摘要 目的探讨实时三维经食管超声心动图(RT-3DTEE)在左心耳封堵术(LAAC)中对封堵器规格的选择及术后随访中的应用价值。方法选取41例行LAAC的患者,应用二维经食管超声心动图(2DTEE)和RT-3DTEE于术前观察左心耳(LAA)形态及有无血栓,术中测量LAA锚定区最大直径(LZD),并与X线造影测值比较,分析3种测量LZD方式与压缩封堵器直径(COD)的相关性和一致性。术后随访观察相关并发症。结果使用RT-3DTEE测量LZD最大直径与X线造影较接近,且略大于2DTEE测值[2DTEE(22.55±2.98)mm、3DTEE(23.50±3.17)mm、X线造影(24.16±3.39)mm]。与2DTEE相比,使用RT-3DTEE所测LZD与COD的相关性和一致性更好(2DTEE r=0.893,P<0.001;RT-3DTEE r=0.941,P<0.001;X线造影r=0.962,P<0.001),并且RT-3DTEE和X线造影测值有显著相关性(r=0.965,P<0.001)。41例患者成功植入Watchman封堵器,术后即刻心包积液者2例,残余分流者3例,术后3个月封堵器表面血栓形成1例,术后6个月随访中仅有1例存在2 mm残余分流。结论 RT-3DTEE在LAAC中为封堵器规格的选择提供可靠及准确的临床建议,同时为术后随访提供更安全有效的检测方法。 Objective To investigate the use of real-time three-dimensional transesophageal echocardiography(RT-3 DTEE) in left atrial appendage closure(LAAC) in the selection of the size of the occluder and the value of postoperative follow-up. Methods In 41 patients with left atrial appendage occlusion, the morphology and thrombosis of left atrial appendage(LAA) were observed by two-dimensional transesophageal echocardiography(2 DTEE)and RT-3 DTEE before operation, the diameter of the landing zone were measured during operation, and compared with X-ray angiography observation, analysis of three kinds of way of measuring LZD and compression occluder diameter(COD) correlation and consistency. Results The maximum diameter of LZD measured by RT-3 DTEE was close to that measured by X-ray angiography, and slightly larger than that measured by 2 DTEE [2 DTEE(22.55±2.98)mm, 3 DTEE(23.50±3.17)mm, and X-ray(24.16±3.39)mm].Compared with 2 DTEE, the correlation and consistency between COD and LZD measured by RT-3 DTEE were better(2 DTEE r=0.893,P<0.001),RT-3 DTEE r=0.941,P<0.001;X-ray r=0.962,P<0.001), and there was a significant correlation between RT-3 DTEE and LZD measured by X-ray angiography(r=0.965, P<0.001). 41 patients were successfully implanted with Watchman occluder, including two cases of intraoperative and immediate postoperative indication of micropericardial effusion and three cases of postoperative residual shunt, one case of small thrombus on the surface of the occluder three months after the operation, and only one case of 2 mm residual shunt during the follow-up six months after the operation. Conclusions RT-3 DTEE in LAAC can provide reliable and accurate clinical recommendations for the selection of occluder specifications in left atrial appendage closure, and provide a more safe and effective detection method for postoperative follow-up.
出处 《中国超声医学杂志》 CSCD 北大核心 2021年第4期406-409,共4页 Chinese Journal of Ultrasound in Medicine
基金 辽宁省自然科这基金项目(No.20180550235)。
关键词 房颤 左心耳封堵术 实时三维经食管超声心动图 二维经食管超声心动图 Atrial fibrillation Left atrial appendage closure Real-time three-dimensional transesophageal ech-ocardiography Two-dimensional transesophageal echocardiography
分类号 R54 [医药卫生—心血管疾病]
