心房颤动患者左心耳封堵后发生延迟性心脏压塞临床分析  

Clinical analysis of delayed cardiac tamponade in atrial fibrillation patients with left atrial appendage closure

作　　者：赵志宏 李炜 朱珞宁 赵汉君 王赛华 郝舒雯 宁忠平[1] 宋湘 Zhao Zhihong;Li Wei;Zhu Luoning;Zhao Hanjun;Wang Saihua;Hao Shuwen;Ning Zhongping;Song Xiang(Department of Cardiology,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;Department of Radiology,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院心内科,上海201318 [2]上海健康医学院附属周浦医院放射科,上海201318

出　　处：《中华急诊医学杂志》2022年第7期908-914,共7页Chinese Journal of Emergency Medicine

基　　金：上海市浦东科技发展基金(PKJ2021Y33);上海市医学重点专科建设基金(ZK2019B25);上海市浦东新区高峰学科建设基金(PWYgf202104)。

摘　　要：目的探讨左心耳封堵术后发生延迟性心脏压塞发生与左心耳毗邻解剖结构及封堵器关系。方法本研究为回顾性研究。纳入13例2016年8月至2021年6月上海健康医学院附属周浦医院因左心耳封堵术导致的延迟性心脏压塞并行急诊心包穿刺引流患者,随访时间(16±12)个月,对其临床资料进行回顾性分析,包括术前,术中及延迟性心脏压塞恢复后通过左心房CTA,食道超声心动评估左心耳及左心耳封堵器周边解剖结构关系。结果左心耳封堵后发生延迟性心脏压塞行心包穿刺引流患者13例,男性7例,年龄(72.1±8.3)岁,6例同时行冷冻消融治疗;患者左心耳菜花型8例,鸡翅型5例;盘式封堵器密封盘直径(29.5±2.8)mm;10例患者心脏压塞恢复后复查左心房CTA,8例锚钩贴靠肺动脉,1例锚钩贴靠左上肺静脉,1例锚钩同时贴靠肺动脉和左上肺静脉;除1例术后2d死亡外其他患者预后良好。结论左心耳封堵后发生延迟性心脏压塞与左心耳毗邻肺动脉,左上肺静脉位置关系密切,与较大的封堵器及其锚钩有关。Objective To investigate the relationship of delayed cardiac tamponade(CT)after left atrial appendage closure(LAAC)in atrial fibrillation(AF)patients and implanted occluders and adjacent anatomical structures.Methods This study was a retrospective study.Thirteen AF patients with LAAC complicated with delayed CT and with concurrent emergency pericardiocentesis drainage in Zhoupu Hospital,Shanghai University of Medicine&Health Sciences from August 2016 to June 2021 were selected.The follow-up time was(16±12)months.The clinical data of these patients were retrospectively analyzed,including the relationship between the left atrial appendage and pulmonary artery,vein anatomy by left atrium computed tomography angiography(CTA)before and after LAAC.Results Thirteen patients with delayed CT were treated by pericardiocentesis and drainage after LAAC and aged(72.1±8.3)years,and 7 patients were male,Six patients received cryoablation simultaneously.The classification types of left atrial appendage included cauliflower and chicken wing types were 8 and 5 respectively.The seal plate diameter of the lobe and-disc devices was(29.5±2.8)mm;10 patients had cardiac CTA reviewed.The occluder was atached to pulmonary artery in 8 patients,attached to left superior pulmonary vein only in one patient,and atached to pulmonary artery and left superior pulmonary vein in one patient.The prognosis was good except one patient who died 2 days after LAAC.Conclusions Delayed CT after LACC is closely related to the location of left atrial appendage adjacent to pulmonary artery and left superior pulmonary vein,and is related to larger oceluder and anchor hook.

关 键 词：心房颤动 左心耳封堵 延迟性心脏压塞 左心耳及毗邻解剖结构 

分 类 号：R541.75[医药卫生—心血管疾病]