三维经食管超声心动图与其他影像技术指导左心耳封堵术的对比  

Comparation of three-dimensional transesophageal echocardiography and other imaging techniques in conducting percutaneous left atrial appendage occlusion

作　　者：孟庆国[1] 尹立雪[1] 曾杰[1] 王胰[1] 

机构地区：[1]四川省医学科学院四川省人民医院心血管超声及心功能科,四川成都610072

出　　处：《中国医学影像技术》2017年第3期365-369,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨三维经食管超声心动图(3D-TEE)和2D-TEE、CTA和术中X线造影在左心耳(LAA)形态、大小评估及指导封堵器型号选择方面的价值。方法对43例拟行LAA封堵术的心房颤动患者行TEE,清晰显示LAA并于0°、45°、90°和135°分别测量其开口最大径和最大深度值;于LAA显示最清晰切面启动3D-ROOM模式测量开口最大径、最小径,并将其与2D-TEE、CTA和X线造影的检查结果进行对比。结果 3D-TEE测量LAA开口最大径与2D-TEE、术中X线造影测值差异无统计学意义(P均>0.05),CTA测量LAA开口最大径明显大于3D-TEE、2D-TEE和X线造影测值(P<0.01);2D-TEE于90°和135°测量LAA最大深度值与CTA测值差异有统计学意义(P均<0.05),与术中X线造影比较,仅在135°时差异有统计学意义(P<0.01)。3D-TEE测量LAA开口最大径与2D-TEE各角度、CTA和X线造影测值呈明显正相关(r=0.70~0.77、0.57、0.58,P均<0.01);2D-TEE各角度测量LAA开口最大径与CTA、X线造影测值均存在相关性(r=0.57~0.71,0.45~0.51;P均<0.01);3D-TEE、2D-TEE、CTA及X线造影LAA开口最大径与封堵器大小均呈明显正相关且(r=0.93、0.70~0.77、0.57、0.47,P均<0.01)。结论 3D-TEE与2D-TEE、CTA和X线造影相比,3D-TEE对于封堵器大小的选择更具指导性。Objective To investigate the value of 3D-TEE,2D-TEE,CTA and X-ray contrast in assessing left atrial appendage（LAA）shape,size and guidance for the choice of occlusion.Methods Forty-three cases of left atrial fibrillation who were referred for LAA closure were performed TEE to measure the opening maximum diameter,and maximum depth of 2D-TEE at 0°,45°,90°and 135°.When LAA showed most clearly,the opening maximum and minimum diameter of LAA were measured by using 3D-ROOM mode,and the results were compared with those measured by CTA and X-ray contrast.Results There was no significant difference for opening maximum diameter of LAA measured by 3D-TEE,2DTEE and X-ray contrast（all P〉0.05）,but that of CTA statistically larger than 3D-TEE,2D-TEE,X-ray contrast（all P〈0.01）.There were significant difference between 2D-TEE at 90°,135°and CTA,2D-TEE at 135°and X-ray contrast in assessing maximum depth of LAA（all P〈0.05）.Opening maximum diameter of LAA measured by 3D-TEE was significantly correlated with each angle of 2D-TEE,CTA,and X-ray contrast（r=0.70—0.77,0.57,0.58,all P〈0.01）,and the opening maximum diameter measured by 2D-TEE also correlated with CTA and X-ray contrast（r=0.57—0.71,0.45—0.51,all P〈0.01）.Also the opening maximum diameter measured by 3D-TEE,2D-TEE,CTA and x-ray contrast were correlated with occluder size（r=0.93,0.70—0.77,0.57,0.47,all P〈0.01）.Conclusion Compared with 2DTEE,CTA and X-ray contrast,3D-TEE is more instructive for occluder selection.

关 键 词：左心耳 心房颤动 超声心动描记术 经食管 

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