实时三维经食管超声心动图在经皮左心耳封堵术治疗非瓣膜病性心房颤动患者中的应用价值

Application value of real-time three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion in patients with non-valvular atrial fibrillation

目的探讨实时三维经食管超声心动图(RT-3D-TEE)在经皮左心耳封堵术(PLAATO)治疗非瓣膜病性心房颤动中的应用价值。方法对62例接受PLAATO的非瓣膜病性心房颤动患者行二维经食管超声心动图(2D-TEE)、RT-3D-TEE和心血管造影(CAG)检查,分别测量左心耳口最大径、左心耳口最小径、左心耳口深度,并比较三者的差异。以RT-3D-TEE测量的左心耳口最大径测量值为依据,选择适当封堵器型号,并在RT-3D-TEE、CAG引导下进行左心耳封堵术。术后进行随访。结果62例均封堵成功,成功率为100%,封堵压缩率为(19.78±6.92)%;术中、术后随访期内均未发生严重并发症。2D-TEE、RT-3D-TEE及CAG测量的左心耳口最大径总体差异有统计学意义(P=0.029),RT-3D-TEE测值高于2D-TEE而低于CAG;三者测量的左心耳口最小径和左心耳深度总体差异均无统计学意义(P均>0.05)。CAG、RT-3D-TEE和2D-TEE测量的左心耳口最大径与封堵器尺寸均呈正相关(r=0.925、0.841、0.716,P均≤0.001)。结论RT-3D-TEE可用于PLAATO治疗非瓣膜病性心房颤动术前筛选、术中引导和术后随访,能准确观察左心耳口形态并评估封堵效果。

Objective To investigate the value of real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) in percutaneous left atrial appendage (LAA) transcatheter occlusion (PLAATO) in patients with non-valvular atrial fibrillation.Methods Totally 62 patients with non-valvular atrial fibrillation who underwent PLAATO were examined with two-dimensional transesophageal echocardiography (2D-TEE),RT-3D-TEE and cardioangiography (CAG).The maximum diameter,minimum diameter and depth of LAA were measured and compared respectively.According to the maximum diameter of LAA measured with RT-3D-TEE,occluder with appropriate type was selected,and LAA occlusion was performed under the guidance of RT-3D-TEE and CAG.Follow-up was conducted after operation.Results Occlusion was successfully performed in all 62 patients,the success rate was 100%,and the compression rate was (19.78±6.92)%.No serious complications occurred during the operation and follow-up period.There was significant difference of the maximum diameter of LAA measured with 2D-TEE,RT-3D-TEE and CAG ( P =0.029).The maximum diameter of LAA measured with RT-3D-TEE was higher than that measured with 2D-TEE,while lower than that measured with CAG.There was no significant difference of the minimum diameter nor depth of LAA measured with 2D-TEE,RT-3D-TEE and CAG (both P >0.05).The maximum diameter of LAA measured with CAG ( r =0.925),RT-3D-TEE ( r =0.841) and 2D-TEE ( r =0.716) were positively correlated with the size of occluder (all P ≤0.001).Conclusion RT-3D-TEE can be used for preoperative screening,intraoperative guidance and post-operative follow-up of PLAATO for non-valvular atrial fibrillation,which may accurately describe the shape of LAA and evaluate the effect of occlusion.