2人以上.6 million Americans have atrial fibrillation (sometimes called A-fib), 一个快速, irregular heartbeat rhythm caused by chaotic electrical activity in the heart's two upper chambers (atria). 因为心脏没有稳定跳动, 协调的方式, 流向身体的血液减少了.

A-fib can cause uncomfortable symptoms, such as fatigue, palpitations and shortness of breath. More serious, it can cause blood clots that may lead to a stroke. Up to 90 percent of these stroke-causing clots originate in the left atrial appendage, 一个小, hollow sac attached to the left atrium where blood can collect. To prevent clots from forming, patients with A-fib are usually prescribed blood-thinning medications. 但有些病人不能耐受这些药物. 对于没有使用血液稀释剂的心房纤颤患者, the risk of stroke increases with age: A-fib causes 15 percent of all strokes, 但在70岁及以上的患者中, 它占中风的25%.

An effective way to reduce stroke risk from A-fib is to close off the left atrial appendage. 几十年来，这都是通过开胸手术来实现的. But recently developed devices have made it possible to close off the appendage through minimally invasive procedures, 在哪里?, flexible tubes (catheters) are guided through blood vessels to access the heart. 如果你正在考虑这些程序, understand that closing the appendage lowers stroke risk but doesn't cure A-fib.

的 Watchman is an implantable device that acts as a plug to seal off the left atrial appendage. This parachute-shaped device is about the size of a quarter and made of light, 用于许多其他医疗植入物的紧凑材料.

UCSF was among the first medical centers to perform a procedure that uses a lasso-like device called the Lariat to close the appendage. 的 Lariat is a pre-tied loop of suture (stitching material) that the doctor places around the outside of the appendage to tie it off from the heart. 加州大学旧金山分校心脏病专家. Randall 李 helped develop the Lariat and has since trained cardiologists from more than 100 medical centers to perform the procedure.

UCSF is one of the few hospitals in the country to offer both treatments.

评价

Potential candidates for either procedure are evaluated in our electrophysiology clinic. 才有资格使用守望者装置, you must be able to take anticoagulation and antiplatelet medications for a period of time after the procedure. 做Lariat手术不需要这个. Some patients can't undergo either procedure because of prior heart surgery or the particular anatomy of their left atrial appendage.

来确定你心房附件的大小和形状, 你的十大赌博平台排行榜会要求你做一个或多个影像学检查. 选项包括:

  • A 心脏核磁共振 uses powerful magnets and radio waves to create pictures of the heart. A harmless dye that highlights blood vessels and heart structures may be injected into the circulatory system.
  • A 心脏CT扫描 takes detailed X-ray images of the heart and blood vessels. 当病人可能在做Lariat手术时, this test is used to evaluate the size and shape of the left atrial appendage.
  • 的 经食管超声心动图 is an ultrasound test in which a thin tube conveys a transducer (a device emitting sound waves) down the throat to obtain clear heart images from inside the body. TEE is the preferred imaging test for the Watchman procedure.

过程

For both the Watchman and Lariat procedures, patients stay in the hospital for at least one night.

的se minimally invasive procedures are performed in a similar manner. A catheter carrying the device is inserted into the femoral artery (in the groin) and threaded through blood vessels to the heart. A combination of X-rays and TEE imaging is used to guide implantation. 一旦装置就位，导管就被取出. 每次手术需要两到三个小时, and patients are under general anesthesia (completely asleep).

In the Watchman procedure, the left atrial appendage is accessed from inside the heart. 该装置被放置在附属物的开口上, 封闭空间，这样血液就不会聚集在里面. Over time, scar tissue grows around the device, securing it in place. 观看这个视频 以了解更多有关守望者程序的资料.

在Lariat程序中, the loop is placed around the outside of the left atrial appendage and pulled tight, 把它和心脏的其他部分隔离开来. This requires accessing the heart through both the groin and chest wall. 的 chest access is obtained by passing a long needle under the rib cage, rather than cutting through the chest wall as in open-heart surgery.

复苏

Following either procedure, you have to stay in bed for at least four hours to prevent bleeding. During that time, we closely monitor your heart rate, blood pressure, oxygen levels and breathing.

大多数病人在手术后第二天就可以回家了. Your doctor may advise you to avoid driving for several days to a few weeks and to avoid strenuous exercise for a week. You may be instructed to take aspirin for about a month to reduce the risk of clots forming in your heart and blood vessels.

Remember, closing the left atrial appendage doesn't cure atrial fibrillation. 这些手术可以降低心房纤颤患者中风的风险. 病人 who undergo one of these procedures still have A-fib and may experience palpitations or other symptoms related to the condition.