RESUMO
Atrial fibrillation is associated with a significantly increased risk of stroke, and oral anticoagulation is the mainstay of preventative treatment. Scenarios arise where the risks of treatment with oral anticoagulation may outweigh the benefits, most commonly when there is an elevated risk of bleeding. Studies of percutaneous closure of the left atrial appendage have strongly implicated this structure in the etiology of stroke in atrial fibrillation, and provide some rationale for the discontinuation of oral anticoagulation following percutaneous closure device implantation. A common clinical concern is the safety of cessation of oral anticoagulation after surgical closure of the left atrial appendage in patients with a history of atrial fibrillation. Here, we review the evidence guiding this management decision and draw comparison with data on percutaneous closure.
Assuntos
Anticoagulantes/efeitos adversos , Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/métodos , Tromboembolia/prevenção & controle , Suspensão de Tratamento , Administração Oral , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Medição de Risco , Dispositivo para Oclusão Septal , Taxa de Sobrevida , Tromboembolia/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
A chronically persistent left atrial pseudoaneurysm is a rare complication of valvular surgery, trauma, myocardial infarction and endocaritis but this is the first known description of a chronic pseudoaneurysm as a complication of coronary rupture during percutaneous coronary intervention (PCI). We report computed tomography images depicting this in the case of elective PCI in an 81-year-old gentleman for limiting angina.
RESUMO
A substantial proportion of patients who undergo cardiac rhythm device implantation receive anticoagulation to prevent thromboembolism. Many patients have coexisting cardiovascular diseases treated with antiplatelet therapy. Anticoagulation may increase the risk of hemorrhagic complication, while withdrawal of anticoagulation may increase thromboembolic risk. In this article, we review and describe the available evidence, in order to inform best practice .
Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Desfibriladores Implantáveis , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/efeitos adversos , Guias de Prática Clínica como Assunto , Perda Sanguínea Cirúrgica/prevenção & controle , Medicina Baseada em Evidências , Humanos , Marca-Passo Artificial , Assistência Perioperatória , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controleRESUMO
Left ventricular noncompaction is a rare cardiomyopathy characterized by prominent ventricular hypertrabeculation. Here, we discuss the case of a 30-year-old man who presented with rapidly conducted atrial fibrillation. The images we present demonstrate appearances characteristic of this cardiomyopathy, with prominent trabeculations and an end-diastolic noncompacted to compacted myocardial thickness ratio of more than 2 noted on echocardiography and magnetic resonance imaging.
