三维心脏CT血管造影图像结合术中造影指导左心耳封堵术可行性及安全性分析  

Feasibility and safety of left atrial appendage occlusion guided by 3D cardiac CT angiography combined with intra-procedural angiography

作　　者：吴大虎 张波[1] 田为中[1] 张继[1] 朱莉[2] 陈各才[2] WU Dahu;ZHANG Bo;TIAN Weizhong;ZHANG Ji;ZHU Li;CHEN Gecai(Department of Radiology,Taizhou People's Hospital,Taizhou 225300,China;不详)

机构地区：[1]泰州市人民医院医学影像科,225300 [2]泰州市人民医院心内科,225300

出　　处：《心电与循环》2022年第3期235-240,共6页Journal of Electrocardiology and Circulation

基　　金：江苏省333高层次人才科研项目(BRA2020193)。

摘　　要：目的分析三维心脏CT血管造影(CCTA)图像结合术中造影并省略术中经食管超声心动图(TEE)的左心耳封堵术(LAAO)的可行性及安全性。方法选择2019年1月至2021年10月泰州市人民医院行LAAO的46例房颤患者,其中2020年3月至2021年10月实施CCTA图像结合术中造影指导的LAAO为观察组(21例),2019年1月至2020年3月实施标准术式的LAAO的为对照组(25例)。比较两组手术成功率、术中更换装置数量、手术时间、透视时间及术后3个月的随访结果。结果两组患者术后无一例装置栓塞、围术期脑卒中/短暂性脑缺血发作或全身性栓塞,对照组中有3例患者术中因无合适尺寸Watchman装置而更换成LAmbre封堵器装置。观察组的手术时间及透视时间低于对照组,差异均有统计学意义(均P<0.05)。术后3个月CCTA复查未发现封堵器移位和脱落。对照组出现残余漏13例,观察组出现残余漏9例。结论三维CCTA图像结合术中造影并省略术中TEE指导LAAO是安全的,并能缩短手术时间和透视时间。Objective To analyze the feasibility and safety of left atrial appendage occlusion(LAAO)guided by 3D cardiac CT angiography(CCTA)combined with intra-procedural angiography and omitted intraoperative transesophageal echocardiography(TEE).Methods Forty-six patients with atrial fibrillation who received LAAO in Taizhou People’s Hospital from January 2019 to October 2021 were selected.Of them,21 patients underwent LAAO guided by 3D CCTA imaging with intra-procedural angiography(observation group)from March 2020 to October 2021,and 25 patients underwent LAAO using a standard procedure(control group)from January 2019 to March 2020.General clinical data,procedural success rate,the number of alternative devices,procedural time,fluoroscopy time and 3-month follow-up results were compared the two groups.Results All patients underwent successful occlusion without device embolism,perioperative stroke/TIA,or systemic embolism.LAmbre occluder was used instead of Watchman device in 3 patients due to a lack of appropriate size in the control group.The average operation time and fluoroscopy time were significantly lower in the observation group than in the control group(all P<0.01).Device dislocation and shedding were not found on CCTA in 3-month follow-up.Residual leak was detected in 13 cases in the control group and 9 cases in the observation group.Conclusion LAAO guided by 3D CCTA imaging with intra-procedural angiography omitted intraoperative TEE is safety and may reduce the procedure time and fluoroscopy time.

关 键 词：CCTA图像 三维重建 左心耳封堵术 Watchman装置 

分 类 号：R541.75[医药卫生—心血管疾病]