摘要
目的探讨经食管超声心动图(TEE)在心房颤动患者Watchman左心耳封堵术中及随访中的应用价值。方法选取243例心房颤动且行Watchman左心耳经皮介入封堵术的患者,应用TEE观察并记录术中、随访45 d及随访6个月的封堵效果,包括残余分流、有无血栓形成及封堵器压缩径。结果243例心房颤动患者中,成功植入Watchman封堵器241例(99.2%)。术前二维TEE测量左心耳最大直径(23.42±3.68)mm,三维成像技术多平面重建法测量左心耳最大直径(23.85±2.75)mm,两者比较差异无统计学意义;术中左心耳造影测量左心耳最大直径(24.01±2.04)mm,与三维成像技术多平面重建法测值比较差异无统计学意义。左心耳封堵术后封堵器与周边组织残余分流<3 mm者47例,3~5 mm者26例;术后封堵器压缩比为10%~19%者8例,20%~29%者84例,30%~39%者108例,≥40%者41例。随访45 d,发现器械血栓形成3例;随访6个月,未见与器械相关的血栓事件、死亡。结论TEE可用于Watchman左心耳封堵术前、术中及术后随访中,其能准确、客观地评估手术效果及术后并发症情况,具有较好的临床应用价值。
Objective To explore the application value of transesophageal echocardiography(TEE)in percutaneous Watchman closure of left atrial appendage in atrial fibrillation patients.Methods A total of 243 atrial fibrillation patients treated with percutaneous Watchman closure of left atrial appendage by TEE were enrolled,the treatment effect,including residual shunt,thrombus and the diameter of occluder compression were assesed during the operation,45 d and 6 month postoperative follow up.Results Of 243 patients with atrial fibrillation,241 cases(99.2%)were successfully implanted Watchman occluder.The maximum diameter of left atrial appendage(23.42±3.68)mm was measured by preoperative TEE.The maximum diameter of left atrial appendage measured by multiplanar reconstruction with three-dimensional imaging technique was(23.85±2.75)mm,the difference was not statistically significant.The maximum diameter measured by left atrial appendage angiography was(24.01±2.04)mm,which was not statistically different from the multi-planar reconstruction method.Residual shunt after operation were detected,the diameter between occluder and peripheral tissue less than 3 mm was detected in 47 cases,and 3~5 mm in 26 cases.The compression ratio of occluder was 10%~19%in 8 cases,20%~29%in 84 cases,30%~39%in 108 cases,and≥40%in 41 cases.Following up for 45 d,3 cases of instrument thrombosis were found.Following up for 6 months,no thrombus or death related to the device was found.Conclusion TEE plays an important role in Watchman’s left atrial appendage occlusion,it can be used in the preoperative,intraoperative and postoperative follow-up.
出处
《临床超声医学杂志》
CSCD
2019年第9期677-680,共4页
Journal of Clinical Ultrasound in Medicine
基金
武汉市卫计委课题(WX16Z69)
关键词
超声心动描记术
经食管
左心耳封堵术
血栓
Echocardiography,transesophageal
Left atrial appendage closure
Thrombs
