Marchandise Sébastien, Kefer Joëlle, le Polain de Waroux Jean-Benoît, Jean-Louis Vanoverschelde Christophe Scavée
Division of Cardiology, Cardiovascular Department, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium.
J Atr Fibrillation. 2013 Jun 30;6(1):702. doi: 10.4022/jafib.702. eCollection 2013 Jun-Jul.
Thromboembolic stroke is the most serious complication in patients suffering from Atrial Fibrillation. Atrial thrombi have a predilection to form in the left atrial appendage. Accordingly, oral anticoagulation is recommended for patients with high risk of stroke. However, it is widely underused and problems of compliance are associated with serious risk of bleeding or inefficacy. In these patients with non-valvular atrial fibrillation, percutaneous occlusion of the left atrial appendage might help to reduce the risk of thromboembolism. Cardiac imaging plays a crucial role at all stages of this procedure and trans-esophageal echocardiography represents the current gold-standard for the assessment of the left atrial appendage. Cardiac imaging is mandatory to precisely determine the left atrial appendage anatomy and to select the appropriate size for the device. Finally, real time three-dimension echocardiography is a powerful additional tool that improves the safety profile of the procedure. 3D-transoesophageal echocardiography allows for the accurate assessment of left atrial appendage anatomy and helps determine if it's suitable for device implantation. Finally, it also allows for continuous visualization of all intracardiac devices and catheters during the procedure, and the clear delineation of device positioning in the left atrial appendage.
血栓栓塞性中风是心房颤动患者最严重的并发症。心房血栓易在左心耳形成。因此，对于中风高危患者推荐口服抗凝治疗。然而，其应用广泛不足，且依从性问题与严重出血风险或无效相关。在这些非瓣膜性心房颤动患者中，经皮封堵左心耳可能有助于降低血栓栓塞风险。心脏成像在该手术的各个阶段都起着关键作用，经食管超声心动图是目前评估左心耳的金标准。心脏成像对于精确确定左心耳解剖结构和选择合适尺寸的装置至关重要。最后，实时三维超声心动图是一种强大的辅助工具，可提高手术的安全性。三维经食管超声心动图能够准确评估左心耳解剖结构，并有助于确定其是否适合装置植入。最后，它还能在手术过程中持续显示所有心内装置和导管，并清晰描绘装置在左心耳中的定位。
