经食管超声心动图及CT左心耳造影在左心耳Watchman封堵术前的应用价值  

Clinical application value of transesophageal echocardiography and LAA CTA before percutaneous left atrialappendage closure with the Watchman occluder

作　　者：张涛 陈立斌[2] 储慧民[3] 毛锋[2] 俞霏[2] 朱雪丽 

机构地区：[1]浙江省宁波市第九医院超声科315010 [2]宁波市第一医院超声科 [3]宁波市第一医院心内科

出　　处：《中华超声影像学杂志》2017年第11期964-969,共6页Chinese Journal of Ultrasonography

摘　　要：目的评估经食管二维超声心动图（2D-TEE）、实时三维超声心动图（RT3DTEE）及CT左心耳造影（LAACTA）在Watchman左心耳封堵术前的应用价值。方法对50例非瓣膜性心房颤动（以下简称房颤）患者左心耳封堵术前行2D-TEE、RT-3DTEE及LAACTA检查，观察左心耳分叶情况，测量并对比左心耳各参数大小，评估其与置入封堵器尺寸的相关性。结果50例患者RT-3DTEE和LAACTA观测左心耳分叶数目差异无统计学意义（P〉0．05）。左心耳锚定区最大径测值：LAACTA〉RT-3DTEE及213-TEE（f=3．977，5．373；均P〈0．05），RT-3DTEE〉2D-TEE（t=2．124，P〈0．05）；着陆区最小径测值：RT3DTEE〉2D-TEE（t=2．142，P〈0.05）；左心耳深度：I，AACTA〉2T）ITEE及RT-3DTEE（t=2．674，4．066，均P〈0．05），2nTEE〉RT-3DTEE（t=2．114，P〈0．05）。左心耳锚定区最大径、最小径及深度的相关性：2D—TEE与RT-3DTEE间r=0．638，0．734，0．647（均P=0．000），RT-3DTEE与I．AACTA间r=0517，0338，0．591（均P〈0．1／5），2D—TEE与LAACTA间r=0．503，0．359，0．610（均P〈0．05）。术中X线左心耳造影（LAA—A）锚定区最大径为（22．6±3．5）mm。封堵成功的47例患者RT-3DTEE锚定区最大径与封堵器尺寸的相关性（r=0．693）高于2D—TEE及CCTA与封堵器尺寸的相关性（x=0．647，0．586）。术中LAA—A锚定区最大径测值与封堵器尺寸相关性最高（r=0．914）。结论Watchman左心耳封堵术前，2D-TEE、RT-3DTEE及LAACTA左心耳测量数据存在差异，但在封堵器尺寸选择方面均具有指导意义，以RT3DTEE与封堵器直径相关性最好，最有助于封堵器大小的选择。Objective To evaluate the clinical application value of 2-dimentional transesophogeal echoeardiography （2D-TEE）, real-t/me 3-dimensionaI transesophogeal echocardiography（RT-3D TEE） and left atrial appendage CT angiography （LAA CTA） before percutaneous left atrial appendage closure （LAAC） with the Watchman oeeluder. Methods Consecutive 50 atrial fibrillation （AF） patients underwent 2TTEE, RT-3D TEE and LAA CTA examination before LAAC. The number of LAA lobes, the diameter of landing zone （DLZ） and the depth of LAA were measured by using different methods. The correlation between LAA landing zone diameters measured by different methods and device size were calculated. Results Among 50 patients, there was no significant difference in lobe nubmers between RT-3D TEE and LAA CTA （ P 〈0.05）. The maximum diameter of landing zone（DLZ） from LAA CTA was greater than those from RT-3D TEE and 2D TEE （t =3.977,5.373,bothP〈0.05）,and DLZ fromRT3DTEE was greater than that from 2D-TEE （l =2.124, P 〈0.05）. The value measured by RT3D TEE was greater than that by 2DTEE for the LAA minimum DLZ （t =2.142, P 〈 0.05）. LAA depth：CTA value was greater than 21TEE and RT-3D TEE values （ t = 2. 674, 4. 066, both P 〈 0. 05）, and 2D-TEE value was greater than RT-3D TEE value（ t = 2. 114, P 〈0.05）. The correlation coefficient of I.AA maximum, minimum DLZ and LAA depth between 2D-TEE and RT-3D TEE were （1.638.0.7：34.0.647 （all r= 0.000 and q170.338 and 0.591 between RT-3D TEE and LAA CTA, respectively （all P 〈11.05）, and 11. 5113,11. 359 and 0.610 between 2D-TEE and I,AA CTA, respectively （all P 〈0.115）. I,AA DI.Z of LAA angiography （LAA-A） was （22.6± 3.5）mm. Fourty seven AF patients achieved successful LAA occlusion with Watchman device and the size of closure was （27.5 ± 3.3）mm. Correlation coefficient Imtwcen the size of device and LAA maximum DLZ by RT 3D TEE, 2DTEE and I.AA CTA were 11.693, 0.647, 11.586, respectively （all P = 0.000）. Corre

关 键 词：超声心动描记术 经食管 左心耳 封堵术 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] R816.2[医药卫生—临床医学]