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Hüseyin Ayhan Sanghamitra Mohanty
mer Gedikli Chintan Trivedi Ugur Canpolat Alfredo Chauca Tapia Qiong Chen Domenico G. Della Rocca Carola Gianni Anu Salwan Alisara Annanab Bryan MacDonald Angel Mayedo J. David Burkhardt Rodney Horton Gerald J. Gallinghouse Luigi Di Biase Amin Al‐Ahmad Andrea Natale 《Journal of cardiovascular electrophysiology》2020,31(9):2338-2343
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Intracardiac versus transesophageal echocardiography for left atrial appendage occlusion with watchman 下载免费PDF全文
Antonio H. Frangieh MD Jasmina Alibegovic MD Christian Templin MD Oliver Gaemperli MD Slayman Obeid MD Robert Manka MD Erik W. Holy MD Willibald Maier MD Thomas F. Lüscher MD Ronald K. Binder MD 《Catheterization and cardiovascular interventions》2017,90(2):331-338
Background: Left atrial appendage occlusion (LAAO) is mostly performed by transesophageal echocardiography (TEE) guidance. Intracardiac echocardiography (ICE) may be an alternative imaging modality for LAAO that precludes the need for general anesthesia or sedation. Methods and Results: All consecutive single center, single operator LAAO candidates were analyzed. Baseline clinical and procedural characteristics and in‐hospital outcomes were compared between patients in whom a Watchman was implanted with ICE vs. TEE guidance. In 76 consecutive patients the Watchman device was deployed under ICE in 32 patients (42%) and under TEE guidance in 44 patients (58%). Baseline characteristics were comparable between groups, except that patients in the TEE group were older (81 [75–85] years vs. 75 [68–80] years, P = 0.007). Total injected contrast media as well as fluoroscopy time were comparable between groups (90 ml [54–140] vs. 85 ml [80–110], P = 0.86 and 7.9 min [6.4–15.5] vs. 9.8 min [7.0–13.2], P = 0.51, for TEE vs. ICE, respectively). However, time from femoral venous puncture to transseptal puncture and to closure was longer in the ICE group (14 min [7.3–20] vs. 6 min [3.3–11], P = 0.007 and 48 min [40–60] vs. 34.5 min [27–44], P = 0.003, respectively). In the TEE group one patient suffered esophageal erosion with bleeding, which was managed conservatively and one non‐LAAO related in‐hospital mortality occurred in an 88‐year‐old patient. Device implantation success rate was 100% in both groups. No device embolization, no significant peri‐device leak, no tamponade, no stroke, and no access site bleeding occurred in any patient. Total hospital stay for stand‐alone LAAO was comparable between groups (2 days [2–2] vs. 2 days [2–3.3], P = 0.17, in ICE vs. TEE, respectively). Conclusions: ICE guidance for LAAO with the Watchman device is feasible and comparable to TEE and may become the preferred imaging modality for LAAO. © 2016 Wiley Periodicals, Inc. 相似文献
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Non-Surgical Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation. The most feared complication associated with atrial fibrillation (AF) is stroke, the risk of which increases with advanced age. Because of its complex anatomy and diminished blood flow during AF, the left atrial appendage (LAA) has been a common site of left atrial thrombi and presumed source of thromboembolism. Systemic anticoagulation to treat what may be largely a localized phenomenon is associated with significant complications. Newer anticoagulation agents hold great promise in facilitating dosing and eliminating drug and food interactions, but do not eliminate bleeding risk. These challenges have led to interest in mechanical exclusion of the LAA as a means of preventing thromboembolism in AF. Although surgery permits greater visualization and management of complications, the potential morbidity has limited adoption in often-frail elderly patients. In this paper, we review the current state of percutaneous left atrial exclusion for stroke prevention in AF, and the strengths and limitations of each of these strategies. The nonsurgical approaches to excluding the LAA from the central circulation can be divided into 3 broad categories: transseptally placed devices, percutaneous epicardial approach, and hybrid approaches. The availability of several approaches will allow physician selection of the optimal approach for a given patient based on clinical, physiological, and anatomical considerations. LAA exclusion stands to become an increasingly attractive option for patients with nonvalvular AF because it can be offered to elderly AF patients, and eliminates the long-term cumulative bleeding risks and adherence challenge of anticoagulants. 相似文献
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Ignacio Cruz‐Gonzalez MD PhD Jose‐Angel Perez‐Rivera MD PhD Armando Bethencourt MD PhD 《Catheterization and cardiovascular interventions》2015,85(2):E58-E62
