Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Int J Cardiovasc Imaging. 2019 Oct;35(10):1841-1851. doi: 10.1007/s10554-019-01627-4. Epub 2019 May 27.
Preoperative optimal selection of the occluder size is crucial in percutaneous left atrial appendage (LAA) occlusion, and the maximal width of the LAA orifice is the main reference index, however it can not fully meet the practical operation requirements. We retrospectively analyzed three-dimensional (3D) transesophageal echocardiography (TEE) and computed tomography (CT) imaging dataset of the 41 patients who underwent LAA occlusion with LAmbre™ system. The LAA orifice parameters were overall evaluated to determine their role in device size selection. Eight LAA 3D models of the four cases who had been replaced their device during the procedure based on TEE and CT were printed out to verify the optimal parameter decision strategy. There was a significant concordance of the results between 3D TEE and CT in the LAA orifice evaluation. The correlations between the perimeter and maximal width measurements by 3D TEE and the closure disk of the device were stronger than that between the area measurements and the closure disk (r = 0.93, 0.95, 0.86, respectively and p < 0.001 all), and the result was similar to that by CT (r = 0.92, 0.93, 0.84, respectively and p < 0.001 all). The ratios of the maximal width to the minimal width of the four cases were all > 1.4, however the rest 37 cases were all ≤ 1.4. Based on the comprehensive assessment of the LAA orifice perimeter and maximal width of the 3D printed models, the experiments were all succeed just for one try. The LAA orifice perimeter of 3D printed model based on 3D TEE may help in choosing the optimal device size of LAmbre™, especially for the LAA with flater ostial shape.
经皮左心耳（LAA）封堵术的关键在于术前选择合适的封堵器尺寸，而 LAA 口的最大宽度是主要参考指标，但不能完全满足实际操作要求。我们回顾性分析了 41 例行 LAmbreTM 系统 LAA 封堵术患者的三维（3D）经食管超声心动图（TEE）和计算机断层扫描（CT）成像数据集。全面评估 LAA 口参数，以确定其在器械尺寸选择中的作用。基于 TEE 和 CT，对 4 例术中更换器械的患者的 8 个 LAA 3D 模型进行了打印，以验证最佳参数决策策略。3D TEE 和 CT 在 LAA 口评估方面的结果具有显著一致性。3D TEE 周长和最大宽度测量值与器械闭合力的相关性强于面积测量值与闭合力的相关性（r = 0.93、0.95、0.86，均 p<0.001），且与 CT 结果相似（r = 0.92、0.93、0.84，均 p<0.001）。4 例的最大宽度与最小宽度的比值均>1.4，而其余 37 例的比值均≤1.4。基于 3D 打印模型对 LAA 口周长和最大宽度的综合评估，所有实验均仅尝试一次即成功。3D TEE 基于 3D 打印模型的 LAA 口周长可能有助于选择 LAmbreTM 的最佳器械尺寸，尤其是对于 LAA 口形状较平坦的患者。
