Das GAVE-Syndrom als Indikation zum interventionellen Vorhofohrverschluss

Zusammenfassung

Anamnese und klinische Befunde | Eine 56-jährige Patientin erlitt aufgrund eines GAVE-Syndroms (gastric antral vascular ectasia) rezidivierende transfusionspflichtige obere gastrointestinale (GI) Blutungen, wobei die Situation durch die Notwendigkeit einer Antikoagulation mit Phenprocoumon bei permanentem Vorhofflimmern (CHA₂DS₂-VASc-Score 3 Punkte) aggraviert wurde. Eine Umstellung auf niedermolekulares Heparin brachte keinen Erfolg. Die häufigen Krankenhausaufenthalte beinträchtigten die Patientin in ihrer Lebensqualität.

Therapie und Verlauf | 2 Monate nach Erstdiagnose des GAVE-Syndroms mit zwischenzeitlich fünf Krankenhausaufenthalten sowie mehreren Argonplasmakoagulationen wurde erfolgreich ein interventioneller Vorhofohrverschluss mit einem AmplatzerTM Cardiac Plug 2 durchgeführt. Unter der postinterventionellen dualen Thrombozytenaggregationshemmung mit ASS und Clopidogrel anstelle einer oralen Antikoagulation konnte bereits ein Sistieren der Blutungen erreicht werden.

Folgerung | Der interventionelle Vorhofohrverschluss erscheint bei Patienten mit GAVE-Syndrom und hierunter rezidivierend auftretenden oberen GI-Blutungen sowie nicht-valvulärem Vorhofflimmern als eine effektive therapeutische Alternative zur Reduzierung der Blutungshäufigkeit.

Abstract

History and findings | A 56-year-old female with a gastric antral vascular ectasia (GAVE) suffered from recurrent episodes of upper gastrointestinal bleeding. Because of a history of a permanent atrial fibrillation (CHA₂DS₂-VASc score 3 points) an oral anticoagulation therapy with phenprocoumon was carried out which even worsened the bleeding frequency and intensity. A change of medication to low-molecular weight heparin did not lead to success. The frequent periods in hospital limited the patient’s quality of life.

Therapy and course | Two months after the initial diagnosis of the GAVE syndrome and after 5 hospital admissions together with several argon plasma coagulations an AmplatzerTM Cardiac Plug 2 was successfully implanted. With the postinterventional dual antiplatelet therapy with ASA and clopidogrel instead of an oral anticoagulation the bleedings stopped.

Conclusion | The interventional left atrial appendage closure appears to be a feasible and safe alternative to oral anticoagulation in patients with a GAVE syndrome and non-valvular atrial fibrillation

Schlüsselwörter

GAVE-Syndrom - obere gastrointestinale Blutung - interventioneller Vorhofohrverschluss - LAA-Occluder

Keywords

GAVE - upper gastrointestinal bleeding - interventional left atrial appendage closure - LAA occluder

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