本期病例特邀AHRA专委会陈学智教授与宁波大学附属第一医院沈才杰教授互动展示。
首先请您为大家介绍一下患者情况及手术策略。
• 该患者门诊ECG：快室率房颤
• CV评分5分，HASBLED评分3分
• 【手术策略】：先行FARAPULSE脉冲消融术进行症状管理，再行WATCHMAN FLX心耳封堵进行卒中预防。
该双分叶LAAC非常挑战，第一次LAAC后下分叶提示残余分流过大，在第二次LAAC时有两个策略可选：①双伞封堵，下分叶放置另一个20mmFLX ②单伞封堵，增加封堵器尺寸。这两个备选策略，请问您是如何考量？
策略1-我们采用足位20°造影重新对心耳上下叶进行单独造影，发现上下叶落差很大，上叶极细，上叶至共干开口处突然变大，下叶深度较浅，单纯封堵下叶封堵也有较大难度。
策略2-增加封堵器尺寸，由于分叶较早，远端会留在上分叶，且受到较细上分叶影响近端可能膨胀不充分，肩部能否成功落在心耳下缘将下分叶完全封堵，极大考验封堵器顺应性。但考虑WM FLX的顺应性非常好，我们最终采取了该策略。
非常期待，让我们看一下完整病例！
感谢陈教授的认可。术中操作PASS和术后随访PASS的Double PASS，为患者带来真正的长期获益。
期待下次再次互动！
陈学智 教授
Professor Chen Xuezhi
北京大学国际医院心内科主任医师
• Chief Physician, Department of Cardiology, Peking University International Hospital
北京大学心脏起搏及电生理中青年新技术论坛创始人及执行主席
• Founder and Executive Chair of the New Technology Forum for Young and Middle-aged People on Cardiac Pacing and Electrophysiology, Peking University
亚洲心律协会左心耳封堵（AHRA-LAAC）专委会核心专家
• Core Expert, AHRA-LAAC Committee
波士顿科学Watchman（FLX）左心耳封堵全球带教专家
• Global Proctor for Watchman (FLX) LAAC, Boston Scientific
美敦力MIC带教专家及Micra（AV）全球独立术者及带教专家
• Medtronic MIC Proctor and Micra (AV) Global Independent Physician and Proctor
北京医学会心电生理和起搏分会委员
• Member, Electrophysiology and Pacing Committee, Beijing Medical Association
中国生物医学工程学会心律分会青年委员
• Young Member, Cardiac Rhythm Committee, Chinese Society of Biomedical Engineering
北京大学CME课程特约专家
• Guest Expert, CME Courses, Peking University
北京大学血管医学及血管探秘课程特约教授
• Guest Professor, Vascular Medicine and Vascular Exploration Courses, Peking University.
沈才杰 博士
Ph.D Shen Caijie
副主任医师，医学博士，Banner University Medical center访问学者，宁波大学医学院硕士生导师，宁波市卫生健康青年技术骨干人才。
• Associate Chief Physician, MD, visiting scholar at Banner University Medical Center, master's supervisor at Ningbo University School of Medicine; recognized as a young key technical talent in health care by Ningbo Municipal Health Commission.
浙江省医学会心电生理与起搏分会青委会副主任委员，宁波市医学会心脏电生理与起搏分会青年委员兼秘书，中国超声心动图学会理事，宁波市医学宁波市医学会心血管病分会青年委员，国家心血管病重点建设专科、国家心血管疾病介入诊疗培训中心、浙江省重点实验室、中国房颤中心示范单位建设的核心骨干成员。
• He serves as deputy chair of the Youth Committee, Electrophysiology and Pacing Branch, Zhejiang Medical Association; youth committee member and secretary, Cardiac Electrophysiology and Pacing Branch, Ningbo Medical Association; board member of the Chinese Society of Echocardiography; youth committee member, Cardiovascular Branch, Ningbo Medical Association; a core member in the construction of the National Key Specialty in Cardiovascular Disease, the National Training Center for Interventional Diagnosis and Treatment of Cardiovascular Diseases, Zhejiang Provincial Key Laboratory, and the Demonstration Unit of China AF Center.
