Transcatheter Left Atrial Appendage Closure Using Intracardiac Echocardiographic Guidance From the Left Atrium
Transcatheter Left Atrial Appendage Closure Using Intracardiac Echocardiographic Guidance From the Left Atrium
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DOI：
10.1016/j.cjca.2015.04.031
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发表时间：
2015-12-01
影响因子：
6.2
通讯作者：
Raymond, Jean-Marc
中科院分区：
文献类型：
--
作者：
Masson, Jean-Bernard;Kouz, Remi;Raymond, Jean-Marc
背景：最常见的左心耳（LAA）闭塞手术是在经食管超声心动图（TEE）指导和全身麻醉下进行的。然而，与TEE相比，心内超声心动图（ICE）提供了潜在的优势，ICE引导的LAA闭塞经验是有限的，并且通常从右侧位置进行，在右侧位置，LAA的可视化可能不是最佳的。我们试图评估使用ICE引导从左心房进行经皮LAA闭塞的有效性和安全性。方法：37例房颤、卒中风险高、长期抗凝禁忌的患者在轻度镇静和ICE指导下，采用Amplatzer心脏塞（St Jude Medical, Inc, St Paul， MN）进行LAA闭合。通过第二次经间隔穿刺将ICE导管引入左心房。患者接受术前TEE以排除血栓，并随访3个月TEE以评估闭塞程度。前瞻性记录患者特征、手术资料、ICE成像效果、闭塞质量和并发症。结果：37例患者中36例（97%）手术成功。在释放装置的所有病例中，闭合完全或接近完全（根据ICE和血管造影分级>= 3）。在所有病例中，ICE成像均获得了良好的LAA和周围结构可视化，并提供了充分的手术指导。发生了三种主要的手术或院内并发症。中位住院时间为1天。随访TEE记录除1例（30例中的29例）外，其余病例均未发现任何残留的装置周围泄漏。结论：初步经验表明，Amplatzer心脏塞在ICE引导下从左心房闭塞LAA是可行的、可重复的和安全的。
Background: Most commonly, left atrial appendage (LAA) occlusion procedures are performed using transesophageal echocardiography (TEE) guidance and general anaesthesia. Intracardiac echocardiography (ICE) offers potential advantages over TEE, however, ICE-guided LAA occlusion experience is limited and has been typically performed from a right-sided location where LAA visualization might be suboptimal. We sought to evaluate the efficacy and safety of percutaneous LAA occlusion using ICE guidance performed from the left atrium.Methods: Thirty-seven patients with atrial fibrillation, significant risk for stroke, and long-term contraindication to anticoagulation underwent LAA closure with the Amplatzer Cardiac Plug (St Jude Medical, Inc, St Paul, MN) with mild sedation and ICE guidance. The ICE catheter was introduced in the left atrium through a second transseptal puncture. Patients underwent preprocedural TEE to rule out thrombus and 3-month follow-up TEE to assess occlusion grade. Patient characteristics, procedural data, effectiveness of ICE imaging, quality of occlusion, and complications were prospectively recorded.Results: Procedural success was achieved in 36 of 37 patients (97%). Closure was complete or near complete (grade >= 3 according to ICE and angiography) in all cases where the device was released. In all cases, ICE imaging yielded good LAA and surrounding structure visualization and adequate procedural guidance. Three major procedural or in-hospital complications occurred. Median length of stay was 1 day. Follow-up TEE documented the absence of any residual peri-device leak in all but 1 (29 of 30) case.Conclusion: Initial experience suggests LAA occlusion with the Amplatzer Cardiac Plug using ICE guidance from the left atrium is feasible, reproducible, and safe.