CAJ | 학술논문

目的探讨综合超声心动图在非瓣膜病心房颤动(房颤)患者左心耳封堵治疗中的应用方法和价值.方法对6例房颤患者行左心耳封堵术,均为男性患者,平均年龄(68.7±5.6)岁.患者发生中风的风险评分CHADS2(充血性心力衰竭、高血压、年龄≥75岁、糖尿病、中风/短暂性脑缺血病史)为(3.2±1.0)分.术前均行经胸超声心动图(TTE)排除风湿性心脏病等瓣膜器质性病变.术中经食管超声心动图(TEE)全程监测,引导房间隔穿刺,测量左心耳入口直径,帮助选择左心耳封堵器型号,监测引导封堵器封堵过程,并及时评价疗效,观察有无并发症的发生.术后采用TTE进行复查及定期随访,随访时间为术后即时、术后24 h、7d或出院时、3个月、6个月、1年.结果 6例患者均封堵成功,其中3例采用LAmbre封堵器,3例采用Watchman封堵器,左心耳入口处直径(22.4±3.3)mm,封堵器型号(28.0±2.8) mm,1例术后封堵器下缘2 mm残余漏.无明显并发症发生.6例患者术后即刻、24 h、7 d TTE复查显示封堵效果良好.结论对于非瓣膜病房颤有抗凝禁忌证的高龄患者,左心耳封堵术是一种可行的预防血栓栓塞的替代治疗方法,综合超声心动图的应用可以使左心耳封堵术更加安全有效,具有重要作用.
목적 탐토종합초성심동도재비판막병심방전동(방전)환자좌심이봉도치료중적응용방법화개치.방법 대6례방전환자행좌심이봉도술,균위남성환자,평균년령(68.7±5.6)세.환자발생중풍적풍험평분CHADS2(충혈성심력쇠갈、고혈압、년령≥75세、당뇨병、중풍/단잠성뇌결혈병사)위(3.2±1.0)분.술전균행경흉초성심동도(TTE)배제풍습성심장병등판막기질성병변.술중경식관초성심동도(TEE)전정감측,인도방간격천자,측량좌심이입구직경,방조선택좌심이봉도기형호,감측인도봉도기봉도과정,병급시평개료효,관찰유무병발증적발생.술후채용TTE진행복사급정기수방,수방시간위술후즉시、술후24 h、7d혹출원시、3개월、6개월、1년.결과 6례환자균봉도성공,기중3례채용LAmbre봉도기,3례채용Watchman봉도기,좌심이입구처직경(22.4±3.3)mm,봉도기형호(28.0±2.8) mm,1례술후봉도기하연2 mm잔여루.무명현병발증발생.6례환자술후즉각、24 h、7 d TTE복사현시봉도효과량호.결론 대우비판막병방전유항응금기증적고령환자,좌심이봉도술시일충가행적예방혈전전새적체대치료방법,종합초성심동도적응용가이사좌심이봉도술경가안전유효,구유중요작용.
Objective To explore the value and methods of echocardiographic application in percutaneous left atrial appendage(LAA) closure for stroke prevention in patients with nonvalvular atrial fibrillation.Methods 6 male patients with nonvalvular atrial fibrillation were enrolled for percutaneous LAA closure,the mean age was (68.7 ± 5.6) years old,the mean CHADS2 (congestive heart failure,hypertension,age≥75 years,diabetes mellitus,and prior stroke or transient ischemic attacks) score was 3.2 ± 1.0.Rheumatic valvular diseases were excluded by transthoracic eehocardiography(TTE) before closure procedure.Transesophageal echocardiography(TEE) was performed to guide the punctures of the atrial septum and then monitored the operation all through the closure procedure.Diameter of LAA orifice was measure by TEE to help choosing the closure device.Immediate results of closure and complications were inspected by TEE simultaneously.24 hours,7 days,3 months,6 months and 1 year follow-up were performed using TTE.Results All the 6 patients underwent LAA closure successfully.3 LAmbre(Lifetech Scientific,Shenzhen) devices and 3 Watchman(Boston Scientific,Natick,Massachusetts) devices were implanted respectively in the 6 patients.Mean diameter of the LAA orifice was (22.4 ± 3.3)mm,and mean size of the closure devices was (28.0 ± 2.9) mm.2 mm in width residual flow at the inferior edge of closure device existed in 1 ease.No complication was observed.Post-procedure 24 hours and 7 days post-procedure followup showed optimal results in all cases.Conclusions Implantation of both LAA closure devices can be performed with high success rates in patients with nonvalvula ratrial fibrillation,with high risk for stroke,and who either had contraindication or were not willing to accept oral antieoagulation.Echocardiography plays a core role all through the closure procedure and can make it safer and more efficient.