Zhang Lizi, Cong Tao, Liu Ansheng
Department of Echocardiography, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Echocardiography. 2019 Mar;36(3):537-545. doi: 10.1111/echo.14262. Epub 2019 Feb 8.
The aim of this study was to investigate the value of real time three-dimensional transesophageal echocardiography (RT3DTEE) in percutaneous closure of the left atrial appendage (LAAC). In addition, this study also explored the change in the size of the left atrial appendage (LAA) from 24 hours before the operation to just before implantation during the operation.
In a retrospective study, 32 patients underwent two-dimensional transesophageal echocardiography (2DTEE) and RT3DTEE 24 hours prior to operation and during operation. The maximal LAA orifice diameter (by 2DTEE, 22.7 ± 2.7 vs 24.6 ± 2.2 mm, P < 0.01; by RT3DTEE, 24.2 ± 2.9 vs 25.8 ± 2.7 mm, P < 0.01), the maximal landing zone diameter (by 2DTEE, 19.0 ± 2.8 vs 20.4 ± 2.8 mm, P < 0.01; by RT3DTEE, 20.4 ± 2.7 vs 22.6 ± 3.0 mm, P < 0.01), and the maximal depth diameter (by 2DTEE, 25.2 ± 3.2 vs 26.5 ± 3.0 mm, P < 0.01; by RT3DTEE, 26.4 ± 3.2 vs 27.5 ± 3.7 mm, P < 0.01) all increased significantly during the operation. The highest correlation (R) between the maximal landing zone diameter and the compressed occluder diameter was determined for RT3DTEE measurements during the operation (R = 0.90), whereas the landing zone diameter (R = 0.80) measured by 2DTEE was less correlated. In addition, our study showed that RT3DTEE was of great value in discriminating the LAA orifice shape, allowing differentiation of the LAA morphology and identification of the number of LAA lobes.
A certain amount of intravenous rehydration just before and during operation increased the LAA size significantly. The measurements by RT3DTEE showed a closer correlation to LAA occluder size than those by 2DTEE. The LAA displayed by RT3DTEE was more visible than that by 2DTEE.
本研究旨在探讨实时三维经食管超声心动图（RT3DTEE）在经皮左心耳封堵术（LAAC）中的应用价值。此外，本研究还探讨了左心耳（LAA）从术前24小时至术中植入封堵器前的大小变化。
在一项回顾性研究中，32例患者在术前24小时及术中接受了二维经食管超声心动图（2DTEE）和RT3DTEE检查。术中LAA最大开口直径（2DTEE测量：22.7±2.7 vs 24.6±2.2mm，P<0.01；RT3DTEE测量：24.2±2.9 vs 25.8±2.7mm，P<0.01）、最大着陆区直径（2DTEE测量：19.0±2.8 vs 20.4±2.8mm，P<0.01；RT3DTEE测量：20.4±2.7 vs 22.6±3.0mm，P<0.01）和最大深度直径（2DTEE测量：25.2±3.2 vs 26.5±3.0mm，P<0.01；RT3DTEE测量：26.4±3.2 vs 27.5±3.7mm，P<0.01）均显著增加。术中RT3DTEE测量的最大着陆区直径与压缩封堵器直径之间的相关性最高（R=0.90），而2DTEE测量的着陆区直径相关性较低（R=0.80）。此外，本研究表明RT3DTEE在鉴别LAA开口形状、区分LAA形态及识别LAA叶数方面具有重要价值。
术前及术中适量静脉补液可使LAA大小显著增加。RT3DTEE测量结果与LAA封堵器大小的相关性比2DTEE更密切。RT3DTEE显示的LAA比2DTEE更清晰。
