经食管超声心动图在Amplatzer Cardiac Plug（ACP）左心耳封堵术中的应用

Application of transesophageal echocardiography in left atrial appendage closer with Amplatzer Cardiac Plug

目的评估经食管超声心动图（TEE）在Amplatzer Cardiac Plug（ACP）左心耳封堵术中的应用价值。方法对32例高卒中风险非瓣膜性心房颤动患者（CHADS2≥1分）在TEE引导下用ACP封堵器行左心耳封堵术。术前二维TEE测量左心耳锚定区（着陆区）和左心耳口部的最大径、最小径以及左心耳深度，分析影响封堵结果的相关因素。结果封堵成功27例，其中2例封堵器周边有残余分流，分别为2．8mm、3．6mm。5例封堵失败患者中，3例由于左心耳着陆区直径过大（〉30mm），1例由于深度过浅（深度15mm），1例由于左心耳位置过低。二维TEE测量左心耳口最大径、最小径、深度分别为（25．9±4．9）mm、（20．0±3．8）mm、（31．0±5．6）mm；二维TEE测量左心耳着陆区最大径、最小径分别为（26．2±6．2）mm、（19．4±4．3）mm。10例着陆区直径≥30mm的患者中7例封堵成功，3例封堵失败。最终置入封堵器大小平均（26．4±3．8）mm，封堵器平均压缩率（7．6±5．5）％。封堵器大小与TEE测量左心耳着陆区及口部最大径相关（r分别为0．770、0．717）。1例发生心包填塞并发症。结论二维TEE测量数据均在ACP左心耳封堵器型号选择方面具有指导意义，其中二维TEE测量左心耳着陆区直径与ACP封堵器尺寸相关性较好，左心耳大小可能是影响封堵成败的主要因素。

Objective To assess the value of transesophageal echocardiography （TEE） in left atrial appendage （LAA） closer with Amplatzer Cardiac Plug （ACP）. Methods Consecutive 32 atrial fibrillation patients （CHADS2≥1） with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE. Measurements of LAA anchoring area diameter （AAD） and LAA anatomical orifice diameter （AOD） including maximum, minimum values, and LAA depth on 2 dimentional TEE （2D TEE） were conducted before closer device implantation. The outcomes of LAA occlusion were analyzed. Results Among 32 patients,27 cases achieved successful LAA occlusion, including 2 cases with peripheral leakage 45 ram, and 5 cases failed occlusion. Among 5 failed closed patients, 3 cases with LAA AAD≥ 30mm, 1 case with LAA of short depth, and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA. LAA AAD maximum, minimum and LAA depth were （25.9± 4.9） mm, （20.0±3.8） mm, （31.0± 5.6） mm, respectively, and LAA AOD maximum, minimum diameters were （26.2±6.2） mm, （ 19.4±4.3） mm, respectively. Among 10 cases with LAA AAD≥ 30 mm,7 cases achieved successful LAA occlusion, but 3 cases failed. The implanted device diameter was （26.4 ±3.8）mm, and device compression rate was （7.6±5.5）%. The coefficient of correlation between device diameter and large LAA AAD and AOD is 0. 770 and 0. 717, respectively. There was no complication but 1 case with pericardial effusion. Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder. The AAD of 2D TEE has the good correlation with ACP occluderrs size, the AADs are important factors which affect the success ofLAA occlusion.