心脏CT三维分析在简化式左心耳封堵术中的应用研究  

The Value of Cardiac 3-Dimensional Computed Tomography in the Simplified Left Atrial Appendage Occlusion

作　　者：程诚 杜薇薇[3] 何非 盛建龙[2] 黄正[2] 王晓晨 CHENG Cheng;DU Weiwei;HE Fei;SHENG Jianlong;HUANG Zheng;WANG Xiaochen(Department of Cardiovascular,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,China;Department of Cardiovascular,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Anhui Medical University,Hefei 230032,China)

机构地区：[1]安徽医科大学第一附属医院心血管内科,安徽省合肥市230088 [2]安徽医科大学第二附属医院心血管内科,安徽省合肥市230601 [3]安徽医科大学,安徽省合肥市230032

出　　处：《中国全科医学》2024年第35期4439-4445,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(82102308);安徽省卫生健康科研项目(AHWJ2022b020)。

摘　　要：背景简化式左心耳封堵术(LAAO)是预防非瓣膜性心房颤动患者血栓栓塞的重要治疗手段之一,心脏CT三维(CT-3D)分析在LAAO术前评估和术后随访的相关研究尚少。目的探讨CT-3D分析在简化式LAAO中的可行性、安全性、手术效率及术后随访价值。方法前瞻性纳入2021年5月—2024年1月于安徽医科大学第二附属医院行简化式LAAO的52例患者,采用抽签方法分为对照组和研究组。对照组术前行经食管心脏超声心动图(TEE)检查,研究组术前行CT-3D分析。采集患者基线资料和术中数据,包括左心耳(LAA)最大开口直径和深度,输送鞘管和LAA轴匹配率、手术时间、X线曝光时间和曝光量、造影剂用量、封堵器一次性展开率和选择成功率、术中封堵器残余分流(PDL)以及围术期并发症等,在术后90 d对患者进行CT-3D随访。结果对照组和研究组均为26例,均使用WATCHMAN封堵器,均成功完成LAAO,均未出现严重围术期并发症。入选患者术前检查均未发现心腔内血栓。对照组LAA最大开口直径在术前TEE和术中数字减影血管造影(DSA)测量值分别为(22.9±4.1)mm和(25.4±2.9)mm,两指标无相关性(r=0.374,P=0.060);对照组LAA可用深度在术前TEE和术中DSA测量值分别为(25.7±8.1)mm和(23.7±3.4)mm,两指标呈正相关(r=0.392,P=0.048)。研究组LAA最大开口直径在术前CT-3D和术中DSA测量值分别为(25.0±3.3)mm和(24.9±5.8)mm,两指标呈正相关(r=0.566,P=0.003);研究组LAA可用深度在术前CT-3D和术中DSA测量值分别为(23.5±4.2)mm和(23.1±4.0)mm,两指标呈正相关(r=0.774,P<0.001)。研究组输送鞘管和LAA轴匹配率[25例(96.2%)]高于对照组[20例(76.9%)](χ^(2)=4.172,P=0.042);研究组房间隔穿刺时间、封堵时间、X线曝光时间、曝光量、造影剂用量均少于对照组,研究组术中微小PDL发生率低于对照组(P<0.05)。共37例患者(对照组16例,研究组21例)完成术后90 d随访,未发现器械相关血栓(DRT)或>5 mBackground Simplified left atrial appendage occlusion(LAAO)is one of the important treatment methods for preventing thromboembolism in patients with nonvalvular atrial fibrillation.Currently,there are few studies on the value of cardiac 3-dimensional computed tomography(3D-CT)in the simplified LAAO.Objective To investigate the feasibility,safety,surgical efficacy and postoperative follow-up value of 3D-CT in simplified LAAO.Methods We prospectively recruited 52 patients who underwent simplified LAAO in the Second Affiliated Hospital of Anhui Medical University from May 2021 to January 2024.They were randomly assigned into the control group and study group by lottery.Preoperative transesophageal echocardiography(TEE)and preoperative cardiac 3D-CT were performed in the control group and study group,respectively.The baseline data,maximum ostium diameter and maximum depth of the left atrial appendage(LAA),match rate between the delivered sheath and the axis of LAA,operation time,time for x-ray exposure and dose,consumption of contrast agent,the rate of non-recapture and non-change of occlusion device,peri-device leakage(PDL),and perioperative complications were collected.A 3D-CT follow-up was performed for 90 days after LAAO.Results Both the control group and the study group comprised 26 cases each,using the WATCHMAN device for LAAO,with no serious perioperative complications.Preoperative examinations showed no intracardiac thrombus in all patients.In the control group,the maximum ostium diameter of the LAA measured by preoperative TEE and intraoperative DSA was(22.9±4.1)mm and(25.4±2.9)mm,respectively,not showing a positive correlation(r=0.374,P=0.060).The usable depth of the LAA in the control group measured by preoperative TEE and intraoperative DSA was(25.7±8.1)mm and(23.7±3.4)mm,respectively,showing a positive correlation(r=0.392,P=0.048).In the study group,the maximum ostium diameter of the LAA measured by preoperative 3D-CT and intraoperative DSA was(25.0±3.3)mm and(24.9±5.8)mm,respectively,showing a pos

关 键 词：心房颤动 左心耳封堵术 心脏CT-3D 经食管心脏超声心动图 

分 类 号：R541.75[医药卫生—心血管疾病]