经食管超声心动描记术评价非风湿性房颤患者左心耳功能

目的应用多平面经食管超声心动图技术（ＴＥＥ）评价排风湿性房颤患者左心耳功能。方法对３０名健康人和３０例非风湿性房颤（ＮＲＡＦ）患者分别在心底短轴观测量了左心耳最大直径,同一心动周期内左心耳最大、最小面积及左心耳最大排空速度,并将ＮＲＡＦ患者按照左房自发显影及血栓的有无分为２组。结果ＮＲＡＦ组左心耳增大,收缩力及血流速度均减低,且这种变化在有血栓和（或）有血栓形成倾向的患者中更为明显。结论应用ＴＥＥ技术评价左心耳功能可为判断ＮＲＡＦ患者血栓栓塞危险程度提供新的依据。     

彩色多普勒超声对急性心肌梗塞病人左房功能的分析

应用二维彩色多普勒超声技术评价急性心肌梗塞病人的左房功能。结果显示，急性心肌梗塞组与正常对照组比较其各指标均有显著性差异（Ｐ＜０．００１或Ｐ＜０．０５）。左房内径（ＬＡＤｄ）、左房容积（ＬＡＶ）、左房压力（ＬＡＰ）、左房张力（ＬＡＴ）、左房射血期（ＬＡＥＴ）、左房每搏量（ＬＡＳＶ）、左房射血分数（ＬＡＥＦ）和Ａ峰均增加，而Ｅ峰、Ｅ／Ａ比值、射血前期（ＬＡＰＥＰ）和ＬＡＰＥＰ／ＬＡＥＴ比值降低。结论：急性心肌梗塞后，左房代偿性收缩功能增强，维持一定的左房与左室间的压差（ＡＶＰＧ），对增加左室充盈量起重要作用，符合Ｆｒａｎｋ—ｓｔａｒｌｉｎｇ定律。     

超声心动图对急性心肌梗塞后左房代偿功能的分析研究

应用超声心动图分析评价急性心肌梗塞（ＡＭＩ）患者的左房功能代偿机制。结果示：ＡＭＩ组与正常对照组比较，各指标均有显著性差异。左房内径（ＬＡＤｄ）、左房容积（ＬＡＶ）、左房压力（ＬＡＰ）、左房张力（ｔＡＴ）、左房射血期（ＬＡＥＴ）、左房每搏量（ＬＡＳＶ）、左房射血分数（ＬＡＥＦ）及峰值速度Ａ（ＰｖＡ）均增加，而峰值速度Ｅ（ＰＶＥ）、ＰＶＥ／ＰＶＡ比值、射血前期（ＬＡＰＥＰ）及ＬＡＰＥＰ／ＬＡＥＴ值降低。结论：ＡＭＩ后左房代偿性收缩功能增强，维持一定的左房与左室间的压差（ＡＶＰＧ），对增加左室充盈量起重要作用，其作用机理符合Ｆｒａｎｋ－ｓｔａｒｌｉｎｇ定律。     

经食管超声评价左心耳功能及意义

左心耳（ＬＡＡ）是血栓形成的好发部位且与体循环栓塞有密切关系。因此ＬＡＡ功能日益引起人们重视。经食管超声技术（ＴＥＥ）由于从心脏后方食道内探查心脏,避开了胸壁、肋骨及肺组织的干扰,而且左房及ＬＡＡ位于声束的近场,因此为左房特别是ＬＡＡ提供了高清晰的图...     

非风湿性心房纤颤患者左心耳及左房功能的超声研究

目的： 了解非风湿性心房纤颤患者的左心耳及左房功能改变的特点。方法： 分析了２７ 例患者左心耳和左房的超声表现。结果： 左心耳血流频谱可为两种： 清晰型 （峰速≥２５ｃｍ ／ｓ） 占 ４０．８％ （１１／２７）, 模糊型 （峰速＜ ２５ｃｍ ／ｓ） 占５９．２％ （１６／２７）。与清晰型相比, 频谱模糊型患者的左心耳充盈血流峰速、排血峰速及左心耳面积变化率显著减小, 左心耳内径及面积增大, 自发性超声对比 （ＳＥＣ） 现象检出率显著增高 （Ｐ＜ ０．０５）, 且４ 例患者发现血栓。而两型间的左房功能无显著性差异。结论： 非风湿性房颤患者的左心耳功能改变有其特点, 超声了解之有助临床预测血栓形成及指导治疗。     

