Department of Cardiology, Quebec Heart & Lung Institute, Laval University, 2725, chemin Sainte-Foy, Quebec City, G1V 4G5, Quebec, Canada.
Cardiovasc Ultrasound. 2021 Jan 2;19(1):3. doi: 10.1186/s12947-020-00230-1.
In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure.
The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure.
There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90, and 20.2 ± 4.1 mm at 135. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90 (p<0.001), and 1.3 ± 1.0 mm at 135 (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90, and 23.9 ± 5.8 mm at 135. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90 and 135, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements).
Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.
在接受左心耳（LAA）封堵术的患者中，准确测量 LAA 的大小是优化器械尺寸、提高手术成功率和减少并发症的关键。先前的研究表明，术中容积负荷增加 LAA 尺寸并改善器械尺寸。然而，在 LAA 封堵术的术前经食管超声心动图（TEE）检查期间给予液体负荷对 LAA 和器械尺寸的安全性和影响尚不清楚。本研究旨在确定在 LAA 封堵术的术前评估中，TEE 期间给予静脉（IV）液体负荷的安全性以及对 LAA 尺寸和器械尺寸的影响。
本研究共纳入 72 例接受 TEE 评估是否适合 LAAC 并接受 500ml 生理盐水静脉负荷的患者。在容积负荷前后通过 TEE 测量 LAA 着陆区（LZ）和深度，并使用这些测量值预测随后经皮 LAAC 术中植入的器械尺寸。
容积负荷无相关并发症。基线时 LZ 在 90°时为 19.6±3.6mm，在 135°时为 20.2±4.1mm。液体负荷后，最大直径在 90°时增加 1.5±1.0mm（p<0.001），在 135°时增加 1.3±1.0mm（p<0.001）。基线时 LAA 的平均深度在 90°时为 26.5±5.5mm，在 135°时为 23.9±5.8mm。液体负荷后，平均深度增加 1.5±1.8mm（p<0.001）和 1.6±2.0mm（p<0.001），分别在 90°和 135°。基于 LZ 负荷后测量值进行器械尺寸选择，在 71.0%的病例中与术中最终器械尺寸选择更一致（与负荷前测量值的 42.0%相比）。
在 LAAC 的术前评估中，作为门诊 TEE 的一部分进行容积负荷是安全的，并且显著增加了 LAA 的尺寸。这种策略可能成为新标准，特别是在没有 TEE 指导的情况下进行 LAAC 的中心，因为它改善了 LAA 尺寸测量，并更准确地预测了最终器械尺寸。
