Jain Renuka, Wessly Priscilla, Saric Muhamed, Richardson Karl, Garcia-Sayan Enrique, Addetia Karima, Howard Lauren, Finn Thomas, Quader Nishath
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin; Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin.
Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
J Am Soc Echocardiogr. 2025 Jul 25. doi: 10.1016/j.echo.2025.07.009.
Left atrial appendage occlusion (LAAO) has emerged as an important intervention for stroke prevention in patients with nonvalvular atrial fibrillation (AF) who are unable to tolerate long-term anticoagulation. The development of advanced imaging technologies and techniques, such as three-dimensional (3D) echocardiography with multiplanar reconstruction, multidetector cardiac computed tomography (MDCT), 3D intracardiac echocardiography (ICE), 3D printing, and simulation, has revolutionized preprocedural planning, intraprocedural guidance, and postprocedural surveillance, ensuring improved precision and outcomes. Transesophageal echocardiography (TEE) remains a foundational imaging modality for assessing left atrial appendage morphology, excluding thrombi, and obtaining accurate measurements for device sizing. Recent advances in 3D TEE and multiplanar reconstruction techniques enable enhanced visualization of complex left atrial appendage anatomies, improving device selection and procedural planning. MDCT has a growing role, offering high-resolution 3D reconstructions for detailed anatomic assessment. Additionally, its applications in 3D printing and virtual device simulation provide patient-specific insights, facilitating optimal device sizing and improving procedural efficiency. Intraprocedurally, 3D ICE has gained traction as a valuable alternative to TEE. With its real-time imaging capabilities and high spatial resolution, 3D ICE allows precise guidance during transseptal puncture and device deployment while reducing the need for general anesthesia. Postprocedurally, both TEE and MDCT play critical roles in assessing device stability and identifying complications such as device-related thrombus and peridevice leak. This review highlights the evolving role of multimodality imaging in LAAO, including innovations such as 3D ICE, 3D printing, and simulation. The authors also review recent literature to establish state-of-the-art imaging practices, providing a comprehensive discussion of imaging applications across pre-, intra-, and postprocedural phases to optimize outcomes and minimize complications in LAAO.
左心耳封堵术（LAAO）已成为无法耐受长期抗凝治疗的非瓣膜性心房颤动（AF）患者预防卒中的重要干预措施。先进成像技术和方法的发展，如具有多平面重建功能的三维（3D）超声心动图、多排心脏计算机断层扫描（MDCT）、3D心腔内超声心动图（ICE）、3D打印和模拟，彻底改变了术前规划、术中引导和术后监测，确保了更高的精度和更好的治疗效果。经食管超声心动图（TEE）仍然是评估左心耳形态、排除血栓以及获取准确测量值以确定器械尺寸的基础成像方式。3D TEE和多平面重建技术的最新进展能够增强对复杂左心耳解剖结构的可视化，改善器械选择和手术规划。MDCT的作用日益重要，它能提供高分辨率的3D重建以进行详细的解剖评估。此外，其在3D打印和虚拟器械模拟中的应用提供了针对患者的见解，有助于优化器械尺寸并提高手术效率。在手术过程中，3D ICE作为TEE的一种有价值的替代方法受到了关注。凭借其实时成像能力和高空间分辨率，3D ICE在经房间隔穿刺和器械植入过程中允许精确引导，同时减少了全身麻醉的需求。在术后，TEE和MDCT在评估器械稳定性以及识别诸如器械相关血栓和器械周围渗漏等并发症方面都发挥着关键作用。本综述强调了多模态成像在LAAO中不断演变的作用，包括3D ICE、3D打印和模拟等创新技术。作者还回顾了近期文献以确立最新的成像实践，全面讨论了术前、术中和术后各阶段的成像应用，以优化LAAO的治疗效果并将并发症降至最低。
