CAJ | 학술논문

目的：探讨超声心动图在非瓣膜性心房颤动患者行经皮左心耳(LAA)封堵术中及术后近期随访中的应用价值。方法2014年3-12月共20例心房颤动患者应用 LAmbre 封堵器行经皮左心耳封堵术。术前患者行经胸超声心动图(TTE)和经食管超声心动图(TEE)检查,排除风湿性心脏病等瓣膜器质性病变,术中 TEE 全程监测指导,引导房间隔穿刺,联合 X 线血管造影选择封堵器型号,引导封堵器成功植入或回收再释放过程,观察术中并发症的发生情况,进行即刻有效性和安全性评估,并于术后24 h 和1个月行 TTE 检查随访。结果20例患者均成功完成左心耳封堵,9例患者术后未出现封堵器周围残余分流,1例出现≤1 mm 的封堵器周围残余分流,10例出现1~3 mm 的封堵器周围残余分流。术后即刻所有患者均未出现其他封堵相关并发症。术后24 h,3例患者出现迟发性少量心包积液,其中2例患者在术后1月随访时心包积液已消失。在近期随访中,封堵器对左心耳周围邻近结构无任何不良影响,手术前后患者的心功能亦无明显改变,所有患者均未出现任何不良事件。结论在 TEE 监测下行经皮导管左心耳封堵可获得良好的手术成功率和较低的并发症发生率,在对患者术后近期随访评价中,TTE 也起着不可或缺的影像学作用。
목적：탐토초성심동도재비판막성심방전동환자행경피좌심이(LAA)봉도술중급술후근기수방중적응용개치。방법2014년3-12월공20례심방전동환자응용 LAmbre 봉도기행경피좌심이봉도술。술전환자행경흉초성심동도(TTE)화경식관초성심동도(TEE)검사,배제풍습성심장병등판막기질성병변,술중 TEE 전정감측지도,인도방간격천자,연합 X 선혈관조영선택봉도기형호,인도봉도기성공식입혹회수재석방과정,관찰술중병발증적발생정황,진행즉각유효성화안전성평고,병우술후24 h 화1개월행 TTE 검사수방。결과20례환자균성공완성좌심이봉도,9례환자술후미출현봉도기주위잔여분류,1례출현≤1 mm 적봉도기주위잔여분류,10례출현1~3 mm 적봉도기주위잔여분류。술후즉각소유환자균미출현기타봉도상관병발증。술후24 h,3례환자출현지발성소량심포적액,기중2례환자재술후1월수방시심포적액이소실。재근기수방중,봉도기대좌심이주위린근결구무임하불량영향,수술전후환자적심공능역무명현개변,소유환자균미출현임하불량사건。결론재 TEE 감측하행경피도관좌심이봉도가획득량호적수술성공솔화교저적병발증발생솔,재대환자술후근기수방평개중,TTE 야기착불가혹결적영상학작용。
Objective To explore the value of echocardiography in percutaneous left atrial appendage (LAA)closure for stroke prevention in patients with nonvalvular atrial fibrillation during procedure and for short-term follow-up.Methods Twenty patients were enrolled to undergo percutaneous LAA closure with the LAmbre device.Rheumatic valvular diseases were excluded by transthoracic echocardiography (TTE) and transesophageal echocardiography(TEE)before the closure procedure.TEE was performed during the procedure for the trans-septal puncture and the release of the closure device.Combined TEE with angiographic measurements,guidance for the optimal device size was provided.The closure effect and procedure-related complications were observed immediately by TEE and also evaluated by TTE at 1-day and 1-month follow-up.Results All patients underwent LAA occlusion successfully.TEE color Doppler evaluation have shown nine patients with complete closure immediately,one with a ≤ 1 mm residual LAA leak,and ten with a 1 -3 mm jet.There were no other complications during the procedure.One day after the closure,small pericardial effusions were observed for three patients while two of the three were free of the pericardial effusion at the 1-month follow-up.During the short-term follow-up,no damage was found at any anatomical structures near LAA due to the closure process,and there was no significant difference of cardiac function before and after the procedure.Conclusions With the guidance of TEE,the successful rate of percutaneous LAA closure procedure was preferable and the occurrence rate of compliance was acceptable. And TTE played an important role in patients'short-term follow-up.