Left Atrial Appendage Thrombus
Left Atrial Appendage Thrombus
The left atrial appendage is a small chamber inside the left atrium. In people with a normal sinus rhythm, the atria contracts regularly, emptying all the blood in the atrium and the appendage. In someone with atrial fibrillation, however, the atria do not contract normally, which can increase the risk of developing a blood clot in the left atrial appendage as well as increase the risk of stroke. This is called left atrial appendage thrombus. Traditionally, this condition has been treated with either aspirin or anti-coagulation with warfarin.
Risk Factors
- Atrial fibrillation
Symptoms
Left atrial appendage thrombus does not cause any recognizable symptoms. However, if the thrombus becomes dislodged, it can increase your risk for a stroke.
Diagnosis and Tests
- Echocardiogram
- Transesophageal echocardiogram
Treatments
Traditionally, aspirin or medical management with anti-coagulation with warfarin has been used to prevent left atrial appendage thrombus. Some patients do not tolerate warfarin and may be candidates for a new class of anti-coagulants for thrombus prevention called direct oral anticoagulants. There are also left atrial appendage closure devices that do not require medications after placement.
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Left Atrial Appendage Occlusion
Left Atrial Appendage Occlusion
The left atrial appendage occluder (LAAO), or WATCHMAN, implant procedure is an advanced treatment for people with non-valvular atrial fibrillation (an irregular heartbeat not caused by a heart valve problem).
The insertion of this lightweight, umbrella- or parachute-shaped device can reduce stroke risk and enable patients to stop taking blood thinners. The procedure is performed under general anesthesia in our catheterization laboratory using a standard percutaneous (minimally invasive) technique.
In patients with non-valvular atrial fibrillation, more than 90% of stroke-causing clots that come from the left atrium are formed in the left atrial appendage. Implantation of the LAAO/WATCHMAN device, a one-time procedure, closes off the left atrial appendage, preventing blood clots from migrating out.
Conditions
Your doctor may recommend LAAO implantation if you:
- have experienced intercranial hemorrhaging
- have non-hemorrhoidal GI bleeding with no treatable etiology
- experience recurrent bleeding issues (e.g., hemorrhoidal disease, epistaxis, hematuria) with no treatable etiology
- have severe anemia (hemoglobin < 7) or thrombocytopenia (platelet < 50,000) assessed by a hematologist with no treatable etiology and a high risk of recurrent bleeding
- have amyloid angiopathy
You may also be considered for the procedure if:
- you have a history of recurrent or traumatic falls
- your lifestyle is associated with a risk of bleeding (e.g., if you participate in aggressive recreational sports that increase risk of fall/trauma)
- you have vocational duties associated with a risk of bleeding (i.e., duties involving the use of sharp objects, ladders or heavy machinery)
LAAO implantation is not recommended if you:
- are allergic to a material in the device, such as nickel or titanium
- can’t take blood thinners
- need to take blood thinners for a reason other than AFib
- should not (or cannot) undergo heart catheterization procedures
What’s Next for Candidates
After your doctor determines you are a candidate for the device, you will meet with one of our implanting physicians for an in-depth discussion regarding whether you think this procedure is right for you and want to proceed, as well as the risks that are associated with the procedure.
Each patient is part of the shared decision to proceed with the procedure. Our multidisciplinary team will jointly discuss your case, and you may be asked to undergo additional testing which may include:
- a follow-up appointment with an expert in another specialty (e.g., neurologist, gastroenterologist, oncologist, hematologist)
- a transesophageal echocardiogram, or TEE (one thing we look for during this process is a clot in the left atrial appendage; if one is found, you may need treatment and a repeat TEE to see if it has disappeared before we can implant the LAAO/WATCHMAN device)
- computerized tomography (CT) scan
- other non-invasive testing
What to Expect During LAAO Implantation Procedure
The procedure takes place in our cardiac catheterization lab, which has specialized equipment your doctor can use to test the electrical activity of your heart. After you are placed under general anesthesia, your doctor will make a small incision in your groin and insert a thin, flexible tube called a catheter into a blood vessel. At the end of the catheter is the LAAO/WATCHMAN device.
The doctor will guide the catheter to the opening of your left atrial appendage. The LAAO/WATCHMAN device is spring-loaded to expand to about the size of a quarter once placed. The device has no batteries or wires and is intended to be left in place permanently.
The procedure takes about an hour and will require you to stay in the hospital overnight. You will also be required to take blood-thinning medication until scar tissue grows over the device and seals off the left atrial appendage. Most patients can stop taking blood thinners within 45 days.
Follow-Up Visits
Forty-five (45) days after the procedure, you will need to return for another TEE to see if the device has sealed. During this appointment, you will receive instructions regarding your anticoagulation.
Six (6) months after the procedure, you will need a follow-up visit with your implanter. One (1) year after the procedure, you must follow up with either your primary care provider, implanter or primary cardiologist. Two (2) years after the procedure, you will need another follow-up visit with your primary care provider, implanter or primary cardiologist.
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LOCATION
Paresh Shah, M.D.
5051 Greenspring Ave Suite 304 Baltimore, MD 21209
Ajay Soodan, M.D.
2021B Emmorton Rd Suite 110 Abingdon, MD 21015
Amir Najafi, M.D.
1838 Greene Tree Rd Suite 304 Pikesville, MD 21208
4000 Old Court Rd Suite 103 Pikesville, MD 21208
Lasik and Photorefractive Keratectomy
Lasik and Photorefractive Keratectomy
Sight is one of our richest, most exciting senses. It is also something many people take for granted. The fact is, our eyes deserve preventive health care stance as much as any other function of the body. Here at the LifeBridge Health Krieger Eye Institute we want you to be aware of the latest advances in eye care, particularly if your eyesight is suddenly changing. So whether you are nearsighted, farsighted, astigmatic or have a family history of glaucoma or cataracts, you should know that many corrective procedures have been improved to the point where there is much less pain, downtime and risk involved correcting the problem.
