Application Of Real-time Three-dimensional Transesophageal Ultrasound To Evaluate The Correlation Between The Left Atrial Appendage Opening Shape And The Effect Of Left Atrial Appendage Occlusion

Objectives:Whether the morphology of the left atrial appendage affects the effect of LAAC（Left atrial appendage closure）,there are currently few relevant studies.This study used RT-3DTEE（Real-time 3D transesophageal echocardiography）to evaluate the left The morphological characteristics of the atrial appendage were compared and analyzed for the correlation between the morphological parameters of the left atrial appendage and the postoperative effect.Methods:Collect 66 patients with non-valvular atrial fibrillation（abbreviated as atrial fibrillation）and LACC in our hospital.RT-3DTEE was used to measure the left atrial appendage opening area,opening long diameter,opening short diameter,and four angles（0°,45°,90°,135°）measure the depth of the left atrial appendage.During the operation,the morphology of the left atrial appendage was recorded after left atrial appendage angiography,the width of the occluder at four angles was measured,and the compression ratio of the occluder was calculated.The RT-3DTEE follow-up was completed 45 days,3 months,and 6 months postoperatively.During the postoperative follow-up,the size of residual leakage,the presence of device-related thrombosis,the presence of pericardial effusion,and the presence of device embolism were recorded.Analyze the correlation between different left atrial appendage parameters and post-occlusion complications,and perform statistical analysis.Results:Among 66 patients,3 patients failed the operation,3 patients were lost to follow-up,and 60 patients were successfully followed up for more than 6 months.The average age of the patients was 68.70±7.68 years old,20 patients were women,34patients had a history of at least one stroke,16 patients had a history of diabetes,51patients had hypertension,and 3 patients had TIA(Transient Ischemic Attack（transient ischemic attack）medical history,4 patients suffered from left ventricular insufficiency,13 patients suffered from coronary heart disease.The CHA₂DS₂-VASc score is4.06±1.16 points,and the HAS-BLED score is 2.88±1.02 points.The proportions of the four types of left atrial appendages are:cauliflower type has 26 cases,accounting for43%;chicken wing type has 17 cases,accounting for 28%;cactus type has 8 cases,accounting for 13%;windsock type has 9 cases,accounting for 15%.During the follow-up,7 cases of device-related thrombosis occurred 45 days after LACC,accounting for 11%.The aspect ratio of the left atrial appendage opening was approximately 1（P=0.010）,and the large left atrial appendage opening area（P=0.010）was related to device-related thrombosis.,The left atrial appendage opening long diameter（P=0.310）,opening short diameter（P=0.340）,average compression ratio（P=0.958）,and left atrial appendage depth at each angle（P>0.05）have nothing to do with device-related thrombosis.After intensive anticoagulation treatment,1 case of device-related thrombosis was followed up for 3 months,accounting for 2%,and no device-related thrombosis occurred during the 6-month follow-up.46 cases had no residual leakage immediately after operation,accounting for 76%;2 cases of residual leakage>0 and≤1 mm,accounting for 3%,8 cases of residual leakage>1 and≤3 mm,accounting for 14%;4 cases of residual leakage>3 and<5 mm,Accounting for about7%.At 6 months postoperative follow-up,35 cases had no residual leakage,accounting for 58%;2 cases with residual leakage>0 and≤1 mm,accounting for 3%;19 cases with residual leakage>1 and≤3 mm,accounting for 32%;4 cases with residual leakage Leakage>3 and<5mm,accounting for about 7%.Immediately after the operation and 6months after the operation,the left atrial appendage opening long diameter,opening short diameter,opening aspect ratio,average compression ratio,and depth of each angle were not associated with residual leakage（P>0.05）.The larger opening area of the left atrial appendage was related to the occurrence of residual leakage immediately after surgery（P=0.007）and was related to the size of residual leakage（P=0.005）.At 6months after operation,the left atrial appendage opening area was correlated with residual leakage（P=0.007）,the left atrial appendage opening area（P=0.000）,the left atrial appendage opening aspect ratio（P=0.004）,and the average compression ratio（P=0.003）And the depth of the left atrial appendage measured at 0°（P=0.012）is related to the size of the residual leakage.The area of the left atrial appendage opening（P=0.000）was related to the change of residual leakage immediately after surgery and 6months after surgery.1 case of pericardial effusion occurred immediately after operation,1 case of gastrointestinal bleeding occurred 1 month after operation,and no occluder embolization occurred during the follow-up after operation.No serious cardiovascular events related to complications occurred postoperatively.Conclusion:1.Different shapes of the effect of left atrial appendage lead to different effects after LACC.2.At 45 days postoperatively,the aspect ratio and area of the left atrial appendage opening are prone to device-related thrombosis.3.The opening area of the left atrial appendage may be closely related to the occurrence of residual leakage immediately after the operation and 6 months after the operation,the size of the residual leakage,and the change of the residual leakage.4.During the follow-up process,the size of the residual leakage increased with time,but all were within the normal range of residual leakage（<5mm）.