三维经食管超声心动图、二维经食管超声心动图、数字减影血管造影测量左心耳开口与左心耳封堵术成功植入封堵器大小的相关性

Correlation between measurement of left atrial appendage orifice by three-dimensional transesophageal echocardiography,two-dimensional transesophageal echocardiography and digital subtraction angiography and the size of successfully implanted occluder in left atrial appendage occlusion

目的 探讨三维经食管超声心动图(three-dimensional transesophageal echocardiography, 3D-TEE)成像、二维经食管超声心动图(two-dimensional transesophageal echocardiography, 2D-TEE)成像、数字减影血管造影(digital subtraction angiography, DSA)测量左心耳开口内径与成功植入左心耳封堵器大小的相关性。方法 回顾性选择2019年1月3日至2020年1月25日于上海交通大学医学院附属新华医院行左心耳封堵术(left atrial appendage occlusion, LAAO)的非瓣膜性房颤(non-valvular atrial fibrillation, NVAF)患者,术前分别采用2D-TEE和3D-TEE评估左心耳开口最大直径,采用DSA进行术中左心耳造影并测量左心耳开口最大直径。比较3种影像学方法测量的左心耳开口最大直径和最终植入的封堵器大小的相关性。结果 共纳入180例患者,年龄(68.25±9.15)岁,男性112例(62.2%)、女性68例(37.8%),CHA2DS2-VASc评分(3.56±1.76)分,左房前后径(46.00±6.31)mm。180例患者均成功植入Watchman左心耳封堵器,最终植入的封堵器直径为(28.1±3.2)mm。术前3D-TEE测量的左心耳开口最大直径为(24.67±2.67)mm,显著高于2D-TEE的测量值[(20.95±2.91)mm, P<0.001]和DSA的测量值[(23.91±2.79)mm, P<0.001]。相关性分析显示,3D-TEE、2D-TEE和DSA测量的左心耳开口最大直径与最终植入封堵器大小均正相关(r=0.862、0.614、0.656, P<0.001)。结论 3D-TEE通过三维容积成像测量的左心耳开口最大直径显著高于2D-TEE和DSA测量的数值,且与成功植入封堵器大小的相关性最强。

Objective To explore the correlation between measurement of left atrial appendage orifice by three-dimensional transesophageal echocardiography(3D-TEE),two-dimensional transesophageal echocardiography(2D-TEE),digital subtraction angiography(DSA)and the size of successfully implanted occluder in left atrial appendage occlusion(LAAO).Methods Patients with non-valvular atrialfibrillation(NVAF)who underwent LAAO in Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 3,2019 to January 25,2020 were retrospectively selected.The maximum diameter of left atrial appendage was evaluated by 2D-TEE and 3D-TEE before operation,and was measured by DSA left atrial appendage angiography during operation.The correlation between the maximum diameter of left atrial appendage orifice measured by three imaging methods and the size of thefinal implanted occluder was compared.Results A total of 180 patients were included,with an average age of(68.25±9.15)years old,112(62.2%)were males and 68(37.8%)were females.The CHA2DS2-VASc score was 3.56±1.76,and the anterior posterior diameter of left atrium was(46.00±6.31)mm.Watchman left atrial appendage occluder was successfully implanted in all patients,and the average size offinal implanted occluder was(28.1±3.2)mm.The maximum diameter of the left atrial appendage orifice measured by 3D-TEE before operation was(24.67±2.67)mm,significantly higher than that measured by 2D-TEE([20.95±2.91]mm,P<0.001)and DSA([23.91±2.79]mm,P<0.001).Correlation analysis showed that the maximum diameter of the left atrial appendage orifice measured by 3D-TEE,2D-TEE and DSA was positively correlated with the size of thefinal implanted occluder(r=0.862,0.614,0.656;P<0.001).Conclusions The maximum diameter of the left atrial appendage orifice measured by 3D-TEE through three-dimensional volume imaging was significantly higher than that measured by 2D-TEE and DSA,and had the strongest correlation with the size of successfully implanted occluder.