Watchman左心耳封堵器的临床应用

Clinical application of Watchman occluder for left atrial appendage occlusion

目的通过应用Watchman左心耳封堵器对非瓣膜病房颤患者左心耳进行封堵治疗,评价左心耳封堵效果与安全性。方法收集我院近期完成的应用Watchman左心耳封堵器进行左心耳封堵的临床资料,总结分析其基线资料,左心耳测量数据（心脏超声及造影）以及介入操作结果。结果 12例行左心耳封堵术治疗患者全部成功（成功率100%）,其中男性6例、女性6例,年龄51～81（66.4±14.5）岁,房颤病史0.5～7（2.78±4.12）年。12例患者CHA2DS2-VASc评分为2～6（4.1±1.9）分。术中TEE测量左心耳开口最大直径为（19.7±2.2）mm;左心耳造影图像测得左心耳开口最大直径为（20.1±2.3）mm;两种方法测量的左心耳开口直径无显著差异（P〉0.05）。所用12枚Watchman封堵器直径（25.0±3.2）mm;植入左心耳内后TEE测量封堵器最大直径（20.3±5.8）mm,压缩率为（22.1±3.9）%。6例患者封堵后有少量残余分流,无手术相关并发症。结论应用Watchman左心耳封堵器进行左心耳封堵是安全、有效的,但需严格把握适应证,遵循严格的操作规范。

Objective To determine the efficiency and safety of Watchman occluder for left atrial appendage（ LAA） occlusion in nonvalvular fibrillation atrial patients.Methods Clinical data of the patients undergoing LAA occlusion with Watchman occluder in our hospital from August to September 2014 were collected.Then the baseline information,measured data of LAA from ultrasound and visualization,and the results of interventional procedures were analyzed.Results Twelve patients were included in this study,including 6 males and 6 females,at an average year of 66.4 ± 14.5 years old（ 51 to 81）,and having AF for an average duration of 2.78 ± 4.12 years（ 0.5 to 7）,and all of them were successfully operated（ 100%）.The average CHA2DS2-VASc score was 4.1 ± 1.9（ ranging from 2 to 6）.The maximum LAA ostium was 19.7 ± 2.2 mm by transesophageal echocardiography（ TEE）,and 20.1 ± 2.3 mm by LAA angioplasty.There was no significant difference in the maximum ostium of LAA between the 2 measurement methods（ P〉0.05）.The average diameter of the 12 implanted Watchman occluders were 25.0 ± 3.2 mm.TEE indicated that the average maximum diameter of the implanted occluders was 20.3 ± 5.8 mm,with a maximum compression ratio of（ 22.1 ± 3.9） %.There were 6 patients showing a small amount of residual shunt,but having no other operation-related complication.Conclusion Watchman occluder is safe and effective for LAA occlusion.But it is necessary to be performed under the indications and followed the practices strictly.