经食管超声心动图与心脏CT血管造影对左心耳封堵的应用价值研究

Application value of transesophageal echocardiography and cardiac CT angiography in preoperative occlusion of left atrial appendage

目的探讨经食管超声心动图(TEE)与心脏CT血管造影(CCTA)在经皮左心耳封堵术(PCLAA)中的临床应用价值。方法选取56例房颤行左心耳封堵术患者(接受Watchman封堵器植入)的术前MDCT和术中TEE的结果。确定LAA口的MDCT测量值(CTmax,CTmin,CTmean)和TEE测量值(TEEmax)。结果56例患者,其中鸡翅型30例(约占53.6%),菜花型19例(约占33.9%),风向标型4例(约占7.1%),仙人掌型3例(约占5.4%)。TEE测得最大径的平均值为(24.13±3.95)mm;CT外测法测量最大径的平均值为(24.85±4.48)mm,CT内测法测量最大径的平均值为(24.87±4.25)mm;造影测得最大径的平均值为(24.43±4.04)mm;封堵器选取均值为(29.29±3.56)mm。CT外测法测量最大径与TEE测得值有相关性(r=0.777),差异有统计学意义(P=0.046<0.05);CT内测法测量最大径与TEE测得值有相关性(r=0.727),差异有统计学意义(P=0.045<0.05)。CT外测法测量最大径与造影测得值有显著相关性(r=0.893),CT内测法测量最大径与造影测得值有显著相关性(r=0.890)。结论与TEE数据相比,CCTA外测法最大径与装置的Watchman封堵器尺寸相关性最强。而TEE可在术中实时监测压缩比及反流情况,两者互相补充。

Objective To evaluate the clinical value of transesophageal echocardiography(TEE)and cardiac CT angiography(CCTA)in percutaneous transcatheter closure of left atrial appendage(PCLAA).Methods The preoperative MDCT and intraoperative TEE results of 56 patients with atrial fibrillation who received transcatheter closure of left atrial appendage(Watchman occluder)in Taizhou people's Hospital from May 2016 to May 2019 were analyzed retrospectively.We determined the MDCT measured value(CTmax,CTmin,CTmean)and the TEE measured value(TEEmax)of the LAA ostium.Results There were 56 patients(mean age:66.14±8.13 years old;male:58.9%),including 30 cases of chicken wing type(about 53.6%),19 cases of cauliflower(about 33.9%),4 cases of weather vane(about 7.1%)and 3 cases of cactus(about 5.4%).The mean maximum diameter measured by TEE was(24.13±3.95)mm by CT external measurement,(24.85±4.48)mm by CT external measurement,(24.87±4.25)mm by CT internal measurement,(24.43±4.04)mm by angiography,and(29.29±3.56)mm by occluder selection.The maximum diameter measured by CT external measurement was correlated with that measured by TEE(r=0.777),and the difference was statistically significant(P=0.046<0.05).The maximum diameter measured by CT internal measurement was correlated with the maximum diameter measured by TEE(r=0.727),and the difference was statistically significant(P=0.045<0.05).There was a significant correlation between the maximum diameter measured by CT external method and the value measured by angiography(r=0.893).There was a significant correlation between the maximum diameter measured by inside method and angiographic value(r=0.893).There was a significant correlation between CT and angiographic value(r=0.890).Conclusion Compared with TEE data,the maximum diameter measured by CCTA has the strongest correlation with the size of Watchman occluder.TEE can monitor the compression ratio and reflux in real time during the operation,which complements each other.