Hospital Clinic de Barcelona, Institut Clínic Cardiovascular, Barcelona, Spain.
Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
J Interv Card Electrophysiol. 2020 Oct;59(1):71-78. doi: 10.1007/s10840-019-00699-5. Epub 2020 Mar 12.
The present paper analyzes the role of different imaging modalities for left atrial appendage (LAA) assessment and the recommended specific measurements to improve device selection with regard to the Amulet device.
Morphological LAA assessment is one of the pivotal factors to achieve proper LAA sealing and potentially reduce the risk of complications by minimizing manipulation inside the appendage.
Eight experienced physicians in LAAO were asked to contribute in the preparation of a device sizing consensus manuscript after comprehensive assessment of previous published data on LAA imaging/measurement.
LAA morphology is often complex and requires more detailed spatial resolution and 3-dimensional assessments to reduce the risk of mis-sizing. Traditionally, upsizing of devices based upon the largest measured LAA diameters have been used. However, this may lead to oversizing in markedly elliptical appendages. Thus, when 3D imaging modalities are available, utilizing the LAA mean diameters might be a better alternative. Operators should also note the systematic biases in differences in measurements obtained with different imaging modalities, with CT giving the largest measurements, followed by 3D-TEE, and then 2D-TEE and angiography. In fact, for 2D imaging techniques (2D-TEE and angiography), LAA diameters tend to be underestimated, and therefore, LAA largest diameters seem to be still the best option for device sizing. Some specific anatomies such as proximal chicken-wing or conic LAAs may require different measurements and implantations to achieve implant success.
In conclusion, LAA mean diameters might be a better alternative to largest diameters when 3D imaging modalities are available.
本文分析了不同成像方式在左心耳（LAA）评估中的作用，以及推荐了特定的测量方法，以改善 Amulet 装置的设备选择。
形态学 LAA 评估是实现适当 LAA 密封的关键因素之一，并通过最大限度地减少在附属物内的操作，潜在地降低并发症的风险。
8 名 LAAO 经验丰富的医生在综合评估了以前发表的关于 LAA 成像/测量的数据后，被要求为设备尺寸共识草案的编写做出贡献。
LAA 形态通常较为复杂，需要更详细的空间分辨率和 3 维评估，以降低错误尺寸的风险。传统上，根据最大测量 LAA 直径来增大设备尺寸。然而，这可能导致在明显的椭圆形附属物中过大。因此，当 3D 成像方式可用时，使用 LAA 的平均直径可能是更好的选择。操作人员还应注意到不同成像方式获得的测量值存在系统偏差，其中 CT 给出的测量值最大，其次是 3D-TEE，然后是 2D-TEE 和血管造影。事实上，对于 2D 成像技术（2D-TEE 和血管造影），LAA 直径往往被低估，因此，LAA 最大直径似乎仍然是设备尺寸的最佳选择。一些特定的解剖结构，如近端鸡翅或锥形 LAA，可能需要不同的测量和植入方法来实现植入成功。
总之，当 3D 成像方式可用时，LAA 的平均直径可能是最大直径的更好选择。
