摘要目的 探讨经食管实时三维超声心动图(RT-3D TEE)在非瓣膜性心房颤动(房颤)患者行经皮左心耳封堵(PCLAA)术及随访中的价值.方法 选取行PCLAA患者15例.术前RT-3DTEE选择封堵器大小;术中结合2D-TEE引导房隔穿刺,监测封堵器的输送和释放;术后即刻评价封堵疗效,术后3、12个月复查.结果 15例患者成功进行LAmbreTMPCLAA术,左心耳锚定区内径(21.60±4.08)mm,术中造影(CAG)锚定区内径(20.91±3.93)mm,最后选择封堵器固定盘的大小为(26.13±4.69)mm.RT-3DTEE和CAG测量左心耳锚定区的相关性好(r=0.84,P=0.0001).Bland-Altman散点图显示左心耳锚定区的RT-3DTEE和CAG测值有86.67%(13/15)数据点在一致性界限以内.术后即刻发现2例患者封堵器边缘有<3mm残余分流.术后3、12个月复查,所有患者封堵器形态良好,位置固定,表面均未见血栓形成.2例患者封堵器边缘仍有少量残余分流.结论 RT-3DTEE在PCLAA术及随访中具有重要的作用.RT-3D TEE测量左心耳锚定区内径与CAG测量值之间相关性好,两种方法一致性好.

abstractsObjective To evaluate the application of real-time three-dimensional transesophogeal echocardiography(RT-3D TEE)in percutaneous left atrial appendage closure and its follow-up in patients with non-valvular atrial fibrillation.Methods Fifteen patients including 6 males and 9 females were refractory to percutaneous closure of left atrial appendage.The morphology of the left atrial appendage (LAA)in those patients was evaluated by RT-3D TEE.Combined with two-dimensional transesophogeal echocardiography(2D-TEE),RT-3D TEE was performed during the procedure of LAA occlusion,including the measurement of left atrial appendage,the selection of occluder,the puncture of atrial septal,the delivery and release of occlusive device.Finally,it was also used immediately to evaluate the effect of blocking and complications after the operation.The closure effect and related complication were also evaluated by RT-3D TEE at 3 months and 1 2 months followed up,respectively.Results Fifteen patients were successfully undergone the LAA closure procedures with LAmbre TM device.The dimension of LAA landing zone was (21.60±4.08)mm,the measurement of cardiac angiography(CAG)during the procedure was(20.91 ± 3.93)mm and finally the fixed plate size of LAmbreTMdevice was(26.13±4.69)mm.Correlation between the measurements by RT-3D TEE and selective angiography was significant(r =0.84,P =0.0001). Bland-Altman plot showed that 86.67% of plots were among limits of agreement.The width of the flow jet was <3 mm near the LAA closure device in 2 patients immediately after the procedure.At the 3 months and 1 2 months follow-up,the LAA closures had good morphology,fixed position,and no thrombus formation on the surface.There was still slight flow j et near the closure device in 2 patients at that time. Conclusions RT-3D TEE plays an important role in the procedure of left atrial appendage closure and its follow-up.There is better correlation and consistency between the measurements by RT-3D TEE and CAG.