Hammerstingl Christoph, Yahya Mohammed Ali, Völz Alexander
Department of Internal Medicine and Cardiology, Eduardus-Krankenhaus, Custodisstr. 3-17, 50679 Cologne, Germany.
Eur Heart J Case Rep. 2023 Feb 13;7(3):ytad078. doi: 10.1093/ehjcr/ytad078. eCollection 2023 Mar.
Different procedural strategies have been published targeting to facilitate transcatheter left atrial appendage closure (LAAc). We demonstrate feasibility of a procedural set-up allowing single-operator LAAc in a selected patient.
A 87-year-old male with persistent Afib (CHADSVASc, five; HASBLED, three) was referred to our hospital for LAAc. Pre-procedural planning and device sizing with three-dimensional transesophageal echocardiography (3DTEE) confirmed a non-complex anatomy of the essential anatomical structures predicting suitability for LAAc. Therefore, the procedure was performed with a simplified single-operator interventional approach. Intraprocedural TEE guidance, device preparation, and LAAc were accomplished by the interventionalist himself. For procedural guidance, the TEE probe was arranged and handled in a technique comparable to the use of intracardiac echocardiography (ICE). Procedure time (skin-to-skin) was 21 min, left atrial access time 9 min, and fluoroscopy time was 4:28 min without the use of contrast dye. The patient was discharged the following day in good medical conditions.
To the best of our knowledge, this is the first report on successful single-operator LAAc in a selected patient. The intervention, pre-procedural screening, and intraprocedural 3D TEE were performed by one single experienced interventionalist. This simplified technique is based on a standardized pre-procedural imaging-protocol with 3D echocardiography. According to our experience, this streamlined approach is a valuable option in non-complex LAAc cases. In the growing field of structural cardiac interventions, this approach might be an interesting option for centres with limited personal and technical resources.
已发表了不同的手术策略，旨在促进经导管左心耳封堵术（LAAc）。我们证明了一种手术设置在特定患者中进行单操作者LAAc的可行性。
一名87岁男性，持续性房颤（CHADSVASc评分，5分；HASBLED评分，3分），因LAAc转诊至我院。术前通过三维经食管超声心动图（3DTEE）进行规划和器械尺寸测量，证实关键解剖结构的解剖不复杂，预测适合LAAc。因此，采用简化的单操作者介入方法进行手术。术中TEE引导、器械准备和LAAc均由介入医生本人完成。为进行手术引导，TEE探头的布置和操作采用了与心内超声心动图（ICE）使用类似的技术。手术时间（皮肤到皮肤）为21分钟，左心房进入时间为9分钟，透视时间为4分28秒，未使用造影剂。患者次日病情良好出院。
据我们所知，这是关于特定患者成功进行单操作者LAAc的首例报告。干预、术前筛查和术中3D TEE均由一名经验丰富的介入医生完成。这种简化技术基于标准化的术前3D超声心动图成像方案。根据我们 的经验，这种简化方法在非复杂LAAc病例中是一种有价值的选择。在不断发展的心脏结构介入领域，这种方法对于个人和技术资源有限的中心可能是一个有趣的选择。
