二维和实时三维经食管超声心动图术前指导选择LAmbre左心耳封堵器的对比研究

Clinical value of two-dimensional and real-time three-dimensional transesophageal echocardiography for the guidance of left atrial appendage closure： a comparison study for LAmbre device selection

目的对比多切面二维经食管超声心动图（2D-TEE）和实时三维经食管超声心动图（RT3D-TEE）呈现左心耳解剖形态的方法及开口径测值与临床左心耳封堵时LAmbre TM封堵器型号之间的相关性，并评价2D-TEE和RT3D-TEE技术在左心耳封堵术前指导LAmbre TM封堵器型号选择的应用价值。方法41例行TEE检查的心房颤动患者，在食管中段水平获取左心耳二维超声图像后分别于0°、45°、90°、135°测量左心耳开口内径、外径和深度，获取实时三维超声图像并测量左心耳开口的最大径、最小径，对比二维超声测值与三维超声测值的差异及相关性。在11例行LAmbreTM左心耳封堵的患者中，比较2D-TEE和RT3D-TEE左心耳开口的最大测量值与X线造影测量的左心耳开口径以及最终使用的封堵器大小之间的相关性。结果41例心房颤动患者均顺利完成2D-TEE检查。二维超声测量0°,45°、90°、135°切面左心耳开口内径及三维超声测量左心耳开口最大径分别为（2．00±0．43）cm、（1．97±0．38）cm、（2．12±0．46）cm、（2．30±0．50）cm、（2．49±0．52）cm。二维超声在135。切面测量的左心耳开口内径为4个切面测量的最大值，与三维超声测值之间存在差异（P=0．012）。11例行左心耳封堵术的患者X线造影测量左心耳开口径为（2．49±0．44）cm，术中选择的封堵器固定盘大小为2．4～3．6cm。11例患者左心耳三维超声测值、二维超声测值与X线造影测值之间的相关系数分别为0．816（P=0．002），0．693（P=0．018）；其与封堵器固定盘大小的相关系数分别为0．914（P=0．000），0．688（P=0．019）。结论与2D-TEE比较，RT3D-TEE测量左心耳开口的最大径与X线造影及封堵器型号之间具有更好的相关性，因此在左心耳封堵术中对于LAmbre TM封堵器型号的选择具有更好的指导意义。

Objective To explore the clinical value of two-dimensional transesophageal echocardiography （2D-TEE） and real-time three-dimensional transesophageal echocardiography （RT3D- TEE） for the left atrial appendage （LAA） closure procedures by the visualization of LAA shape by 2D-TEE and RT3D-TEE and the comparison between the measurement of LAA ostium and the sized LAmbreTM device during the procedure. Methods Forty-one atrial fibrillation patients, who had undergone 2D-TEE examination at our hospital, were enrolled in the study. At the mid-esophageal, dimensions of inner and outer ostium and depth of LAA were measured at the 2D-TEE views of 0,45,90 and 135 degree respectively. RT3D-TEE views were acquired and the maximal and the minimal dimensions of LAA inner ostium were measured. The measurement by RT3D-TEE and 2D-TEE were compared to find the difference and correlation. Eleven of 41 patients who have complied with the requirements for the LAA closure, were undergone the procedures, measured the dimension of LAA inner ostium at selective angiography intraoperative. Sizes of closure disks of the closure device and the measurement at selective angiography were recorded to compare the measurement at RT3D-TEE and 2D-TEE. Results Forty-one atrial fibrillation patients were completed TEE examination successfully. Inner ostial dimension of LAA was （2.00 ± 0.43）cm,（1.97± 0.38）cm,（2.12 ± 0.46）cm,（2.30±0.50）cm at 2D-TEE views of 0,45,90 and 135 degree,respectively. The maximum dimensions of LAA inner ostium by RT3D-TEE was （2.49---0.52） cm. At 2D-TEE views,the maximum dimensions of LAA inner ostium was at 135 degree,there was a difference between it and the measurement by RT3D-TEE （ P = 0.012）. Monitoring by TEE,LAA closure procedures with LAmbreTM device were successful for all 11 patients, the landing zone by selective angiography was （2.49 ±0.44） cm, and the appropriate sized closure disk of the LAmbreTM device was 2.4 - 3.6 cm. Correlation between the measurements by RT3D-TEE and selective angiography and the sized closure disk were r = 0.816, P =0.002 and r = 0.914, P =0.000,respectively. Correlation between the measurements by 2D-TEE and selective angiography and the sized closure disk were r = 0.693, P = 0.018 and r = 0.688, P = 0.019,respectively. Conclusions There was better correlation among the measurements by RT3D-TEE and selective angiography and the size of closure device. Therefore, compared to 2D-TEE, the guidance of RT3D-TEE was more accurate during LAA closure procedures for LAmbreTM device selection.