What Is Refractive Surgery?
During refractive surgery, the cornea is gently reshaped to better focus light rays on the retina. Depending upon the results of your full ophthalmic evaluation, your Krieger ophthalmologist will recommend the refractive surgery procedure that meets your specific needs. Refractive surgery is quickly gaining popularity due to the fact that it is an outpatient procedure which offers minimal time in surgery, fast and comfortable recovery times, as well as a diminished dependence on glasses or contacts.
Millions of Americans are affected by conditions that fall under a category called "refractive errors." Most commonly, these include myopia (nearsightedness), hyperopla (farsightedness), astigmatism, as well as combinations of astigmatism and either myopia or hyperopla.
Laser Assisted Intrastromal Keratomileusis (LASIK)
During LASIK , a more recent procedure to correct nearsightedness, farsightedness and astigmatism, the ophthalmologist utilizes a precise surgical instrument called an automated microkeratome to create a flap on the surface of the cornea. Then a laser vaporizes a micro-thin layer of corneal tissue beneath the flap. The flap of tissue is replaced and the cornea begins to heal without a need for stitches. Since the surface of the cornea is not treated, LASIK offers quicker recovery and improvement of vision. As with the other refractive surgery procedures, approximately 95 percent of patients achieve 20/40 or better corrected vision.
Photorefractive Keratectomy (PRK)
PRK is specifically used to correct higher degrees of nearsightedness, and mild to moderate cases of farsightedness and astigmatism. The ophthalmologist uses a specially computerized laser to transmit gentle pulses of ultraviolet light to the cornea. Each programmed pulse vaporizes an infinitesimal layer of tissue that flattens the cornea to its proper shape. PRK's advanced laser technology provides a high degree of accuracy and takes no longer than 90 seconds to perform. In the weeks to months following PRK, patients experience gradual vision improvement. Overall results are comparable to RK, with approximately 95 percent of patients achieving 20/40 or better corrected vision.
A New Way of Thinking About Your Eyes
Since early detection is the key to successfully treating many diseases of the eye, it is important to schedule annual visits with your ophthalmologist at LifeBridge Health's Krieger Eye Institute. Krieger's ophthalmic services include routine and emergency eye care, glaucoma, corneal and retinal treatment, diabetic eye care, pediatric eye care, eyelid surgery, refractive surgery, reconstructive surgery, laser skin resurfacing surgery, low vision evaluations and contact lens fitting and care.
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Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy
Laparoscopic sleeve gastrectomy is a nonreversible weight-loss procedure that reduces stomach size by 85 percent, generating weight loss solely through reduced food intake.
Benefits
Studies have shown that patients who undergo laparoscopic sleeve gastrectomy lose 55 to 65 percent of excess weight within one year. The surgery can reduce cravings for sweets and improve your overall quality of life. Because it is a minimally invasive surgery, the procedure will require a shorter hospital stay and result in a faster recovery time.
Before Surgery
Your cardiovascular, pulmonary and endocrine systems must be evaluated before you undergo sleeve gastrectomy surgery. Also, a psychological evaluation is necessary to help determine your response to dramatic weight loss and a new body image. You will also speak with a care team member about dietary/nutritional issues related to your surgery.
During Surgery
During surgery, the stomach is divided vertically. The portion of the stomach that remains is shaped like a very slim banana or sleeve which measures from 1 to 5 ounces.
There is no intestinal bypass, only stomach reduction. The lack of an intestinal bypass reduces the risk of potential long-term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.
After Surgery
Like with the traditional gastric bypass procedure, you will be able to limit the amount of food you eat at one time after laparoscopic sleeve gastrectomy because smaller portions will satisfy you. You will need to make other changes to your overall diet and eating habits, including drinking at least eight cups of water per day and chewing your food completely.
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Laparoscopic Gastric Bypass
Laparoscopic Gastric Bypass
Laparoscopic gastric bypass surgery involves stapling the stomach and re-routing the small intestine to form a small stomach pouch about the size of an egg.
Benefits
The major benefit of laparoscopic bypass surgery is dramatic weight loss during the first year following surgery. With this weight loss comes the reduced risk of medical problems like diabetes, hypertension and coronary artery disease. You will also see less scarring after this surgery because the incisions are smaller than those of traditional abdominal surgery.
Before Surgery
The major benefit of laparoscopic bypass surgery is dramatic weight loss during the first year following surgery. With this weight loss comes the reduced risk of medical problems like diabetes, hypertension and coronary artery disease. You will also see less scarring after this surgery because the incisions are smaller than those of traditional abdominal surgery.
During Surgery
During gastric bypass surgery, a limb of intestine is attached to the pouch to create a bypass. After surgery, food enters the pouch and empties into the small intestine. As a result, food bypasses almost all of the stomach and a segment of the intestine.
The overwhelming majority of surgeries are performed laparoscopically using small incisions, 1/4-inch to one inch in size. Your surgeon will determine the best approach for you based on your medical history, height and weight.
After Surgery
After surgery, you will feel satisfied with eating smaller portions because your stomach will only hold a small amount of food. Thoroughly chew your food so it does not cause pain when traveling down your intestine. Remember to take the appropriate vitamins and supplements. Also, schedule follow-up visits with your doctor to check your physical and mental status.
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Laboratory Services
Results You Can Count On
At LifeBridge Health, we make it easy and accessible to get the tests you need to capture critical health information that will better enhance your diagnosis and treatment options. Our lab services are performed by our highly skilled pathologists and technicians, who are dedicated to getting you results, as quickly as possible.
