7 research outputs found
La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y c贸mo), o no cerrar (y por qu茅)
The left atrial appendage is considered the main source of emboli in strokes in
patients with atrial fibrillation. Oral anticoagulant therapy significantly
reduces the risk of cerebral embolic events compared to aspirin, but it is
associated with bleeding complications, and is not always used. Closure of the
left atrial appendage reduces the rate of thromboembolic events, and it is
currently recommended in patients with atrial fibrillation submitted to mitral
valve surgery. However, the formation of emboli in these patients may be due to
other causes, as the role of the atrial appendage could be less important than is
assumed. Moreover, not all patients are candidates for oral anticoagulation, and
not all are kept in a proper therapeutic range, which could justify the formation
of atrial thrombi. There are several methods for performing the closure of the
appendage: direct suture in concomitant mitral surgery, epicardial exclusion by
stapling or clips, or endovascular occlusion by percutaneous application.
However, the results seem inconclusive with regards to their effectiveness for
complete occlusion of the appendage, safety, and efficacy in preventing cerebral
embolic events. To add to the confusion, some authors reveal no clear benefit in
suture closure, and even describe an increased risk of thromboembolism. We
present a review of left atrial appendage closure for the prevention of strokes,
as well as the different procedures described above
Giant left atrial thrombus 17 years after orthotopic heart transplantation
We present the case of a 66-year-old woman who underwent orthotopic heart transplantation 17 years earlier for dilated cardiomyopathy.
After 7 years allograft coronary vasculopathy developed requiring coronary artery angioplasty. In year 15 postoperatively she experienced
congestive heart failure and she became symptomatic requiring diuretics and digoxin treatment. In year 16 postoperatively a routine
coronary computed tomography (CT) angiography study revealed a giant thrombus in the left atrium. The patient had had no thromboembolicrelated
symptoms. Anticoagulation therapy was introduced and the patient has not presented any thromboembolic-related complication.
As the symptoms of cardiac insufficiency worsened we decided to evaluate the patient for re-transplantation
Cirug铆a de la fibrilaci贸n auricular
Atrial fibrillation surgery is based on creating scars in the atrium, in order to
avoid re-entry phenomena that may initiate and perpetuate arrhythmia, and driving
the normal stimuli from the sinus node to the atrio-ventricular node. The
complexity and increased risk of the initial surgical technique, based on a
"cut-and-sew" procedure, have enhanced other current procedures, in which
different energies are used making it possible to perform scars in a safer and
less invasive way. At present, atrial fibrillation surgery is not performed
routinely in all cardiothoracic surgical centers, and there is no consensus in
which is the best type of technique. Even if the results are good, they depend on
multiples factors such as duration of arrhythmia, atrial size and type of
technique employed. In addition, there is some variability in the description
within the scientific community of the results and procedures used, which makes
its analysis confusing. In this paper we review the different techniques
described, the results and their application in minimally invasive surgery
Left atrial appendage occlusion by invagination and double suture technique
Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed.We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture)
La orejuela izquierda como fuente de accidentes cerebrovasculares: cerrar (y c贸mo), o no cerrar (y por qu茅)
The left atrial appendage is considered the main source of emboli in strokes in
patients with atrial fibrillation. Oral anticoagulant therapy significantly
reduces the risk of cerebral embolic events compared to aspirin, but it is
associated with bleeding complications, and is not always used. Closure of the
left atrial appendage reduces the rate of thromboembolic events, and it is
currently recommended in patients with atrial fibrillation submitted to mitral
valve surgery. However, the formation of emboli in these patients may be due to
other causes, as the role of the atrial appendage could be less important than is
assumed. Moreover, not all patients are candidates for oral anticoagulation, and
not all are kept in a proper therapeutic range, which could justify the formation
of atrial thrombi. There are several methods for performing the closure of the
appendage: direct suture in concomitant mitral surgery, epicardial exclusion by
stapling or clips, or endovascular occlusion by percutaneous application.
However, the results seem inconclusive with regards to their effectiveness for
complete occlusion of the appendage, safety, and efficacy in preventing cerebral
embolic events. To add to the confusion, some authors reveal no clear benefit in
suture closure, and even describe an increased risk of thromboembolism. We
present a review of left atrial appendage closure for the prevention of strokes,
as well as the different procedures described above
Left atrial appendage occlusion by invagination and double suture technique
Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed.We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture)
Cirug铆a de la fibrilaci贸n auricular
Atrial fibrillation surgery is based on creating scars in the atrium, in order to
avoid re-entry phenomena that may initiate and perpetuate arrhythmia, and driving
the normal stimuli from the sinus node to the atrio-ventricular node. The
complexity and increased risk of the initial surgical technique, based on a
"cut-and-sew" procedure, have enhanced other current procedures, in which
different energies are used making it possible to perform scars in a safer and
less invasive way. At present, atrial fibrillation surgery is not performed
routinely in all cardiothoracic surgical centers, and there is no consensus in
which is the best type of technique. Even if the results are good, they depend on
multiples factors such as duration of arrhythmia, atrial size and type of
technique employed. In addition, there is some variability in the description
within the scientific community of the results and procedures used, which makes
its analysis confusing. In this paper we review the different techniques
described, the results and their application in minimally invasive surgery