二尖瓣口短暂球囊充盈对左心耳云雾状影和流速的影响

目的： 观察经皮二尖瓣球囊扩张术（ＰＢＭＶ） 中, 球囊充盈和排空对左心耳云雾影（ＳＥＣ） 现象和左心耳流速的影响。方法： 对３５例符合ＰＢＭＶ适应征的风心病二尖瓣狭窄患者, 行术中ＴＥＥ检查, 采用长轴二腔心并充分显示左心耳的平面。共充盈球囊１２３ 次, 其中用于观察左心耳ＳＥＣ的６１次, 平均充盈时间４．６±１．１秒; 测定左心耳流速的６２次, 平均充盈时间４．５±１．３秒。结果： 球囊充盈时ＳＥＣ增强或新出现者占６１次中的５３次, 无明显改变的８ 次; 球囊排空后, 和球囊充盈时比较, 无明显改变的６次, 程度减轻３７次, 完全消失１８ 次。球囊充盈时, 左心耳最大充盈流速（ＭＦＶ） 和最大排空流速（ＭＥＶ） 显著低于球囊充盈前和排空后, Ｐ均＜ ０．００１。结论： 二尖瓣口球囊充盈时左心耳ＳＥＣ显著增强和左心耳流速的显著减低, 直接反映左心耳ＳＥＣ现象是左心房和左心耳血流高度淤滞的结果, 和二尖瓣口面积显著缩小有关, 是一种动力性的和可复性的变化。同时提示, ＰＢＭＶ术中可能促进左心房及左心耳血栓形成和血栓栓塞。     

超声评价左心耳血栓形成的影响因素

目的应用超声心动图评价房颤患者左心耳血栓形成的相关因素及其预测价值。方法选取58例非瓣膜性房颤伴左心耳血栓患者为血栓组(A组),另选取60例非瓣膜性房颤不伴左心耳血栓患者为非血栓组(B组),记录患者基线资料。对两组患者进行经胸及经食管超声心动图检查,对比两组患者左房内径(LAd)、左房舒张末期容积(LAEDV)、左房收缩末期容积(LAESV)、左房射血分数(LAEF)、左室射血分数(LVEF)、左心耳口平均横径(LAA-w)及左心耳内血流速度(LAA-v),进行统计学分析。结果 A组LAEF、LVEF、LAA-v均小于B组,LAEDV、LAESV、LAd均大于B组(P0.05)。多因素Logistics回归分析显示LAd39.5 mm,LAEF48.5%与左心耳血栓形成相关,且校正了年龄、性别及CHA2DS2-VASc评分后亦如此。结论房颤患者左心耳血栓形成与左房结构及功能改变相关,且有一定预测价值。     

经食管脉冲组织多普勒评价阵发性房颤患者的左心耳功能

目的：利用脉冲组织多普勒评价阵发性房颤患者左心耳功能。方法：176例阵发性房颤患者，经食管超声发现左心耳血栓或高凝状态26例（Ⅰ组），无血栓150例（Ⅱ组）；正常心律对照者30例（Ⅲ组）；经胸超声分别测量左房前后径、左室射血分数、左房射血分数、E/E’；经食管超声测量左心耳射血分数、左心耳充盈血流峰速和排空血流峰速，脉冲组织多普勒测量左心耳壁收缩期峰速和舒张期峰速。结果：Ⅰ组左心耳充盈血流峰速和排空血流峰速较Ⅱ组和Ⅲ组减小（P<0.05）；Ⅰ组左房射血分数及左心耳射血分数低于Ⅰ组和Ⅲ组（P<0.05）；脉冲组织多普勒测量左心耳侧壁收缩期和舒张期速度Ⅰ组小于Ⅱ组和Ⅲ组（P<0.05）；Ⅰ组左房前后径、E/E’较Ⅱ组和Ⅲ组增大（P<0.05）；Ⅱ、Ⅲ组各参数无明显差别（P>0.05）。结论：脉冲组织多普勒可用来评价左心耳功能，预测左心耳血栓形成风险。     

