摘要
目的多腔左心耳占80%,具有分叶多,封堵器选择及操作难度大等特点,现报道我们植入LAmbre封堵器的操作经验。方法入选年龄18至85岁之间的心房颤动患者,不愿意口服抗凝药物或口服抗凝药物有禁忌证,具有左心耳封堵适应证。根据经食道超声心动图及术中造影结果,选择多腔心耳患者,选择合适的LAmbre封堵器,植入左心耳。结果在17例入选患者中,经造影证实13例系多腔心耳,年龄71.4±7.8岁,其中9例为女性患者。所有患者均成功植入LAmbre封堵器,其中常规型10例,小伞大盘型3例。术后即刻行左心耳造影及TEE均未发现血流渗漏。术后出现心包积液1例,随访12个月无并发症发生。结论多腔心耳植入LAmbre封堵器安全可靠。锚定区判定对选择封堵器非常关键。食道心脏超声结合造影是可以提供良好保障。
Objective The left atrial appendage(LAA) is multilobed(80% have two or more lobes) and it is difficult for us to choose device and close multilobed LAA. This report aims at making preliminary assessment of the risks in LAA closure with LAmbre System and guiding for selection of both the size and location of the closure devices. Methods Inclusion criteria were:voluntary patients with both atrial fibrillation and indication for LAA closure aging from 18 to 85 who had contraindication for oral anticoagulants or unwillingness to take long-term oral anticoagulation therapy. All the candidates were preoperatively accepted TEE and angiography. With the results of both TEE and LAA radiography,multilobed appendages and the size and location for the closure device were chosen. The devices were planted at the ostium of the LAA. Results Seventeen atrial fibrillation patients were enrolled,all were successfully planted with the LAmbre LAA closure devices. Thirteen of them(9 female),with average age of( 71. 4± 7. 8) years old,were multilobed appendages. Among all devices. 10 were general type devices and 3 were ungeneral type devices. Regular postoperative TEE and LAA radiography both showed no blood leakage around the device. No complications of bleeding,embolism,or stroke were detected through the follow-ups of both peri-operative period and six-month-time after the operation apart from 1 cardiac tamponade. Conclusion It is safe to close multilobed appendages with LAmbre System. The anchor zone is critical to decide to choose the closure device. Preoperative shows of structure of LAA by TEE and LAA radiography provides significant references for the LAA closures.
