Study On The Clinical Value Of Transesophageal Ultrasonography In The Closure Of Left Atrial Appendage With Left Atrial Appendage

Objective:To explore the value of transesophageal echocardiography(TEE)in analysis of the internal structure of left atrial appendage(LAA)for left atrial appendage closure(LAAC).Method:Ninety-eight patients who planned for left atrial appendage closure were enrolled.Preoperative,intraoperative and postoperative TEE examinations were carried out.The operation time,X ray exposure time,exposure amount,and immediate effect related indicators(shoulder protrusion and residual leak width around the occluder)were recorded.The correlations between the distance of pectinate muscle to ostium of LAA,the ratio of ostium diameter and depth of LAA,ratio of ostium diameter and distance of pectinate muscle to LAA ostium and operation time,exposure time,exposure amount,residual leak and shoulder protrusionwere analyzedrespectively.Result:The Watchman devices were successfully implanted in line with the PASS principle in all ninety-eight patients.1.The distance of pectinate muscle to ostium of LAA(15.0±4.5)mm was negatively correlated with the operation time(40.2 ± 19.0)min,exposure amount(816.0±538.0)mGy and the exposure time(887.0±466.0)s respectively(r=0.33,P=0.001、r=0.24,P=0.027、r=0.26,P=0.015).2.The ratio of ostiumdiameter and depth of LAA(0.79±0.15)was positively correlated with the operation time(40.2 ±19.0)min,the exposure amount(816.0±538.0)mGy and the exposure time(887.0±466.0)s(r=0.37,P<0.001、r=0.27,P=0.013、r=0.37,P<0.001).3.The ratioof ostium diameter and distance of pectinate muscle to LAA ostium(1.55±0.49)was positive correlated with the operation time(40.2±19.0)min,exposure amount(816.0 ±538.0)mGy and exposure time(887.0±466.0)s(r=0.41,P<0.001、r=0.30,P=0.005、r=0.27,P=0.013).4.The multi-factor Logistic regression analysis showed that the ratio of ostiumdiameter and depth of LAA wasan independent risk factorfor LAAC difficulty.Conclusion:1.The distance of pectinate muscle to ostium of LAA,the ratio of ostium diameter and depth of LAA,ratio of ostium diameter and distance of pectinate muscle to LAA ostium can be used as a good reference to predict the difficulty of LAAC.2.The ratio of ostium diameter and depth of LAA is an independent risk factor for the difficulty of LAAC.