Zatvaranje aurikule leve pretkomore Watchman uređajem u prevenciji tromboembolijskih komplikacija kod bolesnika sa atrijalnom fibrilacijom: Prva iskustva u Srbiji

  • Milan A. Nedeljković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Branko Beleslin Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milorad Tešić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
  • Bosiljka Vujisić Tešić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vladan Vukčević Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Goran Stanković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Siniša Stojković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Dejan Orlić Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Tatjana Potpara Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Nebojša Mujović Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Milan Marinković Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
  • Olga Petrović Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
  • Marek Grygier Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
  • Alexey V. Protopopov Invasive Cardiology Department, State Clinical Hospital, Krasnoyarsk Medical University by the Name of ProfV.F.Voino-Yasenetck, Krasnoyarsk, Russia;
  • Vladimir Kanjuh Serbian Academy of Sciences and Arts, Belgrade, Serbia.
  • Milika Ašanin Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP160205202N
Ključne reči: atrial fibrillation||, ||fibrilacija pretkomora, cerebrovascular disorders||, ||cerebrovaskularni poremećaji, risk assessment||, ||rizik, procena, therapeutic occlusion||, ||okluzija, terapijska, heart atria||, ||srce, pretkomora,

Sažetak


Uvod. Atrijalna fibrilacija (AF) je glavni uzrok moždanog udara, posebno kod starijih bolesnika preko 75 godina. Preporuke Evropskog udruženja kardiologa preporučuju hroničnu antikoagulantnu terapiju kod bolesnika sa atrijalnom fibrilacijom i CHA2DS2-VASc skorom ≥ 1 [CHA2DS2-VASc skor za procenu rizika od nastanka moždanog udara kod bolesnika sa ne-reumatskom AF koji se sastoji od početnih slova bolesti: C – kongestivna srčana slabost; H – hipertenzija; A2 – starost preko 75 godina; D – dijabetes melitus; raniji moždani udari ili tranzitorni ishemijski atak (TIA) ili tromboembolizam; V – vaskularne bolesti; A – starost 65–74 godine; Sc – pol]. Međutim, značajan broj bolesnika ima visok rizik od krvarenja ili kontraindikacije za hroničnu antikoagulantnu terapiju, i predstavljaju bolesnike kod kojih su neophodni alternativni načini lečenja u prevenciji tromboembolijskih komplikacija. Transkatetersko perkutano zatvaranje aurikule leve pretkomore (LAAC) putem posebnih zatvarača preporučuju se kod bolesnika sa kontraindikacijama za hroničnu antikoagulantnu terapiju. Prikaz slučaja. Predstavljamo naša prva 3 bolesnika sa ne-valvularnom AF i kontraindikacijama za hroničnu antikoagulantnu terapiju kod kojih su uspešno ugrađeni Watchman LAAC zatvarači u Sali za kateterizaciju Klinike za kardiologiju Kliničkog centra Srbije u Beogradu. Zaključak. Naši inicijalni rezultati sa Watchman LAAC zatvaračima su obećavajući i ohrabrujući, a predstavljaju pravu alternativu za bolesnike sa ne-valvularnom AF i kontraindikacijom za primenu dugotrajne antikoagulantne terapije, odnosno za one kod kojih postoji visok rizik od krvarenja.

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Objavljeno
2017/06/28
Broj časopisa
Vol. 74 Br. 4 (2017)
Rubrika
Prikaz bolesnika