超声心动图在非瓣膜性心房颤动患者经皮左心耳封堵术中的应用

目的应用超声心动图评估非瓣膜性心房颤动(以下简称房颤)患者行经皮左心耳封堵术(LAAC)的并发症,以及因其引起的心腔大小和心功能改变情况,探讨超声心动图在LAAC中的应用价值。方法选取205例在我院行LAAC的非瓣膜性房颤患者,分别于LAAC术前及术后48 h、3~6个月、1年检测其收缩末期左房前后径(LAD)、舒张末期左室前后径(LVDd)、收缩末期右房横径(RAT)、舒张末期右室前后径(RVD)、左室射血分数(LVEF)、左室缩短分数(LVFS)、舒张末期容积(EDV)及每搏输出量(SV),分析不同时间点各参数的差异。观察患者并发症发生情况。结果205例房颤患者成功完成LAAC 202例(98.5%),与术前比较,术后48 h LVEF、LVFS、SV均增高,差异均有统计学意义(均P<0.05);术后3~6个月及术后1年各参数与术前比较差异均无统计学意义。205例患者中,术后封堵器相关血栓形成17例(8.4%),心包积液4例(2.0%),封堵器周边残余分流29例(14.4%,分流束间距均<5 mm),所有患者均未发生封堵器脱落和移位。结论超声心动图在LAAC术前检测、术中引导及术后随访中均有重要价值,是确保LAAC成功的关键。

Application of echocardiography in left atrial appendage occlusion inpatients with non-valvular atrial fibrillation

Objective To evaluate the complications and the changes of cardiac chamber size and cardiac function caused by percutaneous left atrial appendage occlusion(LAAC) in patients with non-valvular atrial fibrillation by echocardiography, and to explore the application value of echocardiography in LAAC.Methods A total of 205 patients with non-valvular atrial fibrillation who underwent LAAC in our hospital were selected.The parameters of anteroposterior diameter of left atrium at the end of systole( LAD), end-diastolic left ventricular anteroposterior diameter( LVDd), transverse diameter of right atrium at the end of systole( RAT), end-diastolic anteroposterior diameter of right ventricle( RVD), ejection fraction of left ventricle( LVEF), left ventricular shortening fraction(LVFS), end diastolic volume(EDV) and stroke volume(SV) at different time points were measured before LAAC and 48 h, 3~6 months and 1 year after LAAC.The complications of the patients were summarized.Results Among the 205 patients with atrial fibrillation,LAAC was successfully completed in 202 cases( 98.5%) .Compared with those before operation,LVEF,LVFS and SV were increased 48 h after LAAC,and the differences were statistically significant( all P<0.05) . Compared with those before operation,there were no significant differences in the parameters between 3~6 months and 1 year after LAAC.Among the 205 patients with atrial fibrillation,there were occluder-related thrombosis in 17 cases( 8.4%), pericardial effusion in 4 cases( 2.0%), residual shunt around the occluder in 29 cases( 14.4%,shunt beam spacing<5 mm) .No occluder exfoliation and displacement occurred in all patients. Conclusion Echocardiography has important value in the preoperative detection,intraoperative guidance and postoperative follow-up of LAAC,which is the key to ensure the success of LAAC.