二维、三维经食管超声心动图及术中心血管造影在左心耳封堵器型号选择中的价值

Value of 2D and 3D transesophageal echocardiography and intraoperative central angiography in the selection of left atrial appendage occluder

目的 比较经食管二维超声心动图(two dimensional transesophageal echocardiography,2D–TEE)、经食管实时三维超声心动图(real–time threedimensional transesophageal echocardiography,RT–3D–TEE)及术中心血管造影(angiocardiography,CAG)3种影像学方法在指导左心耳封堵器型号选择中的价值。方法 选取2020年1月至2021年12月在南昌市第一医院行左心耳封堵术的非瓣膜病心房颤动患者31例。所有受试患者均行2D–TEE、RT–3D–TEE及CAG检查,分别测量左心耳锚定区最大径、最小径及左心耳深度,并比较三者之间的差异。以左心耳口锚定区最大径作为依据,选择适当封堵器型号并记录。比较3种方法测量的左心耳锚定区最大径与左心耳封堵器型号之间的相关性及3种测量方法与封堵器型号的一致性。结果 31例患者均成功植入Watchman封堵器,3种方法测得的左心耳锚定区开口最大径比较差异有统计学意义(P<0.01),2D–TEE测得的左心耳锚定区最大径显著小于RT–3D–TEE,差异有统计学意义(P<0.05),RT–3D–TEE测得的左心耳锚定区最大径小于CAG,但差异比较无统计学意义(P>0.05)。3种检查方法测得的左心耳锚定区开口最小径和左心耳深度比较,差异均无统计学意义(P>0.05)。2D–TEE、RT–3D–TEE及CAG 3种方法测得的左心耳最大径与封堵器尺寸大小均呈正相关(r=0.725、0.867、0.921,P<0.001)。采用Bland–Altman分析3种测量方法测得的左心耳口锚定区最大径与封堵器大小之间的一致性显示,RT–3D–TEE及CAG两种方法测量值的平均差值更小、一致性界限更窄。结论 RT–3D–TEE及CAG在左心耳封堵器型号的选择中具有重要的指导意义。

Objective To compare the value of twodimensional transesophageal echocardiography(2D–TEE), real–time threedimensional transesophageal echocardiography(RT–3D–TEE) and angiocardiography(CAG) in guiding the selection of left atrial appendage occluder. Methods 31 patients with non–valvular atrial fibrillation who received left atrial appendage occlusion in the First Hospital of Nanchang from January 2020 to December 2021 were selected.All patients underwent 2D–TEE, RT–3D–TEE and CAG examinations, and the maximum and minimum diameters of the anchoring area of the left auricular foramen and the depth of the left auricular foramen were measured respectively, and the differences among the three were compared.According to the maximum diameter of the anchoring zone of the left entricular port, the appropriate type of sealing device was selected and recorded. The correlation between the maximum diameter of left atrial appendage anchoring zone measured by three methods and the type of left atrial appendage sealing device was compared, and the consistency between the three methods and the type of left atrial appendage sealing device was compared. Results The Watchman barrier was successfully implanted in all 31 patients. The overall difference of the maximum diameter of the opening of the left atrial adicular anchorage zone measured by the three methods was statistically significant(P<0.01), the inner diameter of the left atrial adicular anchorage zone measured by 2D–TEE was lower than that measured by RT–3D–TEE, the difference was statistically significant(P<0.05), and the inner diameter of the left atrial adicular anchorage zone measured by RT–3D–TEE was lower than that measured by CAG, the difference was not statistically significant(P>0.05). There was no significant difference in the minimum diameter and depth of left atrial appendage anchorage zone measured by the three methods(P>0.05). The maximum opening inner diameter of left atrial annulus measured by 2D–TEE, RT–3D–TEE and CAG were positively correlated with the size of the occluder(r=0.725, 0.867, 0.921, all P<0.001). Bland–altman analysis of the consistency between the maximum diameter of the left entricle port anchor zone measured by the three methods and the size of the packer showed that the average difference between the values measured by RT–3D–TEE and CAG was smaller and the consistency limit was narrower. Conclusion RT–3D–TEE and CAG have important guiding significance in the selection of left atrial appendage occluder.