First of all, we need to know what left atrial appendage is. The left atrial appendage is a small accessory structure of the left atrium, which is shaped like a small ear, so it is called atrial appendage. The function of the left atrial appendage is to help the left atrium squeeze blood out and into the left ventricle when the heart contracts. However, when there is a heart arrhythmia called atrial fibrillation, the contractions of the left atrium and left atrial appendage become uncoordinated, causing blood to stagnate in the left atrial appendage and form a blood clot.
If these blood clots break off, they can travel through the bloodstream to the brain, causing a life-threatening stroke. So, how can you prevent stroke caused by atrial fibrillation?A common method is to take anticoagulant medications that stop blood clotting, thereby reducing the formation of blood clots.
However, anticoagulant drugs also have certain *** such as increased risk of bleeding, or are not suitable for some patients' constitution. So, is there a better way?This is where left atrial appendage occlusion comes in. Left atrial appendage occlusion is an interventional procedure, which is based on the principle of sealing the opening of the left atrial appendage through a catheter delivery of a special occluder, so as to isolate the blood flow between the left atrial appendage and the left atrium, prevent the thrombus from falling off the left atrial appendage, and achieve the purpose of preventing stroke.
The advantage of this surgery is that it is safe and effective, does not require long-term anticoagulant medication, and does not affect the normal function of the heartSo, how is left atrial appendage occlusion performed?
Generally, this is a procedure that needs to be performed in a cardiac intervention room and requires local anesthesia and sedation. The procedure is as follows: The surgeon punctures the patient's right femoral vein, places a guidewire, and follows the vascular access to the right atrium. A special needle is used to pass through the fossa ovale and into the left atrium. This procedure, called puncture of the atrial septum, is a critical step in the surgery and involves precise control of the position and direction of the puncture with the help of imaging techniques such as X-rays and ultrasound.
The operator will use a delivery sheath to deliver the occluder to the opening of the left atrial appendage, release the occluder, and allow it to unfold and cover or fill the mouth of the left atrial appendage. The shape and size of the occluder should be selected according to the anatomy of the left atrial appendage to ensure the stability and integrity of the occluder. The surgeon will use imaging techniques such as ultrasound to check the position and effect of the occluder to confirm that there is no missing seal or displacement, and that there are no other complications such as pericardial effusion.
If everything is normal, the surgeon will release the occluder, retract the sheath, and end the procedure. The time of left atrial appendage closure surgery is generally about 1 hour, and you need to be hospitalized for 3 days after the operation, and then you can be discharged.
Anticoagulant medication is required for a certain period of time after surgery to prevent thrombosis around the occluder, usually 3 to 6 months. Regular ultrasound examinations are also required after surgery to monitor the condition of the occluder, such as whether there is residual blood flow and whether there is tissue covering. Left atrial appendage occlusion is an emerging technology, and its clinical application and research are still developing and improving.
At present, there are a number of international and domestic guidelines and consensuses that recommend or support left atrial appendage closure for the prevention of nonvalvular atrial fibrillation stroke.
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