硝酸甘油加黄芪注射液治疗心功能不全疗效观察

目的：探讨硝酸甘油加黄芪注射液治疗心功能不全的临床疗效。方法：心功能不全患者７０ 例,随机分为观察组（用硝酸甘油加黄芪注射液治疗）４２ 例和对照组（用利尿剂加洋地黄制剂治疗）２８ 例。应用 Ｎ Ｃ Ｃ Ｏ Ｍ３ Ｒ Ｔ 型心功能测定仪观察心脏指数（ Ｃ Ｉ）、每搏指数（ Ｓ Ｉ）、舒张末期指数（ Ｅ Ｄ Ｉ）、体循环阻力指数（ Ｓ Ｖ Ｒ Ｉ）、左心做功指数（ Ｌ Ｃ Ｗ Ｉ）、射血分数（ Ｅ Ｆ）、平均动脉压（ Ｍ Ａ Ｐ）、心率（ Ｈ Ｒ）及症状、体征等治疗前后的变化。结果：观察组临床症状、体征明显改善,与对照组比较差异显著, Ｐ＜ ０００５。观察组 Ｃ Ｉ、 Ｓ Ｉ、 Ｌ Ｃ Ｗ Ｉ、 Ｅ Ｆ均明显增加, Ｅ Ｄ Ｉ、 Ｍ Ａ Ｐ、 Ｓ Ｖ Ｒ Ｉ均显著降低,２ 组治疗后比较差异显著（ Ｐ＜ ００５, Ｐ＜ ００１ 或 Ｐ＜ ０００１）。结论：硝酸甘油加黄芪注射液治疗心功能不全疗效优于小剂量洋地黄制剂加利尿剂。     

缺血性心肌病患者血浆心钠素与左房血流动力学变化的关系

目的：探讨缺血性心肌病患者血浆心钠素（ＡＮＦ）与左房血流动力学变化的关系。方法：应用二维多普勒超声技术和放射性免疫测定法，对３６例缺血性心肌病（ＩＣＭ）患者左房血流动力学变化与ＡＮＦ水平进行分析。结果：ＩＣＭ组ＡＮＦ水平显著高于正常对照（ＮＣ）组（Ｐ＜０．００１）；ＡＮＦ水平与左房功能指标：左房张力（ＬＡＴ）、左房收缩期最大容积（ＬＡＶ）、左房压力（ＬＡＰ）、左房射血力（Ｆ）、左房内径（ＬＡＤ）、Ａ峰和收缩期左室壁应力（ＥＳＳ）呈显著线性相关（ｒ值依次为０．８２、０．８０、０．７９、０．７８、０．７５、０．７２和０．７０，Ｐ＜０．０１～０．００１）；与左室功能指标：左室舒张末容积（ＬＶＶ）、左室射血分数（ＥＦ）及峰值充盈速度（ＰＦＲ）呈中度相关（ｒ值依次为０．６８、０．６７和０．６６，Ｐ＜０．０１）。随着心力衰竭的加重，ＡＮＦ水平有增高趋势。结论：测定ＡＮＦ将有助于全面客观地评价左房室血流动力学异常变化的程度。     

Pathophysiologic Correlates of Thromboembolism in Nonvalvular Atrial Fibrillation: I. Reduced Flow Velocity in the Left Atrial Appendage (The Stroke Prevention in Atrial Fibrillation [SPAF-III] Study)

