Prolapse of left atrial appendage during transcatheter left atrial appendage closure.
Prolapse of left atrial appendage during transcatheter left atrial appendage closure.
复制标题
经导管左心耳封堵术期间左心耳脱垂。
DOI：
10.1093/eurheartj/ehz533
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发表时间：
2019
影响因子：
39.3
通讯作者：
Gibson,DouglasN
中科院分区：
文献类型：
--
作者：
Pandey,AmitabhC;Alhama-Belotto,Marta;Niekerk,ChristoffelJvan;Gibson,DouglasN
放置LAAC器械，但需要重新定位。在重新捕获器械进行重新定位时，经食管超声心动图和X线透视显示，左心耳脱垂，基本上倒置到左心房（LA）中（图B和C，在线补充材料，视频S1）。尽管左心房压力升高，但在监测一段时间后左心房仍然脱垂。X线透视和TOE均用于评估穿孔，均不存在穿孔。使用X线透视和经食管超声心动图引导，使用猪尾导管，结合造影剂喷注，帮助将左心耳推回其原始位置（图D和E，在线补充材料，视频S2）。随后，在LAAC中成功展开了27 mm Watchman器械。LAAC术后45天的TOE显示LAA完全密封，未发现任何显著泄漏。手术文献中记录了左心耳脱垂，术后影像学检查经常发现左心耳内翻。在此，我们报告了经皮LAAC期间首次记录的LAA脱垂发生率，并提供了矫正策略。在LAAC期间，在X线透视和/或TOE上很容易识别LAA脱垂，并且在这种情况下很容易纠正。在这种情况下，机械解决方案是有帮助的，因为它使我们能够完成这个案例。否则，我们将不得不终止该病例，并随访患者自行消退。
LAAC device was placed but needed to be repositioned. As the device was recaptured for repositioning, it was noted on TOE as well as fluoroscopy that the LAA had prolapsed and was essentially inverted into the left atrium (LA)(Panels B and C, Supplementary material online, Video S1). The LAA remained prolapsed after a period of monitoring despite an elevated LA pressure. Both fluoroscopy and TOE were used to asses for perforations, with none being present. Using fluoroscopy and TOE guidance, a pigtail catheter was used, in conjunction with puffs of contrast, to help push the LAA back to its original position (Panels D and E, Supplementary material online, Video S2). Subsequently, a 27 mm Watchman device was successfully deployed for LAAC. A 45-day post-LAAC TOE demonstrated complete seal of the LAA without any significant leaks noted. Prolapse of the LAA has been documented in the surgical literature with the inverted LAA often noted on postoperative imaging. Here, we report the first documented occurrence of prolapse of the LAA during percutaneous LAAC and provide a strategy for correction. During LAAC, LAA prolapse is easily recognized on fluoroscopy and/or TOE, and in this case was easily corrected. In this case, the mechanical solution was helpful because it allowed us to complete the case. We otherwise would have had to terminate the case and follow the patient for spontaneous resolution.