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在移植患者的左心室尾关闭后,与设备相关的巨型血栓,患有多变性心肌病

Tianyang Lu¹, Guanhua Wang¹, Sha Zhang¹

¹Department of Cardiology, Changhai Hospital, Naval Medical University, Shanghai, P.R. China.

JACC. Case reports

|March 12, 2026

概括

左心房尾关闭 (LAAC) 是心房动 (AF) 患者无法使用抗凝药的中风预防选择. 在缩性心肌病 (HCM) 患者中,LAAC需要谨慎管理,以防止与设备相关的血栓形成 (DRT).

科学领域:

心脏病学心脏病学
干预心脏病学干预心脏病学
电子生理学电子生理学

背景情况:

左心房尾关闭 (LAAC) 为心房动 (AF) 患者提供中风预防,患者不能耐受抗凝药.
同时的多变性心肌病 (HCM) 增加了LAAC后设备相关血栓形成 (DRT) 的风险.

研究的目的:

报告一个成功管理与器件相关的血栓形成 (DRT) 的病例,该病例发生在患有高性心肌病 (HCM) 和心房 (AF) 的患者身上,该患者正在接受左心房尾关闭 (LAAC).

主要方法:

一名59岁的女性患有HCM,永久性AF,以及脏移植史,用Watchman设备进行了LAAC.
双抗血小板治疗在手术后1个月过早停止.
在6个月的随访期确定了与设备相关的血栓形成 (DRT),并用长期,分阶段,剂量调整的里瓦洛克萨班疗程治疗.

主要成果:

在LAAC. 6个月后检测到一个大的DRT (5.2厘米×2.5厘米).
在接受Rivaroxaban治疗后,DRT完全消失.
尽管有并发症,但患者的中风预防得到了有效的管理.

结论:

在不能耐受抗凝血剂的HCMAF患者中使用LAAC是有争议的,但在高出血风险场景中可能是可行的选择.
精细的规划,警的DRT监测和个性化的抗血栓管理对于成功的结果至关重要.
这一案例凸显了通过调整的抗凝治疗成功解决DRT的潜力.

关键词:

这是一种抗凝血药物.与设备相关的血栓.过度缩性心肌病变性心脏病.左心房附属体的关闭闭关闭

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