title: Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation.
abstract: Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia. Electronic address: dale_murdoch@health.qld.gov.au.
authors.forename: Dale
authors.initials: D
authors.lastname: Murdoch
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: McAulay
authors.affiliation: The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000628:therapy*; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation; Rheumatic heart disease; Thromboembolism; Watchman®