Late left atrial appendage closure device displacement and massive thrombus formation: a case report
Late left atrial appendage closure device displacement and massive thrombus formation: a case report
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晚期左心耳封堵器移位和大量血栓形成：病例报告
DOI：
10.1093/ehjcr/ytaa014
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
F. Riediger
中科院分区：
文献类型：
--
作者：
B. Sasko;O. Ritter;P. Bramlage;F. Riediger
摘要背景使用WATCHMAN器械进行左心耳（LAA）封堵术是预防选定房颤（AF）患者卒中的抗凝治疗的替代方案。 很少发生左心房（LA）器械相关血栓形成，对此了解甚少。由于左心耳覆盖不完全导致的血栓形成更为罕见，可能发生在器械植入后的最初几个月内。病例总结在此，我们报告了一例68岁男性患者，患有永久性房颤、药物和肝炎诱导的肝硬化（CILD评分B），既往接受过主动脉瓣置换术。 患者有使用WATCHMAN器械经皮左心耳封堵术的病史。他在植入后2年发生了大量器械周围泄漏和器械与附件裂缝之间的空间产生的血栓。由于HAS-BLED评分为5分，出血风险高，因此选择手术作为首选治疗，而不是长期抗凝治疗。患者出院时临床状况良好，计划每年随访一次。讨论该病例强调了选择适当尺寸的左心耳封堵器并计划定期介入后随访的重要性，以最大限度地降低每件器械泄漏和血栓的风险。
Abstract Background Left atrial appendage (LAA) closure with the WATCHMAN device is an alternative to anticoagulation therapy for the prevention of stroke in selected patients with atrial fibrillation (AF). Infrequently, left atrial (LA) device-related thrombus formation occurs and it is poorly understood. Thrombus formation due to incomplete covering of the LAA is even rarer and may occur within the first few months after device implantation. Case summary Here, we present a case of a 68-year-old male patient with permanent AF, drug- and hepatitis induced liver cirrhosis (CILD Score B), and prior aortic valve replacement. The patient had a history of percutaneous LAA closure using a WATCHMAN device. He developed massive peri-device leak and thrombus arising from the space between the device and appendage cleft 2 years after implantation. Because of the high bleeding risk with a HAS-BLED score of 5 points, surgery was chosen as the therapy of choice instead of long-term anticoagulation. The patient was discharged in good clinical condition and has been scheduled for a yearly follow-up. Discussion This case emphasizes the importance of choosing appropriately sized LAA occluder devices and planning for regular post-interventional follow-ups to minimize the risk of per-device leaks and thrombi.
影响因子：
24
作者：
January, Craig T.;Wann, L. Samuel;Yancy, Clyde W.
通讯作者：
Yancy, Clyde W.