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Percutaneous closure of the left atrial appendage: The value of real time 3D transesophageal echocardiography and the intraoperative change in the size of the left atrial appendage
Author(s) -
Zhang Lizi,
Cong Tao,
Liu Ansheng
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14262
Subject(s) - medicine , appendage , percutaneous , cardiology , atrial appendage , nuclear medicine , atrial fibrillation , anatomy , sinus rhythm
Objective The aim of this study was to investigate the value of real time three‐dimensional transesophageal echocardiography ( RT 3 DTEE ) in percutaneous closure of the left atrial appendage ( LAAC ). In addition, this study also explored the change in the size of the left atrial appendage ( LAA ) from 24 hours before the operation to just before implantation during the operation. Methods and results In a retrospective study, 32 patients underwent two‐dimensional transesophageal echocardiography (2 DTEE ) and RT 3 DTEE 24 hours prior to operation and during operation. The maximal LAA orifice diameter (by 2 DTEE , 22.7 ± 2.7 vs 24.6 ± 2.2 mm, P < 0.01; by RT 3 DTEE , 24.2 ± 2.9 vs 25.8 ± 2.7 mm, P < 0.01), the maximal landing zone diameter (by 2 DTEE , 19.0 ± 2.8 vs 20.4 ± 2.8 mm, P < 0.01; by RT 3 DTEE , 20.4 ± 2.7 vs 22.6 ± 3.0 mm, P < 0.01), and the maximal depth diameter (by 2 DTEE , 25.2 ± 3.2 vs 26.5 ± 3.0 mm, P < 0.01; by RT 3 DTEE , 26.4 ± 3.2 vs 27.5 ± 3.7 mm, P < 0.01) all increased significantly during the operation. The highest correlation ( R ) between the maximal landing zone diameter and the compressed occluder diameter was determined for RT 3 DTEE measurements during the operation ( R = 0.90), whereas the landing zone diameter ( R = 0.80) measured by 2 DTEE was less correlated. In addition, our study showed that RT 3 DTEE was of great value in discriminating the LAA orifice shape, allowing differentiation of the LAA morphology and identification of the number of LAA lobes. Conclusions A certain amount of intravenous rehydration just before and during operation increased the LAA size significantly. The measurements by RT 3 DTEE showed a closer correlation to LAA occluder size than those by 2 DTEE . The LAA displayed by RT 3 DTEE was more visible than that by 2 DTEE .