Neuzner Joerg, Dietze Thomas, Paliege Robert, Möller Michael, Saeed Giovanni, Gradaus Rainer
Department of Cardiology, Klinikum Kassel, Germany.
Cardiol J. 2015;22(2):201-5. doi: 10.5603/CJ.a2014.0063. Epub 2014 Oct 9.
In left atrial appendage (LAA) closure, the correct sizing of the implantable devices is crucial. Data on the time-dependent changes in the shape and positioning of LAA occlusion devices are missing. We analyzed the results of 33 consecutive patients after implantation of an Amplatzer™ Cardiac Plug (ACP) LAA closure device to get more information on the optimal device sizing during implantation.
Thirty-three consecutive patients were enrolled in this observational study. ACP implantation was guided by fluoroscopy and three dimensional transesophageal echocardiography (3-D TEE). Device sizing was based on the largest measured diameter of the intended landing zone adding 2-4 mm of device oversizing. Fluoroscopies were performed at 1 day after, and after 3 months, control 3-D TEE was performed 3 months after implantation. The stability of device positioning and shape was matched with the results of 3-D TEE. Patients' mean age was 70.2 ± 8 years; mean CHA2DS2VASc score was 3.8 ± 1.1. According to the manufacture's classification, the post-implant degree of compression of the device-lobe was classified in three categories 1) undercompression "square-like shape" (1 patient); 2) optimal compression "tire-like shape" (20 patients), 3) overcompression "strawberry-like shape" (12 patients). Changes in the degree of device compression by more than one classification class occurred in 18/33 of our patients. A complete loss of device compression ("square-like shape") was observed in 9 patients. Despite the changes in device compression, a complete closure of the LAA was achieved in 32/33 patients.
There is a temporal change in shape and positioning of the ACP within 3 months after implantation. A late decompression of the ACP lobe was observed in 61% of our patients, leading to a complete loss in device compression in 27%. This observation may be the rationale for a higher degree of ACP oversizing during implantation.
在左心耳（LAA）封堵术中，可植入装置的正确尺寸选择至关重要。关于LAA封堵装置形状和位置随时间变化的数据尚缺。我们分析了连续33例植入Amplatzer™心脏封堵器（ACP）进行LAA封堵患者的结果，以获取更多关于植入过程中最佳装置尺寸选择的信息。
本观察性研究纳入了连续33例患者。ACP植入在荧光透视和三维经食管超声心动图（3-D TEE）引导下进行。装置尺寸选择基于预期着陆区测量的最大直径，并增加2 - 4 mm的装置尺寸余量。术后1天进行荧光透视检查，术后3个月进行复查，植入后3个月进行对照3-D TEE检查。将装置位置和形状的稳定性与3-D TEE结果进行匹配。患者的平均年龄为70.2±8岁；平均CHA2DS2VASc评分为3.8±1.1。根据制造商的分类，装置叶瓣植入后的压缩程度分为三类：1）压缩不足“方形”（1例患者）；2）最佳压缩“轮胎形”（20例患者）；3）过度压缩“草莓形”（12例患者）。我们18/33的患者出现了装置压缩程度超过一个分类等级的变化。9例患者观察到装置压缩完全丧失（“方形”）。尽管装置压缩发生了变化，但32/33的患者实现了LAA的完全封堵。
植入后3个月内，ACP的形状和位置存在时间变化。我们61%的患者观察到ACP叶瓣晚期减压，导致27%的患者装置压缩完全丧失。这一观察结果可能是植入过程中ACP尺寸选择更大的理论依据。