Stroke associated with atrial fibrillation (AF) is mainly due to embolism of thrombus formed during stasis of blood in the left atrial appendage (LAA). Pathophysiologic correlates of appendage flow velocity as assessed by transesophageal echocardiography (TEE) in patients with AF have not been defined. To evaluate the hypothesis that reduced velocity is associated with spontaneous echocardiographic contrast and thrombus in the LAA and with clinical embolic events, we measured LAA flow velocity by TEE in 721 patients with nonvalvular AF entering the Stroke Prevention in Atrial Fibrillation (SPAF-III) study. Patient features, TEE findings, and subsequent cardioembolic events were correlated with velocity by multivariate analysis. Patients in AF during TEE displayed lower peak antegrade (emptying) flow velocity (Anu(p)) than those with intermittent AF in sinus rhythm during TEE (33 cm/s vs 61 cm/s, respectively, P <.0001). Anu(p) < 20 cm/s was associated with dense spontaneous echocardiographic contrast (P <.001), appendage thrombus (P <.01), and subsequent cardioembolic events (P <.01). Independent predictors of Anu(p) < 20 cm/s included age (P =.009), systolic blood pressure (P <.001), sustained AF (P =.01), ischemic heart disease (P =.01), and left atrial area (P =.04). Multivariate analysis found both Anu(p) <20 cm/s (relative risk 2.6, P =.02) and clinical risk factors (relative risk 3.3, P =.002) independently associated with LAA thrombus. LAA Anu(p) is reduced in AF and associated with spontaneous echocardiographic contrast, appendage thrombus, and cardioembolic stroke. Systolic hypertension and aortic atherosclerosis, independent clinical predictors of stroke in patients with AF, also correlated with LAA Anu(p). Our results support the role of reduced LAA Anu(p) in the generation of stasis, thrombus formation, and embolism in patients with AF, although other mechanisms also contribute to stroke.     

经食管超声心动图组织多普勒评价左心耳功能

目的观察窦性心律和心房纤颤（房颤）患者经食管超声心动图左心耳脉冲组织多普勒的图像特点,结合脉冲多普勒初步研究使用组织多普勒技术评价左心耳功能的价值。 方法窦性心律和房颤患者各15例均经食管超声心动图检查,房颤患者根据有无心房血栓或心房血流浓密自显影分为2组,并将经食管超声心动图的指标进行比较。 结果窦性心律患者的左心耳血流频谱和脉冲组织多普勒图像为可测量的三相波;房颤患者则表现为无规律的可测量的多相波。左心耳血流速度在各组间均有显著性差异;脉冲组织多普勒指标在窦性心律和房颤患者中有显著性差异,在有血栓和心房血流自显影的房颤患者中进一步降低或有进一步降低的趋势。 结论经食管超声心动图检查能获得可测量的左心耳（包括房颤患者）组织多普勒图像,可作为分析左心耳功能的重要补充。     

房颤患者左心耳血栓形成与结构功能的关系

目的 分析房颤患者血栓形成与左心耳结构功能的关系。方法 采用经食管超声心动图检测88例房颤患者及18例对照组患者的左心腔前后径(LA-D)、左心耳入口宽度(LAA-W)、左心耳长度(LAA-L)、左心耳前壁、后壁及顶部的运动速度及左心耳充盈及排空速度等指标。根据左心耳内透声,将房颤患者分为无自发显影(NO SEC)亚组、自发显影(SEC)亚组、泥浆样改变(sludge)亚组和血栓(thrombosis)亚组,并将各指标与对照组进行比较。结果 与对照组相比,房颤组患者左心耳结构及功能均有不同程度的改变;sludeg亚组及thrombosis亚组的LAA-W均较对照组增大,差异有统计学意义(P均<0.05);血栓亚组的LAA-L较对照组增大,差异有统计学意义(P<0.01);房颤各亚组的LA-D均较对照组扩大(P均<0.05);房颤各亚组的左心耳充盈及排空速度均较对照组降低(P均<0.05),在血栓亚组降低更为明显;除无自发显影亚组外,余各亚组的左心耳各壁运动速度差异均有统计学意义(P均<0.01)。结论 房颤患者左心耳内血栓形成与左心耳的结构以及功能改变密切相关。     

Evaluation of atrial thrombus formation and atrial appendage function in patients with pacemaker by transesophageal echocardiography

