Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography
Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography
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使用三维经食管超声心动图选择合适的经导管房间隔缺损封堵装置
DOI：
10.1007/s10554-020-02095-x
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Fukuda Keiichi
中科院分区：
文献类型：
--
作者：
Kitakata Hiroki;Itabashi Yuji;Kanazawa Hideaki;Miura Kotaro;Kimura Mai;Shinada Keitaro;de Jongh Marjolein C.;Endo Jin;Tsuruta Hikaru;Murata Mitsushige;Kawamura Akio;Murata Mitsuru;Fukuda Keiichi
详细的形态学评估是房间隔缺损成功封堵的关键。三维经食管超声心动图（3D-TEE）是新兴的，但很少有研究全面验证3D-TEE的有效性。我们将329例在我们大学医院接受经导管ASD封堵术的患者分为常规组157例，采用二维经食管超声心动图和球囊测量（BS）进行评价，3D-TEE组172例额外采用3D-TEE进行评价。我们评估了3D-TEE的有效性，并考虑了适当的器械选择程序。总体而言，3D-TEE组中器械尺寸调整的百分比倾向于低于传统组（10.1% vs 6.0%，p = 0.187）。在术前模式中，器械尺寸主要根据BS直径决定。Logistic回归分析表明，大的房间隔动脉瘤（阿萨）与BS直径与术前3D-TEE直径的差异≥ 2 mm相关（p < 0.05）。与Amplatzer间隔封堵器相比，使用Occlutech Figulla Flex II封堵器（FFII）时，器械尺寸和术前ASD测量值的差异更大。特别是，在植入FFII的患者中，阿萨较大的患者的器械尺寸与3D-TEE测量值的差异大于阿萨较小的患者。术前3D-TEE有助于选择适当的器械尺寸。特别是，当在患有间隔动脉瘤的患者中使用FFII时，有必要选择比术前3D-TEE测量结果大得多的器械。
Detail morphological evaluation for ASD is essential to achieve successful transcatheter closure. Three-dimensional transesophageal echocardiography (3D-TEE) is emerging, but few studies have comprehensively verified the usefulness of 3D-TEE. We divided 329 patients who underwent transcatheter ASD closure at our university hospital into 157 in the Conventional group evaluated with 2-dimensional transesophageal echocardiography and balloon sizing (BS), and 172 in the 3D-TEE group evaluated with 3D-TEE additionally. We assessed usefulness of 3D-TEE and consider appropriate device selection procedure. Overall, the percentage with re-sizing of device tended to be lower in the 3D-TEE group than in the Conventional group (10.1% vs 6.0%, p = 0.187). Among preprocedural modalities, the device size was mainly decided based on the BS diameter. A logistic regression analysis demonstrated that large atrial septum aneurysms (ASA) were associated with a ≥ 2 mm discrepancy of the BS diameter from the preprocedural 3D-TEE diameter (p < 0.05). Compared to the Amplatzer Septal Occluder, the differences in device size and the preprocedural ASD measurement were greater when using the Occlutech Figulla Flex II Occluder (FFII). Particularly, among the patients implanted with FFIIs, the discrepancies of the device size from the 3D-TEE measurement were greater in patients with large ASA than those with small ASA. Preprocedural 3D-TEE is useful to select the appropriate device size. Particularly, it is necessary to select a much larger device than that derived from the preprocedural 3D-TEE measurement when using FFII in patients with a septal aneurysm.
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