三维经食道超声心动图在左心耳封堵术中的应用价值

摘要

Objective]To evaluate the value of three-dimensional transesophageal echocardiography(3D-TEE)in the applica⁃tion of percutaneous left atrial appendage occlusionin patients with atrial fibrillation.[Methods]7 patients with atrial fibrillation in Da⁃lian area(female 4,male 3,mean age 71.5 ± 3.3 years)were enrolled in the study.The maximum and minimum diameter and the max⁃imum depth ofleft atrial appendage were measured by 3D-TEE,and export morphology and leaf number were viewed.WATCHMAN occlude size was selectedby 3D-TEE. The process of operation was monitored by 3D-TEE. 3D-TEE was also performed in 3 months after the transcatheter closure.[Results]7 patients were performed the transcatheter closure therapy successfully. Preoperative 3D-TEE showed left atrial appendage export:5 cases were oval,and 2 cases were nearly circular. The leaf number was 1.6 ± 0.8. The maximum diameter of the left atrial appendage export was(23.1 ± 1.7)mm,(19.2 ± 2.1)mm minimum diameter,maximum depth of(27.6 ± 3.3)mm. The maximum diameter had good correlation with the size of occluder(r=0.944,P=0.001). 3D-TEE was used for guidance in the transcatheter therapy and succeeded. There were 1 case with little shunt after the transcatheter closure. 3 months af⁃ter the treatment ,position and shape of the occluderswere all in good.[Conclusion]3D-TEE has the great value in the percutaneous closure of left atrial appendage.%【目的】初步探讨经食道三维超声心动图在房颤患者经皮左心耳封堵术中的应用价值。【方法】2015年10月至2016年6月大连地区房颤患者7例，女性4例，男性3例，平均年龄（71.5±3.6）岁。术前利用经食道三维超声心动图测量左心耳开口最大直径、最小直径和最大深度，并观查左心耳开口形态和分叶数，选用美国波士顿WATCHMAN封堵器，判断封堵器大小是否合适。术中在经食道超声引导下监测封堵过程，并于术后3个月复查。【结果】7例患者均封堵成功。术前经食道三维超声心动图显示左心耳开口5例呈椭圆形，2例呈近圆形，分叶数（1.6±0.8）个，测量左心耳口最大直径（23.1±1.7）mm，最小直径（19.2±2.1）mm，最大深度（27.6±3.3）mm，最大直径与封堵器大小相关性良好（r=0.944，P=0.001）。术中经食道三维超声心动图引导房间隔穿刺、输送鞘管放置、封堵器输送释放，释放后压缩比为（20.4±2.7）%，6例无残余分流，1例有少量残余分流。术后3个月复查封堵器位置形态良好。【结论】经食道三维超声心动图术前评估左心耳形态及大小并选择合适封堵器、术中引导房间隔穿刺及封堵器输送和释放、术后即刻评价封堵器位置及残余分流，在经皮左心耳封堵术中具有重要作用。