左心耳经食管超声心动图测量参数与Watchman左心耳封堵器尺寸的相关性分析  

Correlation analysis between left atrial appendage transesophageal echocardiography measurements and Watchman left atrial appendage occluder size

作　　者：陈立斌[1] 张盛敏[1] 毛锋[1] 储慧民[2] 俞霏[1] 朱雪丽[1] 张涛[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,315010

出　　处：《中华超声影像学杂志》2016年第11期942-947,共6页Chinese Journal of Ultrasonography

摘　　要：目的评估经食管超声心动图（TEE）左心耳（LAA）测量参数与所选择WatchmanLAA封堵器尺寸的相关性。方法对59例高卒中风险非瓣膜性心房颤动患者（CHADS2≥1分）在TEE引导下用Watchman封堵器行LAA封堵。术前二维TEE测量LAA参数包括LAA锚定区及LAA解剖口的最大径、最小径及平均直径，LAA深度；术前三维TEE测量LAA参数包括锚定区最大径、最小径及平均直径。分析各参数与最终置入LAAWatchman封堵器大小的相关性。结果封堵成功53例（≤5mm缝隙），失败3例，封堵不完全3例（残余分流〉5mm）。最终置入封堵器的56例患者中，43例有术前三维测量数据。二维TEE测量的LAA锚定区最大径、最小径及平均直径以及最大深度分别为（22．6±3．4）mm、（17．7±2．8）mm、（20．3±2．9）mm、（28．2±5．3）mm，与置入封堵器大小的相关系数分别为0．669、0．564、0．696、0．530（P=0．000）；LAA解剖口的最大径、最小径及平均直径分别为（23．5±4．2）mm、（18．3±3．6）mm、（20．9±3．7）mm，与置入封堵器大小的相关系数分别为0．576、0．610、0．643（P=0．000）。43例三维TEE测量左心耳着陆区最大径、最小径及平均直径分别为（22．2±4．3）mm、（18．2±3．9）mm、（20．2±3．7）mm，与置入封堵器大小的相关系数分别为0．650、0．655、0．727（P=0．000）。结论二维及碱维TEE测量数据均在WatchmanLAA封堵器尺寸选择方面具有指导意义，其中三维TEE及二维TEE平均直径与封堵器直径相关性最好，可能最有助于选择合适尺寸的封堵器。Objective To evaluate the correlation between left atrial appendage （LAA） transesophageal echocardiography （TEE） measurements and Watchman LAA occluder size. Methods Consecutive 59 atrial fibrillation （AF） patients （CHADS2≥1） with high risk bleeding underwent LAA occlusion under the guidance of TEE between October, 2014 and February, 2016. Measurements of the LAA anchoring area diameter and anatomical LAA orifice diameter including maximum, minimum and average values, and LAA depth on behalf of LAA size on 2D TEE, and anchoring area diameter including maximum, minimum and average values on 3D TEE were done before closer device implanation. The correlational analysis between TEE LAA diameter and Watchman LAA occluder size was conducted. Results Fifty-nine patients included 53 cases with successful LAA occlusion （peripheral leakage 45 mm）, 3 cases with incomplete occlusion （peripheral leakage ~5 mm ）, and 3 cases with failed occlusion. Among 56 patients with device implanation, 43 had 3D TEE data. Maximum, minimum and average diameters of LAA anchoring area and LAA depth were （22.6±3.4） mm, （17.7±2.8）mm, （20.3±2.9） mm, （28.2±5.3） mm, respectively, and their coefficient of correlation r were 0. 669,0. 564,0. 696, and 0. 530, respectively （ all P = 0.000） with Watchman device diameter. Maximum, minimum and average diameters of LAA anatomical orifice were （23.5±4.2）mm, （18.3±3.6）mm, （20.9±3.7）mm, respectively, and their coefficient of correlation r were 0. 576, 0. 610, 0. 643 separately （ all P = 0. 000） with Watchman device diameter. Maximum, minimum and average diameters of LAA anchoring area were （22.2±4.3） mm, （ 18.2±3.9）mm, （20.2±3.7）mm, respectively with 3D TEE of 43 patients, and their coefficient of correlation r were 0. 650,0. 655,0. 727, respectively （ all P = 0. 000） with Watchman device diameter. Conclusions Both 2D TEE and 3D TEE measurements of LAA have clinical guiding significance in the selection of proper size of

关 键 词：超声心动描记术 经食管 心房颤动 左心耳 封堵 Watchman封堵器 

分 类 号：R540.45[医药卫生—心血管疾病] R541.75[医药卫生—内科学]