经食管超声心动图、双源CT及左心耳造影对左心耳封堵器型号选择的价值
Comparing value of transesophageal echocardiography, dual-source CT and left atrial appendage angiography in selection of left atrial appendage occluder size
目的 比较经食管超声心动图(TEE)、双源CT(DSCT)及左心耳造影(LAA-A)对左心耳口部及着陆区直径的测量结果,评价3种影像学检查方法在指导ACP封堵器(Amplatzer Cardiac Plug,ACP)型号选择中的价值.方法 本研究回顾性纳入2016年12月至2017年11月在南京医科大学第一附属医院采用ACP封堵器行左心耳封堵术的35例非瓣膜性心房颤动(房颤)患者,分析和比较术前DSCT及术中TEE、LAA-A对左心耳口部及着陆区直径的测量结果,分析其与植入ACP封堵器尺寸的相关性.结果 术中TEE、LAA-A和术前DSCT所测左心耳口部直径分别为头位(22.0±4.4) mm、(22.8±4.4) mm、(23.6±4.6) mm,足位(22.5±3.8) mm、(24.0±4.4) mm、(24.7±4.2) mm;左心耳着陆区直径分别为头位(18.9±4.3) mm、(20.6±4.3) mm、(21.3±4.1) mm,足位(20.2±3.8) mm、(20.7±4.0) mm、(20.8±3.7) mm.DSCT所测头位、足位左心耳口部直径、头位着陆区直径均显著大于TEE(P<0.05).ACP封堵器型号以足位着陆区直径增加3~5 mm进行选择,TEE、LAA-A及DSCT所得ACP型号预测值分别为(24.2±3.8) mm、(24.7±4.0) mm、(24.8±3.7)mim,3种方法所得预测值差异无统计学意义,术中实际选用的ACP封堵器大小为(24.2±3.2) mm.TEE、DSCT和LAA-A所得ACP封堵器尺寸的预测值与实际选用ACP尺寸间均具有良好的相关性(r=0.69、r=0.63、r=0.61,P<0.001).结论 TEE、DSCT及LAA-A所得ACP型号预测值与植入ACP封堵器型号间均有良好的相关性,均可为选择合适的ACP封堵器尺寸提供依据.
更多Objective To compare the measurements of transesophageal echocardiography (TEE),dual-source CT (DSCT) and left atrial appendage angiography (LAA-A),and to evaluate the value of three imaging methods in guiding the selection of Amplatzer Cardiac Plug (ACP) occluder models.Methods Thirty-five patients with nonvalvular atrial fibrillation who underwent left atrial appendage (LAA)occlusion with ACP were included from December 2016 to November 2017 in The First Affiliated Hospital of Nanjing Medical University.LAA orifice and landing zone diameters were evaluated from cranial and caudal projection respectively by TEE,LAA-A during the procedure and DSCT before the operation,and results were used for the selecting of ACP size.Results LAA orifice diameters were (22.0 ± 4.4) mm,(22.8 ± 4.4) mm,and (23.6 ± 4.6) mm for the cranial projection,and (22.5 ± 3.8) mm,(24.0 ± 4.4) mm,and (24.7 ± 4.2) mm for the caudal projection,respectively.Landing zone diameters were (18.9 ± 4.3) mm,(20.6 ± 4.3) mm,and (21.3 ± 4.1) mm for the cranial projection,and (20.2 ± 3.8) mm,(20.7 ± 4.0) mm and (20.8 ± 3.7) mm for the caudal projection,respectively.The diameter of the orifice and the landing zone of DSCT were significantly larger than those by TEE (P<0.05).The predicted ACP device sizes of TEE,LAA-A and DSCT were (24.2 ± 3.8) mm,(24.7 ± 4.0)mm and (24.8 ± 3.7) mm,respectively,and there was no significant difference among them.The implanted ACP device size was (24.2 ± 3.2) mm.Pearson analysis showed well correlation between predicted and implanted ACP sizes for all three imaging modalities (r=0.69,r=0.63.r=0.61,P<0.001).Conclusion TEE,DSCT,and LAA-A measurements could be used as imaging modalities for prediction of ACP device size.
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