We present the case of a 72‐year‐old woman with permanent atrial fibrillation and contraindication to long‐term oral anticoagulant therapy who underwent left atrial appendage (LAA) occlusion. A 24‐mm Amplatzer Cardiac Plug (St Jude Medical) device was deployed. The inferior part of the external disc of the device appeared to be over the posterior leaflet of the mitral valve but no significant mitral stenosis or mitral regurgitation was detected before deployment. After the procedure the patient suffered several syncopes when she tried to stand up. A transesophageal echocardiography (TEE) was performed and no significant differences on the device position were detected, it was not possible to perform the TEE in a stand‐up position due to the patient symptoms (hypotension, tachycardia, dizziness, and loss of consciousness). After discussion with the surgical team, surgical removal of the device and surgical exclusion of LAA was performed. The symptoms disappeared and the patient was discharged. In the best of our knowledge, this is the first time that recurrent syncope has been described as a complication of LAA occlusion. © 2014 Wiley Periodicals, Inc. 相似文献
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The influence of iatrogenic interatrial septum leaks after left atrial appendage closure on cardiac function test results 下载免费PDF全文
Katarzyna Mitrega MD PhD Witold Streb MD PhD Magdalena Szymala MD PhD Tomasz Podolecki MD PhD Anna Leopold‐Jadczyk MD Stanislaw Morawski MD Zbigniew Kalarus MD PhD 《Journal of interventional cardiology》2018,31(5):679-684
Aim
Left atrial appendage occlusion (LAAO) is a technique for preventing thromboembolism in patients with atrial fibrillation and a high risk of irreversible bleeding. In some patients, a spontaneous iatrogenic transseptal leak (ITL) remains after LAAO. The aim of this study was to assess the correlation between ITL incidence and the results of cardiac function tests in patients who underwent LAAO.Methods and Results
LAOO was performed in 62 consecutive patients using the Amplatzer Amulet. Before and 3 months after LAA occlusion, the 6‐min walking distance (6MWD) test was performed in all patients and oxygen consumption assessment (VO2max) was performed in 32. All patients had transesophageal echocardiography before and 3 months after LAAO to assess ITL incidence. The patients were divided according to the presence and absence of ITL and the subgroup of patients with heart failure (HF) were further analyzed. In patients with HF and ITL, an increased VO2max (12.8 ± 5.2 vs 15.3 ± 4.7; P < 0.05) and 6MWD (350.1 ± 77.4 vs 414.3 ± 70.6; P < 0.05) was observed after the procedure comparing to the results before the procedure. The 6MWD was also significantly higher in the patients with transseptal leaks in comparison to those without (P < 0.0001).Conclusion
The presence of transseptal leaks after LAAO does not influence overall cardiac function test results. However, in patients with HF, there is an increase in oxygen consumption and 6MWD. These results indicate that ITLs in patients with HF decrease left atrial pressure, which is the key contributor to the symptoms of heart failure during physical activity.18.
Manuel de J. Ramos Ramirez MD Bonnie Young DNP APRN‐BC Kishore Harjai MD Vernon Mascarenhas MD Pugazhendhi Vijayaraman MD 《Journal of interventional cardiology》2017,30(5):448-456
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Giuseppe Talanas Giuseppe D. Sanna Michele Portoghese Guido Parodi 《Catheterization and cardiovascular interventions》2020,95(3):408-410
Anticoagulation is of paramount importance during left atrial appendage occlusion procedure (LAAOP) to prevent periprocedural stroke. We present the case of a 66‐year‐old male patient who was scheduled to undergo LAAOP because of a prior intracranial bleeding. After transesophageal echocardiography‐guided transseptal puncture, intravenous heparin 5,000 IUs were administered obtaining an ACT greater than 300 s. We planned to implant an Amplatzer‐Amulet 25 mm LAA occluder through the dedicated 12F delivery sheath. After starting the tug test, TEE suddenly showed a floating thrombus whose proximal part was connected to the delivery cable. Because transesophageal echocardiography showed a good position of the device, we decided to release it and to quickly retrieve as a unit into the right atrium both the delivery cable with attached thrombus and the delivery sheath. We discuss about periprocedural anticoagulation dosing and monitoring and the importance to have specific studies in the setting of LAAOP. 相似文献
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