CAJ | 학술논문

目的：探讨经食管实时三维超声心动图(RT-3D TEE)在左心耳封堵术中的应用价值。方法对10例高卒中风险心房颤动患者(CHADS2≥2分)在经食管超声心动图(TEE)引导下行左心耳封堵术,利用 RT-3D TEE 观察左心耳口形态、分叶情况,测量心耳口大小以及左心耳长径,判断封堵器位置是否合适,评估左心耳各参数与置入封堵器尺寸的相关性。结果封堵成功8例,失败1例,封堵不完全1例；形态近圆形5例,近椭圆形5例；分叶数(2.2±0.7)个,三维测量左心耳口最大径略大于二维测值[(21.8±5.1)mm 对(20.8±4.1)mm],最小径略小于二维测值[(16.1±3.0)mm 对(17.0±2.6)mm],但差异无统计学意义(P >0.05)；平均直径及最大深度二者测值相似,二维及二维 TEE 测量左心耳口最大径、最小径、平均直径及最大深度均与最终置入封堵器尺寸相关(三维 TEE：分别 r =0.719、0.690、0.791、0.711,P =0.029、0.040、0.011、0.032；二维 TEE：分别 r =0.887、0.894、0.932、0.896,P =0.001、0.001、0.000、0.000)。RT-3D TEE 判断封堵器位置：合适位置6例,可接受位置2例,不合适位置1例。影响左心耳封堵成功因素除左心耳口大小及深度外,还包括心耳分叶数目、分叶的大小、位置及朝向。结论 RT-3D TEE 在左心耳封堵术中评估左心耳形态,判断左心耳口大小形态及封堵器位置方面均可发挥重要作用。
목적：탐토경식관실시삼유초성심동도(RT-3D TEE)재좌심이봉도술중적응용개치。방법대10례고졸중풍험심방전동환자(CHADS2≥2분)재경식관초성심동도(TEE)인도하행좌심이봉도술,이용 RT-3D TEE 관찰좌심이구형태、분협정황,측량심이구대소이급좌심이장경,판단봉도기위치시부합괄,평고좌심이각삼수여치입봉도기척촌적상관성。결과봉도성공8례,실패1례,봉도불완전1례；형태근원형5례,근타원형5례；분협수(2.2±0.7)개,삼유측량좌심이구최대경략대우이유측치[(21.8±5.1)mm 대(20.8±4.1)mm],최소경략소우이유측치[(16.1±3.0)mm 대(17.0±2.6)mm],단차이무통계학의의(P >0.05)；평균직경급최대심도이자측치상사,이유급이유 TEE 측량좌심이구최대경、최소경、평균직경급최대심도균여최종치입봉도기척촌상관(삼유 TEE：분별 r =0.719、0.690、0.791、0.711,P =0.029、0.040、0.011、0.032；이유 TEE：분별 r =0.887、0.894、0.932、0.896,P =0.001、0.001、0.000、0.000)。RT-3D TEE 판단봉도기위치：합괄위치6례,가접수위치2례,불합괄위치1례。영향좌심이봉도성공인소제좌심이구대소급심도외,환포괄심이분협수목、분협적대소、위치급조향。결론 RT-3D TEE 재좌심이봉도술중평고좌심이형태,판단좌심이구대소형태급봉도기위치방면균가발휘중요작용。
Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.