摘要
目的探讨实时三维经食管超声心动图(RT-3D-TEE)在左心耳封堵术及预后评估中的应用价值。方法选取我院收治的非瓣膜性心房颤动患者42例,均行RT-3D-TEE、CT及心血管造影检查,评估各方法对左心耳形态分型的一致性;检测左心耳口最大径、最小径及左心耳深度,比较各方法测值的差异,选择适合的封堵器型号。于RT-3D-TEE引导下行左心耳封堵术;分析各方法测量左心耳口最大径与固定盘直径的相关性。封堵术后即刻评估手术效果,术后随访10个月,复查RT-3D-TEE评估患者预后情况。结果RT-3D-TEE与CT、心血管造影评估左心耳形态分型的一致性均为97.62%。RT-3D-TEE、CT测量左心耳深度分别为(26.64±3.41)mm、(27.79±4.02)mm,均大于心血管造影测值[(24.53±4.15)mm],差异均有统计学意义(均P<0.05);各方法测量左心耳口最大径、最小径比较差异均无统计学意义。RT-3D-TEE、CT、心血管造影测量左心耳口最大径与固定盘直径均呈正相关(r=0.824、0.808、0.885,均P<0.001)。42例患者左心耳封堵术均成功,成功率为100%,RT-3D-TEE发现3例术后存在少量残余分流,1例于术后32 d出现封堵器表面血栓,预后不良发生率为2.38%(1/42)。结论RT-3D-TEE在左心耳封堵术的术前评估、术中引导及预后评估方面均有较好的应用价值,可准确监测左心耳形态、手术效果及术后恢复情况。
Objective To explore the application value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in left atrial appendage occlusion(PCLAA)and its prognostic evaluation.Methods Fortytwo patients with non-valvular atrial fibrillation patients admitted to our hospital underwent RT-3D-TEE,CT and angiocardiography to evaluate the consistency of left atrial appendage morphology,and the maximum and minimum diameter of the left atrial appendage,and the depth of the left atrial appendage were detected,and an appropriate occluder was selected.PCLAA was performed under the guidance of RT-3D-TEE.The correlation between the maximum diameter of the left atrial appendage and the fixed disk diameter was analyzed.The immediate surgical effect was evaluated after occlusion.RT-3D-TEE was performed 10 months after surgery to record the prognosis of patients.Results The consistency of left atrial appendage morphology classification evaluated by RT-3D-TEE,CT,angiocardiography were both 97.62%.The depth of left atrial appendage measured by RT-3D-TEE and CT was(26.64±3.41)mm and(27.79±4.02)mm,respectively,which was higher than that measured by angiocardiography[(24.53±4.15)mm],with statistical significant differences(both P<0.05).There were no statistical difference in the maximum and minimum diameters of the left atrial appendage measured by different methods.The maximum diameter of the left atrial appendage measured by RT-3D-TEE,CT and angiocardiography was positively correlated with the fixed disk diameter(r=0.824,0.808,0.885,all P<0.001).Left atrial appendage occlusion was successful in all 42 patients with a success rate of 100%,and 3 patients had a small amount of residual shunt after surgery by RT-3D-TEE.1 patient developed thrombus on the occluder surface 32 d after surgery,with a poor prognosis rate of 2.38%(1/42).Conclusion RT-3D-TEE has good application value in preoperative evaluation,intraoperative guidance,and prognosis evaluation of PCLAA.It can accurately monitor the morphology,surgical effect and
作者
彭希威
吴琼碧
赵璐
蒋囡
PENG Xiwei;WU Qiongbi;ZHAO Lu;JIANG Nan(Department of Ultrasound,People’s Hospital of Lishui,Zhejiang 323000,China)
出处
《临床超声医学杂志》
CSCD
2023年第3期183-187,共5页
Journal of Clinical Ultrasound in Medicine
关键词
超声心动描记术
经食管
三维
实时
左心耳封堵术
非瓣膜性心房颤动
Echocardiography,transesophageal,three-dimensional,real time
Left atrial appendage,occlusion
Non-valvular atrial fibrillation
