比较心脏CT血管造影与经食道超声心动图检测左心耳封堵术后残余分流和器械相关血栓的价值  

Value of Cardiac Computed Tomography Angiography and Transesophageal Echocardiography on Detecting Device Related Residual Shunt and Thrombus After Left Atrial Appendage Occlusion

作　　者：沐回凯 孙煌[1] 李锐洁[1] 孟照辉[1] 彭云珠[1] 孙钺[1] 钟蕾 马米尔 罗薇 MU Huikai;SUN Huang;LI Ruijie;MENG Zhaohui;PENG Yunzhu;SUN Yue;ZHONG Lei;MA Mier;LUO Wei(Department of Cardiology,The First Affiliated Hospital of Kunming Medical University,Kunming(650051),Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院心内科,云南省昆明市650051

出　　处：《中国循环杂志》2020年第8期765-770,共6页Chinese Circulation Journal

基　　金：云南省科技计划项目[2017FE467(-13)]。

摘　　要：目的:比较经食道超声心动图(TEE)和心脏CT血管造影(CCTA)用于左心耳封堵术后随访检测器械相关残余分流(PDL)、器械相关血栓的效果。方法:纳入了昆明医科大学第一附属医院2017年7月至2019年8月成功接受左心耳封堵术的非瓣膜性心房颤动(房颤)患者,患者术后45 d、术后6个月同时进行CCTA和TEE检查,分析对比封堵器PDL、器械相关血栓形成及不良事件等。结果:49例患者成功行左心耳封堵术(Watchman^(TM)封堵器35例,Lambre^(TM)封堵器14例),平均年龄(68.3±9.4)岁,CHA2DS2-VASc评分为(3.24±1.28)分,HASBLED评分为(2.61±1.37)分。术后45 d,49例患者完成TEE和CCTA随访,术后6个月,39例患者完成TEE和CCTA随访。术后45 d随访时,CCTA的PDL检出率明显较TEE高(87.7%vs. 67.3%,P=0.006),另外两种检测手段均在同一例患者中检出器械相关血栓。术后6个月随访时,CCTA的PDL检出率仍高于TEE(84.6%vs. 20.5%,P<0.001)。45 d随访时检出的1例器械相关血栓患者,在6个月随访时TEE和CCTA均显示仍存在器械相关血栓,TEE显示血栓大小从23 mm×8 mm缩小到14 mm×3.4 mm。该组病例中有1例患者诊断心原性脑梗死,无死亡事件发生。结论:左心耳封堵术后45 d似乎不能完全封堵左心耳,CCTA比TEE监测到更多的PDL,可作为左心耳封堵术后随访的辅助手段。Objectives:To compare the value of transesophageal echocardiography(TEE)and cardiac CT angiography(CCTA)in detecting device related residual shunt(PDL)and device related thrombus after left atrial appendage occlusion(LAAO).Methods:Non-valvular atrial fibrillation patients,who underwent LAAO from July 2017 to August 2019 in our hospital,were included.All patients underwent CCTA and TEE examinations at the 45 day and 6 month post LAAO.Peri-device leak(PDL),Device-related thrombus(DRT)and major adverse cardiac events were analyzed.Results:During the study period,LAAO was successfully performed in 49 patients(35 WatchmanTM,14 LambreTM),mean age was(68.3±9.4)years,CHA2DS2-VASc score was 3.24±1.28,HASBLED score was 2.61±1.37 in these patients.All 49 patients underwent TEE and CCTA follow-up examination at 45 days post LAAO.At 45 days after operation,PDL was detected in 33 patients(67.3%)by TEE,in 43 patients(87.7%)by CCTA(P=0.006).In addition,DRT was detected in one patient by both TEE and CCTA.At 6 months after operation,39 patients completed the follow-up TEE and CCTA examination,PDL was detected in 8 patients(20.5%)by TEE,in 33 patients(84.6%)by CCTA(P<0.001).Both TEE and CCTA evidenced persistent DRT at 6 months post LAAO in the patient with DRT at 45 days follow-up.TEE showed that the thrombus size decreased from 23 mm×8 mm at 45 days post LAAO to 14 mm×3.4 mm at 6 months post LAAO.During follow-up,one patient developed cardiogenic cerebral infarction,no death occurred.Conclusions:45 days seem to be insufficient for complete LAA seal-off after LAAO.Detecting efficacy of CCTA is higher than that of TEE on detecting PDL post LAAO,CCTA can thus be used as a complementary method of TEE in the follow-up of patients post LAAO.

关 键 词：心房颤动 脑卒中 左心耳封堵术 经食道超声心动图 心脏计算机断层血管造影 

分 类 号：R54[医药卫生—心血管疾病]