三维经食道超声心动图、二维经食道超声心动图、DSA测量左心耳开口与成功植入左心耳封堵器型号大小的相关性研究

目的:探讨三维经食道超声心动图成像（Three-dimensiona transesophageal echocardiography imaging,3D-TEE）、二维经食道超声心动图成像（2D-TEE）、DSA测量左心耳开口与成功植入左心耳封堵器型号大小的相关性。方法：回顾性纳入我院2019-01-03至2020-01-25非瓣膜性房颤择期行左心耳封堵术患者180例,术前分别采用2D-TEE和3D-TEE评估左心耳开口最大直径,术中进行左心耳造影测量左心耳开口最大直径。比较三种影像学方法测量的左心耳开口最大直径和最终植入的封堵器型号大小的相关性。结果：3D-TEE、2D-TEE、DSA测量左心耳开口与成功植入左心耳封堵器型号大小的相关性研究：共180例患者选入本研究,平均年龄68.25±9.15岁,男性112例（112/180,62.2%）,女性68例（68/180,37.8%）,CHA2DS2-VASc评分3.56±1.76,左房前后径46.00±6.31mm。180例患者均成功植入Watchman左心耳封堵器,最终植入的平均封堵器大小为28.1±3.2 mm。术前3D-TEE测量的左心耳开口最大直径为24.67±2.67mm,显著高于2D-TEE测量的左心耳开口最大直径（20.95±2.91mm）（P<0.001）和DSA测量的左心耳开口最大直径（23.91±2.79mm）（P <0.001）。3D-TEE测量的左心耳开口最大直径与最终植入封堵器大小呈正相关且具有极强相关性（r=0.862,P<0.001）,2D-TEE和DSA测量的左心耳开口最大直径与最终植入封堵器大小呈正相关（r=0.614,0.656,P<0.001）。结论3D-TEE通过三维容积成像测量的左心耳开口最大直径显著高于2D-TEE和DSA测量的最大径,且其与成功植入的封堵器大小的相关性最强。 关键词：三维经食道超声心动图成像　左心耳封堵术

Application study of three-dimensional transesophageal echocardiographic imaging in left atrial appendage occlusion

Objective:This study will explore the correlation between three-dimensional transesophageal echocardiography (3D-TEE), two-dimensional transesophageal echocardiography (2D-TEE), DSA measurement of left atrial appendage opening, and the size of successfully implanted left atrial appendage occluder models.Method:Study on the correlation between 3D-TEE, 2D-TEE, and DSA measurements of left atrial appendage opening and the size of successfully implanted left atrial appendage occluder models: A retrospective study was conducted on 180 patients with non valvular atrial fibrillation who underwent selective left atrial appendage closure surgery in our hospital from January 3, 2019 to January 25, 2020. The maximum diameter of the left atrial appendage opening was evaluated using 2D-TEE and 3D-TEE before surgery, and the maximum diameter of the left atrial appendage opening was measured using left atrial appendage angiography during surgery. Compare the correlation between the maximum diameter of the left atrial appendage opening measured by three imaging methods and the size of the final implanted occluder model.Result:Study on the correlation between 3D-TEE, 2D-TEE, and DSA measurements of left atrial appendage opening and the size of successfully implanted left atrial appendage occluder models: A total of 180 patients were selected for this study, with an average age of 68.25±9.15 years. There were 112 males (112/180, 62.2%) and 68 females (68/180, 37.8%), with a CHA2DS2-VASc score of 3.56±1.76 and a left anterior posterior diameter of 46.00±6.31mm. All 180 patients were successfully implanted with the Watchman left atrial appendage occluder, with an average final implant size of 28.1± 3.2mm. The maximum diameter of the left atrial appendage opening measured by 3D-TEE before surgery was 24.67±2.67mm, significantly higher than that measured by 2D-TEE (20.95±2.91mm) (P<0.001) and DSA (23.91±2.79mm) (P<0.001). The maximum diameter of the left atrial appendage measured by 3D-TEE was positively correlated with the size of the final implanted occluder (r=0.862, P<0.001), while the maximum diameter of the left atrial appendage measured by 2D-TEE and DSA was positively correlated with the size of the final implanted occluder (r=0.614, 0.656, P<0.001).Conclusions:The maximum diameter of the left atrial appendage opening measured by 3D-TEE through three-dimensional volume imaging was significantly higher than that measured by 2D-TEE and DSA, and its correlation with the size of successfully implanted occluder was strongest.Keywords: Three dimensional transesophageal echocardiography imaging; Left atrial appendage occlusion