Lindner Simon, Behnes Michael, Wenke Annika, Sartorius Benjamin, Dieker Wulf, Ansari Uzair, Akin Muharrem, Bertsch Thomas, Mashayekhi Kambis, Vogler Nils, Haubenreisser Holger, Schoenberg Stefan O, Borggrefe Martin, Akin Ibrahim
First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research), Mannheim, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Clin Cardiol. 2019 Feb;42(2):264-269. doi: 10.1002/clc.23136. Epub 2018 Dec 21.
Although left atrial appendage (LAA) anatomy and topographic relations are well understood, little is known about the impairment of neighboring structures (NBS) by an implanted left atrial appendage closure (LAAC) device. This prospective longitudinal observational study for the first time describes distances of implanted LAA closure (LAAC) devices to NBS using a standardized imaging protocol of cardiac computed tomography angiography (cCTA).
cCTA imaging is an eligible tool for post-implantation evaluation of LAAC devices and their relation to neighboring structures.
cCTA data sets of consecutive patients 6 months after successful LAAC were acquired on a third generation dual-source CT system and reconstructed with a slice thickness of 0.5 mm. The standardized multi-planar reconstruction LAA occluder view for post-implantation evaluation (LOVE) algorithm was used to measure the distances to NBS in relation to LAA morphology and implanted LAAC devices.
A total of 48 patients (median age 80 years, 25% female) were included. Left upper pulmonary vein and circumflex artery were generally closest to occlusion devices (median 2.9 and 2.8 mm, respectively). AMPLATZER AMULET devices were closer to the mitral valve annulus than WATCHMAN devices (6.6 mm (inter quartile range [IQR] 4.9-8.6) vs 10.9 mm (IQR 7.4-14.0), P = 0.001). Distances to the left upper pulmonary vein were affected by LAA morphology, with cauliflower type having the closest proximity (1.7 mm [IQR 1.0-3.4], P = 0.048).
A standardized cCTA imaging protocol is an eligible tool to accurately measure distances to NBS. Left upper pulmonary vein and circumflex artery are closest to LAAC devices and could thus be most prone to impairment.
尽管左心耳（LAA）的解剖结构和地形关系已为人熟知，但对于植入的左心耳封堵（LAAC）装置对邻近结构（NBS）的损害却知之甚少。这项前瞻性纵向观察研究首次使用心脏计算机断层血管造影（cCTA）的标准化成像方案描述了植入的LAA封堵（LAAC）装置与NBS之间的距离。
cCTA成像对于LAAC装置植入后的评估及其与邻近结构的关系是一种合适的工具。
在第三代双源CT系统上获取成功进行LAAC术后6个月的连续患者的cCTA数据集，并以0.5mm的层厚进行重建。使用标准化的多平面重建LAA封堵器植入后评估（LOVE）算法来测量与LAA形态和植入的LAAC装置相关的NBS距离。
共纳入48例患者（中位年龄80岁，25%为女性）。左上肺静脉和回旋支动脉通常最靠近封堵装置（中位距离分别为2.9mm和2.8mm）。AMPLATZER AMULET装置比WATCHMAN装置更靠近二尖瓣环（6.6mm（四分位间距[IQR]4.9 - 8.6）对10.9mm（IQR 7.4 - 14.0），P = 0.001）。与左上肺静脉的距离受LAA形态影响，菜花型最接近（1.7mm[IQR 1.0 - 3.4]，P = 0.048）。
标准化的cCTA成像方案是准确测量与NBS距离的合适工具。左上肺静脉和回旋支动脉最靠近LAAC装置，因此最容易受到损害。
