三维经食管超声心动图评估非瓣膜性心房颤动患者左心耳封堵术后二尖瓣装置形态

目的:探讨经食管3D超声心动图用于左心耳封堵术后二尖瓣装置形态改变情况的评估价值,旨在为术前封堵器选择提供更多参考。方法：回顾性纳入2017年1月-2022年12月于我院行左心耳封堵术治疗房颤患者共35例,分别于手术前后行经食管2D/3D超声心动图检查,分析二尖瓣装置相关定量参数变化情况,进一步评价术后封堵器压缩比与二尖瓣装置相关定量参数的相关性。结果：术后二尖瓣瓣环瓣环前外侧至后内侧、三维瓣环周长、二维瓣环面积、三维瓣环面积、穹隆容积、穹隆下投影面积及瓣叶联合处直径均显著小于术前(P<0.05)；术后前后径/前外侧至后内侧径显著大于术前(P<0.05)；瓣叶穹隆容积与术后封堵器压缩比呈显著正相关(P<0.05)；术后封堵器压缩比与二尖瓣装置其他相关定量参数间无明显相关性(P>0.05)。结论：经食管3D超声心动图可准确用于左心耳封堵术后二尖瓣装置形态改变评估,同时二尖瓣装置术前穹隆容积及封堵器压缩比均可影响封堵器。

Evaluation of morphological changes of mitral valve device after left atrial appendage occlusion by transesophageal 3D echocardiography

Objective To investigate the evaluation value of morphological changes of mitral valve device after left atrial appendage occlusion by transesophageal 3D echocardiography to provide more reference for the selection of preoperative occluder. Methods 35 patients with atrial fibrillation treated by left atrial aural occlusion were retrospectively chosen in the period from January 2017 to December 2022 in our hospital. 2D/3D transesophageal echocardiography was performed before and after surgery. The change of quantitative parameters related to the mitral valve device was analyzed to further evaluate the correlation between the compression ratio of the occlusive device and the quantitative parameters related to the mitral valve device. Results The anterolateral to posterolateral mitral annulus, the three-dimensional annulus circumference, the two-dimensional annulus area, the three-dimensional annulus area, the dome volume, the projection area under the dome and the diameter at the joint of the mitral annulus after surgery were significantly smaller than before surgery(P<0.05). The anteroposterior diameter/anterolateral to posteromedial diameter after surgery was significantly larger than before surgery(P<0.05). There was the significant positive correlation between flap dome volume and occluder compression ratio(P<0.05). There was no significant correlation between the compression ratio of the occluder and other quantitative parameters of the mitral valve device(P>0.05). Conclusion Transesophageal 3D echocardiography can be used to accurately evaluate the morphological changes of the mitral valve device after left atrial appendage occlusion and both the volume of the fornix before the mitral valve device and the compression ratio of the occlusive device can affect the occlusive device.