Mimics三维成像在经皮左心耳封堵术中的应用

Application of Mimics three-dimensional imaging in percutaneous left atrial appendage closure with Watchman system

目的 使用Mimics三维成像技术重建心房颤动患者左心耳三维结构,初步评估经皮左心耳封堵术（Watchman系统）手术风险,指导封堵器选择及放置.方法 入选2014年5-12月在杭州师范大学附属医院心内科行左心耳封堵术患者10例,年龄40 ～ 85岁的心房颤动患者10例,均不愿长期口服抗凝药物或口服抗凝药物有禁忌证,具有左心耳封堵适应证,且自愿参加本试验.术前行Mimics左心耳三维重建,结合术中经食道超声心动图（TEE）及造影结果,选择Watchman左心耳封堵器尺寸及放置位置,置入封堵器至左心耳颈部.结果 入选心房颤动患者年龄为（66.3±11.9）岁,其中9例为非瓣膜病心房颤动患者,CHADS2-VAS评分（3.2±1.7）分,HAS-BLED评分（2.7±1.6）分;1例为瓣膜病心房颤动患者（曾行二尖瓣成形术,缺乏外科换瓣手术的适应证）.10例患者均成功置入Watchman左心耳封堵系统,术后行左心耳造影及TEE均未发现封堵伞处血流渗漏.围手术期及术后1个月随访无出血及栓塞等并发症发生.结论 术前使用Mimics三维成像技术重建心房颤动患者左心耳三维结构,为左心耳封堵术封堵器置入提供重要的参考依据.

Objective The three-dimensional （3D） structure of left atrial appendage （LAA） in atrial fibrillation patients were reconstructed by Mimics 3D imaging system,aiming at guiding for selection of both the size and location of the closure devices and making preliminary risk assessment of LAA closure with Watchman system.Methods Inclusion criteria were：ten voluntary patients with both atrial fibrillation and indication for LAA closure aging from 40 to 85 years old with contraindication for oral anticoagulants or unwillingness to take long-term oral anticoagulation therapy from May to December 2014.3D reconstruction of LAA was preoperatively made by Mimics 3D imaging system.With the Mimics 3D reconstruction model and the results of both transesophageal echocardiography （TEE） and LAA radiography,the size and location for the closure device were chosen.The devices were planted at the ostium of the LAA.Results Ten atrial fibrillation patients were enrolled （average age：（66.3 ± 11.9） years old） and all successfully implanted with the Watchman LAA closure devices.Nine of them were with non-valvular atrial fibrillation with average CHADS2-VAS score （3.2 ± 1.7） and HAS-BLED score （2.7 ± 1.6）.The rest one was a valvular atrial fibrillation patient with the history of the percutaneous balloon mitral valvuloplasty （PBMV） without surgical indications of mitral valve replacement（MVR）.There was no blood leakage around the device by regular postoperative TEE and LAA radiography examinations.There were no complications of bleeding,embolism,or stroke through both at peri-operative period and at 1 month follow-up post procedure.Conclusion Preoperative Mimics 3D reconstruction of LAA by Mimics 3D imaging system among atrial fibrillation patients provides essential information guiding the successful LAA closures.