Department of Cardiology, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia.
Department of Cardiology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia.
Eur Heart J Cardiovasc Imaging. 2017 Dec 1;18(12):1361-1368. doi: 10.1093/ehjci/jew212.
We evaluated the utility of computerized tomography (CT) with respect to sizing work-up for percutaneous left atrial appendage (LAA) closure, and implications for procedural safety and outcomes.
Contrast-enhanced multi-detector CT was routinely conducted to guide sizing for LAA closure in addition to transoesophageal echocardiography (TOE). Procedural safety and efficacy were prospectively assessed. Across 73 consecutive cases there were no device-related procedural complications, and no severe leaks. Systematic bias in orifice sizing by TOE vs. CT was significant on retrospective analysis (bias -3.0 mm vs. maximum diameter on CT; bias -1.1 mm vs. mean diameter on CT). Importantly, this translated to an altered device size selection in more than half of all cases, and median size predicted by CT was one interval greater than that predicted by TOE (27 mm vs. 24 mm). Of particular note, gross sizing error by TOE vs. CT was observed in at least 3.4% of cases. Degree of discrepancy between TOE and CT was correlated with LAA orifice eccentricity, orifice size, and left atrial volume. Mean orifice size by CT had the greatest utility for final Watchman device-size selection.
In this single-centre registry of LAA closure, routine incorporation of CT was associated with excellent outcomes for procedural safety and absence of major residual leak. Mean orifice size may be preferable to maximum orifice size. A particular value of CT may be the detection and subsequent avoidance of gross sizing error by 2D TOE that occurs in a small but important proportion of cases.
我们评估了计算机断层扫描（CT）在经皮左心耳（LAA）封堵术的大小测量中的作用，以及其对手术安全性和结果的影响。
除经食管超声心动图（TOE）外，常规进行增强多探测器 CT 以指导 LAA 封堵的大小测量。前瞻性评估手术安全性和疗效。在 73 例连续病例中，没有与器械相关的手术并发症，也没有严重的漏诊。回顾性分析显示，TOE 与 CT 在瓣口大小测量方面存在系统偏差（TOE 比 CT 小 3.0mm；TOE 比 CT 小 1.1mm）。重要的是，这导致超过一半的病例改变了器械的选择，而 CT 预测的中位数尺寸比 TOE 预测的尺寸大一个间隔（27mm 比 24mm）。值得注意的是，TOE 与 CT 的瓣口大小误差在至少 3.4%的病例中观察到。TOE 与 CT 的差异程度与 LAA 瓣口偏心度、瓣口大小和左心房容积相关。CT 的平均瓣口大小对最终 Watchman 器械尺寸选择最有用。
在本 LAA 封堵的单中心注册研究中，常规采用 CT 与手术安全性良好和无主要残余漏相关。平均瓣口大小可能优于最大瓣口大小。CT 的一个特殊价值可能是检测并随后避免 2D-TOE 在一小部分病例中出现的明显的瓣口尺寸测量错误。
