Clinical value of two-dimensional and real-time three-dimensional transesophageal echocardiography for the guidance of left atrial appendage closure:a comparison study for LAmbre device selection / 中华超声影像学杂志

ABSTRACT

Objective To explore the clinical value of two‐dimensional transesophageal echocardiography (2D‐TEE) and real‐time three‐dimensional transesophageal echocardiography (RT3D‐TEE) for the left atrial appendage (LAA) closure procedures by the visualization of LAA shape by 2D‐TEE and RT3D‐TEE and the comparison between the measurement of LAA ostium and the sized LAmbreTM device during the procedure .Methods Forty‐one atrial fibrillation patients ,who had undergone 2D‐TEE examination at our hospital ,were enrolled in the study .At the mid‐esophageal ,dimensions of inner and outer ostium and depth of LAA were measured at the 2D‐TEE views of 0 ,45 ,90 and 135 degree respectively . RT3D‐TEE views were acquired and the maximal and the minimal dimensions of LAA inner ostium were measured .The measurement by RT3D‐TEE and 2D‐TEE were compared to find the difference and correlation .Eleven of 41 patients who have complied with the requirements for the LAA closure ,were undergone the procedures ,measured the dimension of LAA inner ostium at selective angiography intraoperative .Sizes of closure disks of the closure device and the measurement at selective angiography were recorded to compare the measurement at RT3D‐TEE and 2D‐TEE .Results Forty‐one atrial fibrillation patients were completed TEE examination successfully .Inner ostial dimension of LAA was (20.0±04.3)cm,(19.7±03.8)cm,(21.2±04.6)cm,(23.0±05.0)cmat2D‐TEEviewsof0,45,90and135 degree ,respectively .The maximum dimensions of LAA inner ostium by RT3D‐TEE was (2 4.9 ± 0 5.2)cm . At 2D‐TEE views ,the maximum dimensions of LAA inner ostium was at 135 degree ,there was a difference between it and the measurement by RT3D‐TEE ( P =0 0.12) .Monitoring by TEE ,LAA closure procedures with LAmbreTM device were successful for all 11 patients ,the landing zone by selective angiography was (2 4.9 ± 0 4.4)cm ,and the appropriate sized closure disk of the LAmbreTM device was 2 4. - 3 6. cm . Correlation between the measurements by RT3D‐TEE and selective angiography and the sized closure disk were r =0 8.16 ,P =0 0.02 and r =0 9.14 ,P =0 0.00 ,respectively .Correlation between the measurements by 2D‐TEE and selective angiography and the sized closure disk were r =0 6.93 ,P =0 0.18 and r =0 6.88 , P=0 0.19 ,respectively .Conclusions There was better correlation among the measurements by RT3D‐TEE and selective angiography and the size of closure device .Therefore ,compared to 2D‐TEE ,the guidance of RT3D‐TEE was more accurate during LAA closure procedures for LAmbreTM device selection .