在左心房尾封闭后,周周器件泄漏和晚期大血栓形成:一个病例报告
Yi-Ting Chen1, Yung-Lung Chen1, Chiung-Jen Wu1
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Medicine
|December 30, 2025
概括
在左心房附带闭塞 (LAAO) 后的晚期设备相关血栓 (DRT) 即使有最小的泄漏也可以形成. 华法林的有效治疗解决了大血栓,强调了警的长期监测和LAAO后量身定制的抗凝药.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械 医疗器械
背景情况:
- 左心房尾阻塞 (LAAO) 是一种替代性中风预防策略,用于对抗凝血不耐受的非膜心房的患者.
- 设备相关血栓 (DRT) 是一种可能降低LAAO疗效的并发症.
- 晚期DRT,特别是与最小的周围设备泄漏 (PDL) 相关,是一个新兴的问题,需要进一步了解最佳患者管理.
研究的目的:
- 在接受LAAO的患者身上呈现大量晚期DRT形成的案例.
- 为了说明最小的PDL作为晚期血栓发育的巢穴的潜力.
- 突出持续监测和个性化抗凝策略在LAAO之后的重要性.
主要方法:
- 一名65岁的男性有史以来的缺血性中风,在LAAO后10个月出现了头.
- 诊断成像,包括输食管回声心电图和心脏CT血管图,在LAAO设备上确定了一个大血栓,PDL最小.
- 该患者接受了高强度华法林治疗 (INR 2.5-3.5),并暂时停止了克洛皮多格雷尔治疗.
主要成果:
- 华法林治疗导致大DRT在2个月内完全消失.
- 在随访期间,该患者在神经学上保持稳定,并且没有出现栓塞并发症.
- 这一结果支持抗凝剂在管理晚期DRT时的有效性.
结论:
- 最小的PDL可能会导致显著的晚期DRT,特别是在中断的抗凝剂时.
- 这一案例强调了长期成像监测和LAAO后个性化抗凝药的必要性.
- 临床医生应保持对晚期DRT的警,并考虑为高风险患者扩展后续检查方案.
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