经食管实时三维超声心动图在左心耳封堵术中的作用  

The use of real-time three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion

作　　者：陈立斌[1] 毛锋[1] 张盛敏[1] 储慧民[2] 俞霏[1] 许幼峰[1] 

机构地区：[1]宁波市第一医院超声科,315010 [2]宁波市第一医院心内科

出　　处：《中华超声影像学杂志》2015年第9期758-762,共5页Chinese Journal of Ultrasonography

摘　　要：目的探讨经食管实时三维超声心动图（RT-3DTEE）在左心耳封堵术中的应用价值。方法对10例高卒中风险心房颤动患者（CHADS2≥2分）在经食管超声心动图（TEE）引导下行左心耳封堵术，利用RT-3DTEE观察左心耳口形态、分叶情况，测量心耳口大小以及左心耳长径，判断封堵器位置是否合适，评估左心耳各参数与置入封堵器尺寸的相关性。结果封堵成功8例，失败1例，封堵不完全1例；形态近圆形5例，近椭圆形5例；分叶数（2．2±0．7）个，三维测量左心耳口最大径略大于二维测值[（21．8±5．1）mm对（20．8±4．1）mm]，最小径略小于二维测值[（16．1±3．0）mm对（17．0±2．6）mm]，但差异无统计学意义（P〉0．05）；平均直径及最大深度二者测值相似，二维及二维TEE测量左心耳口最大径、最小径、平均直径及最大深度均与最终置入封堵器尺寸相关（三维TEE：分别r=0．719、0．690、0．791、0．711，P=0．029、0．040、0．011、0．032；二维TEE：分别r=0．887、0．894、0．932、0．896，P=0．001、0．001、0．000、0．000）。RT-3DTEE判断封堵器位置：合适位置6例，可接受位置2例，不合适位置1例。影响左心耳封堵成功因素除左心耳口大小及深度外，还包括心耳分叶数目、分叶的大小、位置及朝向。结论RT-3DTEE在左心耳封堵术中评估左心耳形态，判断左心耳口大小形态及封堵器位置方面均可发挥重要作用。Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography（RT-3D TEE） in left atrial appendage （LAA） occlusion. Methods Consecutive 10 atrial fibrillation （AF） patients （CHADS2≥2） with high risk bleeding underwent LAA occlusion under the guidance of TEE. The LAA orifice shape and characteristics of lobes were assessed, the size of LAA with RT-3D TEE wee measured before closer implanation, and the position of the LAA occlusion device were evaluated by RT-3D TEE. The correlational analysis between LAA diameter and oceluder size was conducted. Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion. Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium. The average number of LAA lobes were 2.2 ±0.7. LAA ostium long diameter were larger by 313 TEE compared with 2D TEE[-（21.8 ± 5.1 ）mm vs （20.8 ± 4.1 ） mm],and ostium short diameter were smaller by 3D TEE compared with 213 TEE[（16.1± 3.0）mm vs （17.0 ± 2.6）mm], however there were no significant differences between 213 and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods. LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter （3D TEE： r = 0.719,0.690,0.791,0.711 ,and P = 0.029,0.040,0.011, 0.032, respeetively; 2D TEE： r = 0.887, 0.894, 0.932, 0.896, and P = 0.001, 0.001, 0.000, 0.000, respectively）. LAA occlusion device position assessed by RT-3D：6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition. Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA, accurately judging LAA ostium shape and size and position of the occlusion device.

关 键 词：超声心动描记术 经食管 超声心动描记术 实时三维 左心耳 封堵 

分 类 号：R540.45[医药卫生—心血管疾病]