Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention.
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.
Hospital Universitario La Paz, Madrid, Spain. Electronic address: daniele.gemma@hotmail.com.
Daniele
D
Gemma
Hospital Universitario La Paz, Madrid, Spain.
Raúl
R
Moreno Gómez
Hospital Universitario La Paz, Madrid, Spain.
Jaime
J
Fernández de Bobadilla
Hospital Universitario La Paz, Madrid, Spain.
Guillermo
G
Galeote García
Hospital Universitario La Paz, Madrid, Spain.
Teresa
T
López Fernandez
Hospital Infanta Cristina, Badajoz, Spain.
Jose R
JR
López-Mínguez
Hospital Universitario La Paz, Madrid, Spain.
José L
JL
López-Sendón
D000074:Acenocoumarol / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055989:Septal Occluder Device; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants; D000074:Acenocoumarol
Atrial fibrillation; Encerramento percutâneo do apêndice arterial esquerdo; Estenose mitral; Fibrilhação auricular; Mitral stenosis; Percutaneous left atrial appendage closure; Percutaneous mitral valvuloplasty; Valvuloplastia mitral percutânea