CAJ | 학술논문

目的使用Mimics三维成像技术重建心房颤动患者左心耳三维结构,初步评估经皮左心耳封堵术(Watchman系统)手术风险,指导封堵器选择及放置.方法入选2014年5-12月在杭州师范大学附属医院心内科行左心耳封堵术患者10例,年龄40 ～ 85岁的心房颤动患者10例,均不愿长期口服抗凝药物或口服抗凝药物有禁忌证,具有左心耳封堵适应证,且自愿参加本试验.术前行Mimics左心耳三维重建,结合术中经食道超声心动图(TEE)及造影结果,选择Watchman左心耳封堵器尺寸及放置位置,置入封堵器至左心耳颈部.结果入选心房颤动患者年龄为(66.3±11.9)岁,其中9例为非瓣膜病心房颤动患者,CHADS2-VAS评分(3.2±1.7)分,HAS-BLED评分(2.7±1.6)分;1例为瓣膜病心房颤动患者(曾行二尖瓣成形术,缺乏外科换瓣手术的适应证).10例患者均成功置入Watchman左心耳封堵系统,术后行左心耳造影及TEE均未发现封堵伞处血流渗漏.围手术期及术后1个月随访无出血及栓塞等并发症发生.结论术前使用Mimics三维成像技术重建心房颤动患者左心耳三维结构,为左心耳封堵术封堵器置入提供重要的参考依据.
목적 사용Mimics삼유성상기술중건심방전동환자좌심이삼유결구,초보평고경피좌심이봉도술(Watchman계통)수술풍험,지도봉도기선택급방치.방법 입선2014년5-12월재항주사범대학부속의원심내과행좌심이봉도술환자10례,년령40 ～ 85세적심방전동환자10례,균불원장기구복항응약물혹구복항응약물유금기증,구유좌심이봉도괄응증,차자원삼가본시험.술전행Mimics좌심이삼유중건,결합술중경식도초성심동도(TEE)급조영결과,선택Watchman좌심이봉도기척촌급방치위치,치입봉도기지좌심이경부.결과 입선심방전동환자년령위(66.3±11.9)세,기중9례위비판막병심방전동환자,CHADS2-VAS평분(3.2±1.7)분,HAS-BLED평분(2.7±1.6)분;1례위판막병심방전동환자(증행이첨판성형술,결핍외과환판수술적괄응증).10례환자균성공치입Watchman좌심이봉도계통,술후행좌심이조영급TEE균미발현봉도산처혈류삼루.위수술기급술후1개월수방무출혈급전새등병발증발생.결론 술전사용Mimics삼유성상기술중건심방전동환자좌심이삼유결구,위좌심이봉도술봉도기치입제공중요적삼고의거.
Objective The three-dimensional (3D) structure of left atrial appendage (LAA) in atrial fibrillation patients were reconstructed by Mimics 3D imaging system,aiming at guiding for selection of both the size and location of the closure devices and making preliminary risk assessment of LAA closure with Watchman system.Methods Inclusion criteria were:ten voluntary patients with both atrial fibrillation and indication for LAA closure aging from 40 to 85 years old with contraindication for oral anticoagulants or unwillingness to take long-term oral anticoagulation therapy from May to December 2014.3D reconstruction of LAA was preoperatively made by Mimics 3D imaging system.With the Mimics 3D reconstruction model and the results of both transesophageal echocardiography (TEE) and LAA radiography,the size and location for the closure device were chosen.The devices were planted at the ostium of the LAA.Results Ten atrial fibrillation patients were enrolled (average age:(66.3 ± 11.9) years old) and all successfully implanted with the Watchman LAA closure devices.Nine of them were with non-valvular atrial fibrillation with average CHADS2-VAS score (3.2 ± 1.7) and HAS-BLED score (2.7 ± 1.6).The rest one was a valvular atrial fibrillation patient with the history of the percutaneous balloon mitral valvuloplasty (PBMV) without surgical indications of mitral valve replacement(MVR).There was no blood leakage around the device by regular postoperative TEE and LAA radiography examinations.There were no complications of bleeding,embolism,or stroke through both at peri-operative period and at 1 month follow-up post procedure.Conclusion Preoperative Mimics 3D reconstruction of LAA by Mimics 3D imaging system among atrial fibrillation patients provides essential information guiding the successful LAA closures.