The Value Of Two Dimensional Transesophageal Echocardiography And Real-time Three-dimensional Transesophageal Echocardiography In The Perioperative Period Of Left Atrial Appendage Closure

Objective To investigate the application value of two dimensional transesophageal echocardiography(2DTEE)and real time three-dimensional transesophageal echocardiography(RT-3DTEE)in left atrial appendage closure(LAAC)in the selection of occluder specifications and the value of postoperative follow-up.Methods 41 patients with left atrial appendage occlusion were selected,watchman occluder was used in all patients.The left atrial systolic diameter(LAD),left ventricular end diastolic diameter(LVEDd),left ventricular ejection fraction(LVEF),mitral valve diastolic peak velosity(E-peak)and left superior pulmonary vein velocity(LSPV)were measured before and after the operation by transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE).Two dimensional transesophageal echocardiography(2DTEE)and real time three-dimensional transesophageal echocardiography(RT-3DTEE)were used to observe the presence of thrombosis in the left atrial appendage(LAA)before operation.The diameter of the landing zone(LZD)were measured during operation,and compared with X-ray angiography observation.The correlation and consistency between the LZD measured by 2DTEE,RT-3DTEE and X-ray and compression occluder diameter(COD)were analyzed.The complications were observed after the operation.Results The maximum diameter of LZD measured by RT-3DTEE was close to that measured by X-ray angiography,and slightly larger than that measured by 2DTEE(2DTEE:22.55±2.98 mm,3DTEE:23.50±3.17 mm,Xray:24.16±3.39mm).Compared with 2DTEE,the correlation and consistency between COD(24.39±3.46mm)and LZD measured by RT-3DTEE were better(2DTEE r = 0.893,P=0.000;RT-3DTEE r = 0.941,P=0.000;X-ray:r = 0.962,P =0.000),and there was a significant correlation between RT-3DTEE and LZD measured by X-ray angiography(r = 0.965,P=0.000).There was no significant difference in LAD,LVEDd,LVEF,E-peak and LSPV blood flow velocity before and after operation(P >0.05).There were 2 cases of micro pericardial effusion,3 cases of residual shunt between the occluder and the wall of left atrial appendage,1 case of small thrombus on the surface of occluder 3 months after operation,and only 1 case of 2mm residual shunt in the follow-up 6 months after operation.Conclusions 1.RT-3DTEE is more accurate than 2DTEE in the evaluation of LAA size and shape and the selection of occluder specifications;2.RT-3DTEE combined with X-ray provided a more comprehensive and reliable clinical recommendations for the selection of occluder specifications in the operation of left atrial appendage closure;3.RT-3DTEE combined with 2DTEE plays an important role in evaluating the plugging effect,observing the location of the occluder and postoperative complications during postoperative follow-up,and also provides a safer and more effective detection method for postoperative follow-up.