在不完全的手术关闭后,剩余的左心房附属物
Anish K Desai1, Jeffrey Chidester1, Olivia Ondigi1
1Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia, USA.
JACC. Case reports
|February 5, 2026
概括
不完整的外科手术左心房附属体封闭 (LAAO) 需要谨慎管理. 过导管LAAO和医疗策略可以解决LAA残留挑战,成像指导治疗决策.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 医疗器械技术 医疗器械技术
背景情况:
- 心房动 (AF) 需要抗凝药来预防中风,但治疗不耐受是常见的.
- 手术左心房附属体封闭 (LAAO) 为AF患者提供了一种替代性中风预防策略.
- 手术后LAAO的不完全关闭可能导致剩余的左心房附属体 (LAA) 穿透,造成管理困难.
研究的目的:
- 在手术LAAO后呈现两个残留LAA的病例.
- 讨论不完整的手术LAA关闭的管理挑战和治疗选择.
- 突出了手术LAAO患者的后续成像的重要性.
主要方法:
- 在手术LAAO (AtriClip) 后,两名LAA残留患者的病例系列呈现.
- 评估患者的并发症,包括出血风险和之前的中风.
- 对诊断成像 (计算机断层扫描) 的审查,以确认残留的LAA.
- 后续干预的描述,包括跨导管LAAO和医疗管理.
主要成果:
- 案例1:一个81岁的男性患有贫血和手术LAAO后出血,成功地用过导管LAAO治疗了残留的LAA.
- 案例2:一名84岁的女性曾经患上中风和高出血风险,呈现了残留的LAA,排除了抗凝和透管干预.
- 在这两种情况下,不完全的外科 LAA 关闭得到证实.
结论:
- 不完全的手术LAA关闭带来了独特的临床挑战.
- 管理策略,包括跨导管LAAO和医疗疗,应根据个体患者的解剖学和并发症量身定制.
- 定期的后续成像对于检测残留的LAA通透性外科术后闭塞至关重要.
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