Application of real-time three-dimensional transesophageal echocardiography in percutaneous left atrial appendage closure and its follow-up / 中华超声影像学杂志

ABSTRACT

Objective To evaluate the application of real-time three-dimensional transesophogeal echocardiography(RT-3D TEE)in percutaneous left atrial appendage closure and its follow-up in patients with non-valvular atrial fibrillation.Methods Fifteen patients including 6 males and 9 females were refractory to percutaneous closure of left atrial appendage.The morphology of the left atrial appendage (LAA)in those patients was evaluated by RT-3D TEE.Combined with two-dimensional transesophogeal echocardiography(2D-TEE),RT-3D TEE was performed during the procedure of LAA occlusion,including the measurement of left atrial appendage,the selection of occluder,the puncture of atrial septal,the delivery and release of occlusive device.Finally,it was also used immediately to evaluate the effect of blocking and complications after the operation.The closure effect and related complication were also evaluated by RT-3D TEE at 3 months and 1 2 months followed up,respectively.Results Fifteen patients were successfully undergone the LAA closure procedures with LAmbre TM device.The dimension of LAA landing zone was (21.60±4.08)mm,the measurement of cardiac angiography(CAG)during the procedure was(20.91 ± 3.93)mm and finally the fixed plate size of LAmbreTMdevice was(26.13±4.69)mm.Correlation between the measurements by RT-3D TEE and selective angiography was significant(r =0.84,P =0.0001). Bland-Altman plot showed that 86.67% of plots were among limits of agreement.The width of the flow jet was <3 mm near the LAA closure device in 2 patients immediately after the procedure.At the 3 months and 1 2 months follow-up,the LAA closures had good morphology,fixed position,and no thrombus formation on the surface.There was still slight flow j et near the closure device in 2 patients at that time. Conclusions RT-3D TEE plays an important role in the procedure of left atrial appendage closure and its follow-up.There is better correlation and consistency between the measurements by RT-3D TEE and CAG.