A carregar...
Publicação
TAVI e encerramento do apêndice auricular esquerdo numa única abordagem em doente com fibrilhação auricular e contraindicação para terapêutica anticoagulante crónica
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 303.38 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
O tratamento standard dos doentes com Estenose Aórtica (EA) grave consiste na substituição cirúrgica da válvula aórtica. No entanto, em indivíduos com elevado risco operatório, a implantação percutânea da válvula aórtica (TAVI) tem vindo a assumir-se como uma alternativa terapêutica segura e eficaz.
A Fibrilhação Auricular (FA) é a arritmia mais comum e a sua complicação mais frequente é a embolização sistémica, particularmente o Acidente Vascular Cerebral (AVC). Uma vez que a maioria dos trombos se forma no Apêndice Auricular Esquerdo (AAE), o encerramento desta cavidade assume particular importância nos doentes com contraindicação para terapêutica anticoagulante.
É apresentado o caso de uma doente do sexo feminino, de 88 anos de idade, com EA grave, FA paroxística e comorbilidades que determinam a impossibilidade de administrar terapêutica anticoagulante. A doente foi submetida a TAVI e encerramento do AAE. Permaneceu internada durante nove dias e, após a alta hospitalar, não se registaram quaisquer intercorrências.
Até à data, apenas foram reportados casos isolados de intervenções que combinaram a TAVI e o encerramento do AAE; contudo, esta abordagem parece trazer vantagens clínicas, nomeadamente a suspensão imediata da terapêutica anticoagulante com a consequente redução do risco hemorrágico.
Standard treatment for patients with severe Aortic Stenosis (AS) consists in surgical aortic valve replacement (SAVR). However, in patients with high surgical risk scores, Transcatheter Aortic Valve Implantation (TAVI) has become a safe and effective alternative to SAVR. Atrial Fibrillation is the most common arrhythmia and its most frequent complication is systemic embolization, particularly stroke. Since the vast majority of thrombi is formed within the left atrial appendage (LAA), occlusion of the LAA is particularly important in patients for whom anticoagulation is contraindicated. We describe the case of an 88-year-old woman with severe AS, paroxysmal AF and other comorbidities that posed contraindication to anticoagulation therapy. The patient underwent TAVI and LAA occlusion. She was discharged from the hospital nine days after the procedure, and, since then, no complications were registered. Until now, only isolated cases of single interventions combining TAVI and LAA closure were reported; however, this strategy seems to bring clinical advantages, namely the immediate suspension of the anticoagulation therapy, with consequent reduction of the hemorrhagic risk.
Standard treatment for patients with severe Aortic Stenosis (AS) consists in surgical aortic valve replacement (SAVR). However, in patients with high surgical risk scores, Transcatheter Aortic Valve Implantation (TAVI) has become a safe and effective alternative to SAVR. Atrial Fibrillation is the most common arrhythmia and its most frequent complication is systemic embolization, particularly stroke. Since the vast majority of thrombi is formed within the left atrial appendage (LAA), occlusion of the LAA is particularly important in patients for whom anticoagulation is contraindicated. We describe the case of an 88-year-old woman with severe AS, paroxysmal AF and other comorbidities that posed contraindication to anticoagulation therapy. The patient underwent TAVI and LAA occlusion. She was discharged from the hospital nine days after the procedure, and, since then, no complications were registered. Until now, only isolated cases of single interventions combining TAVI and LAA closure were reported; however, this strategy seems to bring clinical advantages, namely the immediate suspension of the anticoagulation therapy, with consequent reduction of the hemorrhagic risk.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Substituição da válvula aórtica transcateter Estenose da valvula aórtica Fibrilhação atrial