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심장 내 이물질로 인한 반복적인 뇌경색 발생에 관한 증례

Percutaneous Treatment of Recurrent Stroke Caused by a Cardiac Foreign Body: A Case Report

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초록

We present a case of recurrent ischemic stroke in a 68-year-old man with a linear foreign body in the right atrium and ventricle and a patent foramen ovale (PFO). The patient developed atrial fibrillation despite taking warfarin at a therapeutic dose and had a third acute stroke. We planned left atrial appendage (LAA) occlusion via the PFO, followed by PFO closure and foreign body removal. The percutaneous LAA occlusion and PFO closure were successful. However, it was difficult to remove the radiolucent foreign body. We inserted an Omni™ catheter via the right jugular vein to contact the foreign body in the right atrium directly, grasped its distal end with a snare, and successfully extracted it. The patient was followed-up in the outpatient clinic and had no recurrent stroke.

Abstract

We present a case of recurrent ischemic stroke in a 68-year-old man with a linear foreign body in the right atrium and ventricle and a patent foramen ovale (PFO). The patient developed atrial fibrillation despite taking warfarin at a therapeutic dose and had a third acute stroke. We planned left atrial appendage (LAA) occlusion via the PFO, followed by PFO closure and foreign body removal. The percutaneous LAA occlusion and PFO closure were successful. However, it was difficult to remove the radiolucent foreign body. We inserted an Omni™ catheter via the right jugular vein to contact the foreign body in the right atrium directly, grasped its distal end with a snare, and successfully extracted it. The patient was followed-up in the outpatient clinic and had no recurrent stroke.

참고문헌 (6)

  1. Freixa X, "Cardiac procedures to prevent stroke : patent foramen ovale closure", left atrial appendage occlusion, 2014, pp.30, 87~95
  2. Leitman M, "Foreign bodies in the heart", Echocardiography, 32, pp.365~371 (2015)
  3. McMahon NE, "Etiologic workup in cases of cryptogenic stroke : a systematic review of international clinical practice guidelines", Stroke, 51, pp.1419~1427 (2020)
  4. Gladstone DJ, "Atrial fibrillation in patients with cryptogenic stroke", N Engl J Med, 370, pp.2467~2477 (2014)
  5. Tzikas A, "Left atrial appendage occlusion through a patent foramen ovale : should we or rather not?", Hellenic J Cardiol, 61, pp.442~443 (2020)
  6. Ho CL, "Dislodgment of port-a-cath catheters in children", Pediatr Neonatol, 49, pp.179~182 (2008)

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