BACKGROUND: Physiologic pacing is claimed to be superior to ventricular pacing in as much as it entails lower risk of atrial fibrillation, stroke, and atrial remodeling. There are few data on the relation between atrioventricular (AV) synchrony and atrial clot formation. Utilizing transesophageal echocardiography (TEE), this study sought to evaluate the effect of AV synchrony loss on left atrial physiology, atrial stasis, and clot formation. METHODS: We conducted a cross-sectional study on patients with both AV and ventricular pacing with left ventricular ejection fraction (LVEF) >30%. TEE enabled us to explore atrial and pacing leads thrombi and measure left atrial appendage (LAA) flow velocity. RESULTS: A total 72 patients (mean age, 65 +/- 11.7) were enrolled in the study. The pacing mode was VVI in 53% and AV sequential in 47% of patients. LVEF (mean +/- SD; %) was 53.3 +/- 6.2% in ventricular pacing mode and 52.2 +/- 6.6 in physiologic pacing mode. Thrombus formation on pacing lead (<10 mm in 97% of patients) was observed in 32% of all the patients (23% in patients with AV sequential pacing mode and 39% with VVI mode). Left atrial appendage flow velocity (LAA-FV) was significantly higher among the patients with AV sequential pacing mode (49.44 +/- 18 cm/s vs 40.94 +/- 19.4 cm/s, P value = 0.02). LAA-FV >40 cm/s was detected in 60% of the patients, 60% of whom were in physiologic mode. Left atrial size was significantly larger among the patients with VVI pacing mode (42.3 +/- 2.3 mm vs 37.79 +/- 4.5 mm, P = 0.001). Multivariate analysis showed no relation between LAA-FV and age, hypertension, diabetes mellitus, left atrial size, and left ventricular function. Only one patient had right atrial clot. There was no thrombus in the ventricles and atrial appendage. CONCLUSION: Long-term loss of AV synchrony induced by VVI pacing is associated with the impairment of LAA contraction. Thrombus formation in the LAA is not increased by VVI pacing in patients with relatively good left ventricular (LV) function and sinus rhythm.     

阵发性房颤环肺静脉电隔离术前后左房结构和功能的研究

目的经胸超声心动图(TTE)和经食道超声心动图(TEE)联合应用对阵发性房颤患者肺静脉前庭电隔离术前后左房、左心耳结构和功能的评价。方法46例阵发性房颤患者和16例正常对照组接受TTE和TEE检查,测量左房内径指数(LADI)、左房面积指数(LAAI)、左房容积指数(LAVI)、左房射血力(LA-EF)、左心耳内径指数(LAADI)、左心耳最大面积指数(LAAmaxI)、左心耳最小面积指数(LAAminI)、左心耳射血分数(LAA-EF)、左心耳最大排空血流速度(LAA-P)和左心耳最大充盈血流速度(LAA-F)及有无血栓征象。41例确诊无左心房及左心耳血栓的患者行肺静脉前庭电隔离术。术后6个月以上对其中39例患者随访行TTE和TEE复查。结果肺静脉前庭电隔离术组、术后随访组与正常对照组间左房结构、功能均有显著差异(P<0.05～P<0.01)。三组间左心耳的结构和功能亦均有显著差异(P<0.05～P<0.01)。阵发性房颤患者左房、左心耳结构与其功能的变化呈线性负相关。结论TTE和TEE联合应用为评价阵发性房颤患者左房的结构、功能以及肺静脉前庭电隔离术前病例的筛选、术后疗效的评估提供重要信息。     

Transesophageal echocardiography assessment of left atrial appendage function in untreated systemic hypertensive patients in sinus rhythm.

