无镇静状态下左心耳封堵监测：一项通过食管途径使用心腔内超声心动图的初步研究。
Left atrial appendage closure monitoring without sedation: a pilot study using intracardiac echocardiography through the oesophageal route.
作者信息
Ternacle Julien, Lellouche Nicolas, Deux Jean-François, Dubois-Randé Jean-Luc, Teiger Emmanuel, Lim Pascal
机构信息
Henri Mondor University Hospital, Cardiovascular Department and INSERM U955, Créteil, France.
出版信息
EuroIntervention. 2015 Dec;11(8):936-41. doi: 10.4244/EIJY14M07_17.
AIMS
We evaluated the safety and feasibility of an intracardiac echocardiography probe through the oesophageal route (ICE-TEE) for the monitoring of left atrial appendage (LAA) closure to avoid general anaesthesia.
METHODS AND RESULTS
The study included 16 consecutive patients (75±7 years) in atrial fibrillation with high embolism (CHADS-VASc=5±1.4) and bleeding risk (HAS-BLED=4±0.9) referred for LAA closure (Amplatzer Cardiac Plug [ACP]). Standard TEE was performed before device implantation for LAA analysis. During the procedure, ICE-TEE was used under local anaesthesia to determine LAA size and monitor ACP positioning. Maximum and minimum LAA diameter by standard TEE averaged 21±3 mm and 18±1 mm, respectively. Eccentricity index (1.1±0.2) increased with LAA diameter (r=0.73, p=0.001). Maximum LAA size (21±3 mm) obtained by ICE-TEE during the procedure closely correlated with standard TEE measurement (r=0.9, p<0.0001). LAA closure was successfully performed in 15 patients without complication (one failed despite testing three ACP). Implanted ACP size averaged 25±3 mm (range 22-30 mm) and correlated with the size predicted by ICE-TEE (r=0.89) and standard TEE (r=0.57). Procedure duration (62±27 min) correlated with LAA size by ICE-TEE (r=0.71, p=0.002) and eccentricity index (r=0.58, p=0.02).
CONCLUSIONS
An ICE-TEE probe through the oesophageal route without general anaesthesia may be used for the monitoring of ACP device implantation.
目的
我们评估了经食管途径的心腔内超声心动图探头（ICE-TEE）用于监测左心耳（LAA）封堵以避免全身麻醉的安全性和可行性。
方法与结果
该研究纳入了16例连续的房颤患者（75±7岁），这些患者具有高栓塞风险（CHADS-VASc=5±1.4）和出血风险（HAS-BLED=4±0.9），因LAA封堵（使用Amplatzer心脏封堵器[ACP]）前来就诊。在植入装置前进行标准经食管超声心动图（TEE）以分析LAA。在手术过程中，在局部麻醉下使用ICE-TEE确定LAA大小并监测ACP定位。标准TEE测得的LAA最大和最小直径分别平均为21±3毫米和18±1毫米。偏心指数（1.1±0.2）随LAA直径增加（r=0.73，p=0.001）。手术过程中通过ICE-TEE测得的LAA最大尺寸（21±3毫米）与标准TEE测量值密切相关（r=0.9，p<0.0001）。15例患者成功完成LAA封堵，无并发症（1例尽管试用了3个ACP仍失败）。植入的ACP尺寸平均为25±3毫米（范围22 - 30毫米），与ICE-TEE预测的尺寸（r=0.89）和标准TEE预测的尺寸（r=0.57）相关。手术持续时间（62±27分钟）与ICE-TEE测得的LAA大小（r=0.71，p=0.002）和偏心指数（r=0.58，p=0.02）相关。
结论
经食管途径的ICE-TEE探头在无全身麻醉的情况下可用于监测ACP装置植入。
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