(4):ytaf150. doi: 10.1093/ehjcr/ytaf150. eCollection 2025 Apr.
After an atrial switch operation, baffle complications such as stenosis and dehiscence are common. While thromboembolic events attributed to baffle leaks are well known, thrombosis at the pulmonary venous baffle as a source of cardioembolic stroke has not been previously reported.
We describe the case of a 43-year-old Caucasian male with recurrent cardioembolic strokes due to a calcified, broken, and thrombosed baffle with floaty, anticoagulant-resistant thrombi adhered to the side of the pulmonary venous return of Mustard patch. Surgery was the only curative option due to thrombi recurrence under different regimes of anticoagulation.
A case of recurrent cardioembolic strokes long after Mustard surgery due to thrombi on a heavily calcified pericardial patch is presented. A fracture in the patch led to the exposure of thrombogenic material, which had accumulated around the pacemaker (PM) leads on the systemic venous side of the baffle. This exposure allowed thrombotic material to reach the pulmonary venous side, ultimately entering the subaortic right ventricle and the systemic circulation. In the Mustard procedure, the material used for the baffle construction is prone to degeneration and calcification over time. We hypothesize that chronic mechanical stress from the PM leads might have contributed to the gradual erosion and fracture and consequently thrombosis of the heavily calcified patch, leading to recurrent strokes. Surgery became necessary as aggressive anticoagulation failed to prevent thrombus recurrence.
心房调转手术后,诸如狭窄和裂开等挡板并发症很常见。虽然因挡板渗漏导致的血栓栓塞事件已为人熟知,但此前尚未有关于肺静脉挡板处血栓形成作为心源性栓塞性卒中来源的报道。
我们描述了一名43岁白种男性的病例,该患者因Mustard补片肺静脉回流侧钙化、破裂且有血栓形成,伴有漂浮的、抗凝抵抗性血栓,反复发生心源性栓塞性卒中。由于在不同抗凝方案下血栓复发,手术是唯一的治愈选择。
本文报告了一例Mustard手术后很久因严重钙化的心包补片上的血栓导致反复心源性栓塞性卒中的病例。补片骨折导致血栓形成物质暴露,这些物质积聚在挡板体静脉侧的起搏器(PM)导线周围。这种暴露使血栓形成物质到达肺静脉侧,最终进入主动脉下右心室和体循环。在Mustard手术中,用于构建挡板的材料随着时间的推移容易发生变性和钙化。我们推测,PM导线产生的慢性机械应力可能导致了严重钙化补片的逐渐侵蚀、骨折,进而导致血栓形成,引发反复卒中。由于积极抗凝未能预防血栓复发,手术成为必要手段。