房间隔缺损或卵圆孔未闭联合左心耳一站式封堵治疗的安全及有效性

Safety and efficacy of one-stop treatment of left atrial appendage occlusion in combination with concomitant closure of atrial septum defect or patent foramen ovale

目的评估先天性房间隔缺损或卵圆孔未闭并发心房颤动(房颤)患者同时行房间隔缺损或卵圆孔未闭联合左心耳封堵术的安全性、疗效及预后。方法回顾性分析珠海市人民医院2017年10月至2019年6月收治的10例先天性房间隔缺损或卵圆孔未闭并发房颤的患者的术前、术中及术后临床资料,评估术中安全性及即刻手术疗效,并于术后的第45天、90天、180天及360天对患者进行随访观察,了解患者临床表现,并确认房间隔缺损或卵圆孔未闭和左心耳封堵器的位置,评估残余分流及血栓形成情况。结果成功对10例患者植入双盘式房间隔缺损或卵圆孔未闭封堵器及左心耳封堵器(均为WATCHMANTM),其中5例为房间隔缺损联合左心耳封堵患者,5例为卵圆孔未闭联合左心耳封堵患者(其中3例患者进行了射频消融联合卵圆孔未闭封堵及左心耳封堵术治疗)。患者术后即刻封堵效果满意,房间隔缺损或卵圆孔未闭封堵器位置固定且无残余分流,WATCHMANTM左心耳封堵器符合PASS原则。术中未发现器械相关性血栓,无心包填塞及血管并发症。随访结果显示,10例患者均未发现新发脑卒中,无心绞痛、心肌梗死以及心功能恶化,且未出现器械相关性血栓及封堵器移位和左心耳封堵器残余分流加重等不良事件。3例同期接受射频消融的患者维持窦性心律,1例房间隔缺损患者自行转为窦性心律。结论对先天性房间隔缺损或卵圆孔未闭并发房颤患者同期实施房间隔缺损或卵圆孔未闭联合左心耳封堵术,操作安全简便,手术效果及随访结果满意。

Objectives To explore the feasibility,safety and efficacy of one-stop treatment of left atrial appendage(LAA)occlusion(LAAO)in combination with concomitant closure of atrial septum defect(ASD)or patent foramen ovale(PFO)in patients with ASD or PFO and concurrent atrial fibrillation(AF).Methods Clinical data of 10 ASD or PFO patients with concurrent AF admitted to Zhuhai People′s Hospital from October 2017 to June 2019 were retrospectively analyzed.The effects of closure of LAA and ASD or PFO were evaluated immediately after operation.The location,exterior thrombosis status and residual leak of the occluders of LAA and ASD or PFO in parallel with patients′clinical manifestations were evaluated on the 45 th,90 th,180 th,360 thdays of follow-up.Results All the patients were successfully implanted with WATCHMANTMdevice and double-plate ASD or PFO occluder,within which,5 patients received ASD occluder and the other 5 patients received PFO occluder(3 of the latter underwent simultaneous radiofrequency ablation of AF).The WATCHMANTMdevice operation was in accordance with the PASS principle.An instant and satisfactory sealing by WATCHMANTMand ASD or PFO occluders were obtained upon operation:all occluders were fixed in proper position with no residual shunts.And there was no exterior device thrombosis,cardiac tamponade or vascular complications throughout the operation.The follow-up results showed that all the 10 patients were protected from newly developed ischemic or hemorrhagic stroke,angina pectoris,myocardial infarction and worsening heart function.Meanwhile,there was no displacement,surface thrombosis or gradual residual leak of the devices.Sinus rhythm had been maintained with improved cardiac function in the 3 patients undergone concomitant radiofrequency ablation,and another patient had spontaneous cardioversion to normal heart rhythm.Conclusions For congenital ASD or PFO patients concurrent with non-valvular AF,one-stop treatment of concomitant ASD or PFO and LAAO is safe and convenient with favorable short-and mid-term clinical outcomes,thus being a feasible and promising strategy for treatment of this cohorts.