To assess left atrial appendage (LAA) function in hypertensive patients without treatment, transesophageal echocardiography (TEE) was performed in 46 hypertensive patients in sinus rhythm, aged 40 to 55 years, and in 16 control subjects (group I) without cardiovascular disease, aged 41 to 54 years. The hypertensive patients were divided into 2 groups according to left ventricular (LV) systolic function: group II, the group with normal LV systolic function (ejection fraction 0.63 +/- 0.08), and group III, the group with LV systolic dysfunction (ejection fraction 0.39 +/- 0.05). The LAA late emptying velocities (EVs) were significantly reduced in the hypertensive subgroups compared with the control group (P <.001), but no significant difference in the LAAEV was found between groups II and III. The LAAEV in the hypertensive patients had a significant negative correlation with diastolic blood pressure, systolic blood pressure, and left atrial (LA) diameter. The maximal LAA areas were significantly larger in the hypertensive subgroups than in the control group (P <.05). No significant difference in LAA maximal area existed between groups II and III. The maximal LAA area in the hypertensive patients had a significant positive correlation with diastolic blood pressure, systolic blood pressure, and LA diameter, but a significant negative correlation with LV ejection fraction. With TEE, LA spontaneous echocardiographic contrast (SEC) was present in 6 (43%) of 14 patients in group III (P <.01) and in 7 (22%) of 32 patients in group II (P <.05). No significant difference in the occurrence of LASEC was found between groups II and III. Left atrial appendage thrombi by TEE were observed in 4 (29%) of 14 patients in group III (P <.05) and in 4 (13%) of 32 patients in group II (P = not significant). No significant difference in the occurrence of LAA thrombus existed between groups II and III. In conclusion, in patients with untreated hypertension, marked elevation of afterload imposed on the left atrium may involve both the left atrium and the LAA, resulting in impairment of LAA function. This condition may worsen with subsequent occurrence of SEC and later, thrombus formation. Therefore assessment of LAA function may be important even in the hypertensive patient in sinus rhythm.     

Transthoracic echocardiographic predictors of the left atrial appendage contraction velocity in stroke patients with sinus rhythm

Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = -0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke.     

Left atrial appendage-flow velocity predicts cardioversion success in atrial fibrillation

Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.     

经食管超声心动图在左心耳封堵术中的应用价值研究

目的探讨经食管超声心动图（TEE）在经皮左心耳封堵术前筛选、术中监测及术后随访中的应用价值。 方法选取2016年1月至2016年12月武汉亚洲心脏病医院共54例心房颤动患者应用Watchman封堵器行经皮左心耳封堵术,依据封堵术后是否出现残余分流分为残余分流组与无残余分流组。术前所有患者均行经胸超声心动图（TTE）和TEE检查,排除瓣膜器质性病变及左心耳血栓者。术前TEE测量入选患者的左心耳最大开口径及最大深度;术中TEE引导房间隔穿刺、联合X线血管造影选择封堵器型号,引导封堵传输系统的定位及指导封堵器释放,并评估术中安全性;术后即刻及45 d进行随访超声检查。残余分流组与无残余分流组的最大压缩比及最小压缩比均值比较采用t检验;TEE所测左心耳最大开口径与术中X线造影及最终所选封堵器大小的相关性分析采用Pearson法。 结果54例行左心耳封堵术的患者,均封堵成功,压缩比均在8%~20%之间,残余分流组与无残余分流组组间最大压缩比及最小压缩比均值比较［（17.70±2.28）% vs（17.10±2.42）%,（12.40±2.82）% vs（12.60±2.68）%］,差异均无统计学意义（P均>0.05）;87%（47/54）的患者左心耳开口径与深度最大值在TEE 135°上获得;TEE 135°上所测LAA开口径与TEE 4个角度上所测最大开口径,TEE测量LAA最大开口径与造影测量LAA开口径,TEE 135°所测LAA开口径与所选封堵器型号,相关性均较好（r=0.919、0.622、0.602,P均<0.001）,相关方程分别为：Y=1.01X＋1.11、Y=0.68X＋6.56、Y=0.80X＋1.24;所有随访患者均未出现脑血管或其他血管栓塞事件,术中出现少量心包腔积液3例,术后7 d复查均未见心包腔积液,2例术后45 d复查封堵器表面出现血栓。 结论TEE在左心耳封堵术前对患者的筛选、术中引导房间隔穿刺、封堵器型号的选择、指导释放过程及即刻评估封堵效果、术后随访中有重要的应用价值,TEE 135°扫查较其他角度检测出残余分流更敏感。