Heart within a Heart
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Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation(AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device relatedthrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oralanti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure devicefor stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review ofthe various LAA closure devices, importance of periodic surveillance via echocardiography and management options to preventthis complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure devicethrombus.
Abstract
Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation(AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device relatedthrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oralanti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure devicefor stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review ofthe various LAA closure devices, importance of periodic surveillance via echocardiography and management options to preventthis complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure devicethrombus.
참고문헌 (11)
- Roger VL, "Heart disease and stroke statistics--2011 update: a report from the American Heart Association", Circulation, 123, pp.e18~e209 (2011)
- Blackshear JL, "Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation", Ann Thorac Surg, 61, pp.755~759 (1996)
- Lardizabal JA, "Mechanical approaches to stroke prevention in atrial arrhythmias", J Innov Cardiac Rhythm Manage, 3, pp.809~813 (2012)
- Holmes DR, "Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial", Lancet, 374, pp.534~542 (2009)
- Reddy VY, "Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology)", J Am Coll Cardiol, 61, pp.2551~2556 (2013)
- De Backer O, "Percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation:an update", Open Heart, 1, pp.e000020~ (2014)
- Plicht B, "Risk factors for thrombus formation on the Amplatzer Cardiac Plug after left atrial appendage occlusion", JACC Cardiovasc Interv, 6, pp.606~613 (2013)
- Urena M, "Percutaneous left atrial appendage closure with the AMPLATZER cardiac plug device in patients with nonvalvular atrial fibrillation and contraindications to anticoagulation therapy", J Am Coll Cardiol, 62, pp.96~102 (2013)
- Cardona L, "Thrombus formation on a left atrial appendage closure device", Circulation, 124, pp.1595~1596 (2011)
- Lammers J, "Thrombus formation on an Amplatzer closure device after left atrial appendage closure", Eur Heart J, 34, pp.741~ (2013)
- Mulvagh SL, "American society of echocardiography consensus statement on the clinical applications of ultrasonic contrast agents in echocardiography", J Am Soc Echocardiogr, 21, pp.1179~1201 (2008)