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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 81-year-old woman with permanent atrial fibrillation &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#61;5&#41; was referred for left atrial appendage &#40;LAA&#41; closure&#46; She had a history of hypertension&#44; stage IV chronic kidney disease and chronic anemia&#44; secondary to gastrointestinal bleeding &#40;HAS-BLED score&#61;3&#41;&#46; Percutaneous LAA closure with a 22 mm first-generation device &#40;Amplatzer&#8482; Cardiac Plug &#91;ACP&#93;&#41; was performed &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>A&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Video 1</a>&#41;&#46; The procedure was guided by three-dimensional transesophageal echocardiography &#40;TEE&#41; and complete occlusion was confirmed &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>B&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Videos 2 and 3</a>&#41;&#46; She was treated with aspirin 100 mg plus clopidogrel 75 mg daily for one month&#44; clopidogrel 75 mg daily for six months&#44; and no antithrombotic drug thereafter&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">By protocol&#44; follow-up TEE was performed at 12 months and revealed a large mobile thrombus attached to the atrial surface of the ACP &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>C and D&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Videos 4 and 5</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Warfarin was started and TEE was scheduled for six months later&#46; In the meantime&#44; the patient developed septic shock due to toxic megacolon and died one month after starting warfarin&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cases of device-related thrombi have been described with the ACP&#46; An early and thorough assessement&#44; either by TEE or angio-computed tomography&#44; should be considered to rule out device thrombosis&#44; especially in first-generation devices&#44; since most thrombi have been documented at 45-day TEE&#46; Newer devices with less thrombotic risk are now available&#46; The optimal duration of antiplatelet therapy and&#47;or a period of oral anticoagulation after device implantation remain to be addressed in future studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data is showed in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data is showed in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Image in Cardiology
Large thrombus formation on an Amplatzer™ Cardiac Plug
Trombose do dispositivo Amplatzer™ Cardiac Plug
Ana Isabel Azevedo
Corresponding author
ana.isabel.az@gmail.com

Corresponding author.
, Lino Santos, José Ribeiro, Francisco Sampaio, Adelaide Dias, Vasco Gama Ribeiro
Cardiology Department, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Implantation of a 22 mm Amplatzer&#8482; Cardiac Plug &#40;ACP&#41;&#59; &#40;B&#41; three-dimensional transesophageal echocardiography guidance of the procedure&#59; &#40;C&#41; thrombus on atrial surface of the ACP on two-dimensional transesophageal echocardiography &#40;white arrow&#41;&#59; &#40;D&#41; three-dimensional transesophageal echocardiography showing thrombus on the device &#40;zoom mode&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 81-year-old woman with permanent atrial fibrillation &#40;CHA<span class="elsevierStyleInf">2</span>DS<span class="elsevierStyleInf">2</span>-VASc score&#61;5&#41; was referred for left atrial appendage &#40;LAA&#41; closure&#46; She had a history of hypertension&#44; stage IV chronic kidney disease and chronic anemia&#44; secondary to gastrointestinal bleeding &#40;HAS-BLED score&#61;3&#41;&#46; Percutaneous LAA closure with a 22 mm first-generation device &#40;Amplatzer&#8482; Cardiac Plug &#91;ACP&#93;&#41; was performed &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>A&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Video 1</a>&#41;&#46; The procedure was guided by three-dimensional transesophageal echocardiography &#40;TEE&#41; and complete occlusion was confirmed &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>B&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Videos 2 and 3</a>&#41;&#46; She was treated with aspirin 100 mg plus clopidogrel 75 mg daily for one month&#44; clopidogrel 75 mg daily for six months&#44; and no antithrombotic drug thereafter&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">By protocol&#44; follow-up TEE was performed at 12 months and revealed a large mobile thrombus attached to the atrial surface of the ACP &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>C and D&#44; <a class="elsevierStyleCrossRef" href="#sec0030">Videos 4 and 5</a>&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Warfarin was started and TEE was scheduled for six months later&#46; In the meantime&#44; the patient developed septic shock due to toxic megacolon and died one month after starting warfarin&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cases of device-related thrombi have been described with the ACP&#46; An early and thorough assessement&#44; either by TEE or angio-computed tomography&#44; should be considered to rule out device thrombosis&#44; especially in first-generation devices&#44; since most thrombi have been documented at 45-day TEE&#46; Newer devices with less thrombotic risk are now available&#46; The optimal duration of antiplatelet therapy and&#47;or a period of oral anticoagulation after device implantation remain to be addressed in future studies&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data is showed in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data is showed in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Article information
ISSN: 21742049
Original language: English
DOI:10.1016/j.repce.2016.06.011
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