Gorani Daut, Dilic Mirza, Kulic Mehmed, Gojak Rifet, Zvizdic Faris, Gorani N, Mekic Mevludin, Miseljic Sanja
Department of Cardiology, University Clinical Center of Prishtina, Prishtina, Kosovo.
Clinical Center of Sarajevo University, Sarajevo, Bosnia and Herzegovina.
Med Arch. 2013;67(5):318-21. doi: 10.5455/medarh.2013.67.318-321.
Our objective was the comparison of combined utility of two-dimensional (2D) transthoracic echocardiography (TTE) and three-dimensional (3D) TTE versus 2D and 3D transesophageal echocardiography (TEE) in evaluation of anatomy of the left atrium appendage (LAA) and for clot formation in LAA.
2DTEE as semi-invasive method has been for a long time used to visualize the LAA. Improved echocardiography technology has increasingly improved visualization of LAA by 2DTTE and 3DTTE in many patients and decreased the need for TEE performance.
We compared combined 2DTTE and 3DTTE with 2DTEE and 3DTEE in evaluating the LAA for anatomical features and thrombus. Eighty-six patients underwent 2DTTE, 3DTTE, 2DTEE and 3DTEE.
LAA could be visualized in all patients. 31 % of patients had one lobe, 43% had 2 lobes and 26% had > 2 lobes. Of 86 patients studied, 79 had no thrombus and 7 had thrombus in the LAA by all modalities. Six patients, 3 with atrial fibrillation (AF), and 4 in sinus rhythm (SR) had a suspected thrombus by 2DTEE. Only in one patient 3DTEE cropping has been needed to clearly show thrombus which was suspected in short axis view on 2DTEE as rounded echo dense mass.
Our preliminary study suggests that combined 2DTTE and 3DTTE has comparable accuracy to TEE in evaluating the LAA anatomy and pathology in terms of thrombus. Only in inappropriate (obese) patients 2TTE, but not 3DTTE, may misdiagnose pectinate musculature as thrombus.
我们的目的是比较二维（2D）经胸超声心动图（TTE）和三维（3D）TTE联合应用与二维和三维经食管超声心动图（TEE）在评估左心耳（LAA）解剖结构及LAA内血栓形成方面的综合效用。
二维经食管超声心动图作为一种半侵入性方法，长期以来一直用于观察LAA。随着超声心动图技术的不断改进，二维经胸超声心动图和三维经胸超声心动图在许多患者中越来越多地改善了对LAA的观察，并减少了进行经食管超声心动图检查的必要性。
我们比较了二维经胸超声心动图和三维经胸超声心动图联合应用与二维经食管超声心动图和三维经食管超声心动图在评估LAA的解剖特征和血栓方面的情况。86例患者接受了二维经胸超声心动图、三维经胸超声心动图、二维经食管超声心动图和三维经食管超声心动图检查。
所有患者的LAA均可被观察到。31%的患者有一个叶，43%有两个叶，26%有两个以上叶。在研究的86例患者中，79例LAA内无血栓，7例LAA内有血栓，所有检查方式均能检测到。6例患者，3例为心房颤动（AF），4例为窦性心律（SR），二维经食管超声心动图检查怀疑有血栓。仅1例患者需要三维经食管超声心动图裁剪以清晰显示血栓，该血栓在二维经食管超声心动图短轴视图中疑似为圆形回声密集团块。
我们的初步研究表明，在评估LAA的解剖结构和血栓病理方面，二维经胸超声心动图和三维经胸超声心动图联合应用与经食管超声心动图具有相当的准确性。仅在不适合（肥胖）的患者中，二维经胸超声心动图（而非三维经胸超声心动图）可能将梳状肌误诊为血栓。
