摘要
目的 探讨综合超声心动图在非瓣膜病心房颤动（房颤）患者左心耳封堵治疗中的应用方法和价值.方法 对6例房颤患者行左心耳封堵术,均为男性患者,平均年龄（68.7±5.6）岁.患者发生中风的风险评分CHADS2（充血性心力衰竭、高血压、年龄≥75岁、糖尿病、中风/短暂性脑缺血病史）为（3.2±1.0）分.术前均行经胸超声心动图（TTE）排除风湿性心脏病等瓣膜器质性病变.术中经食管超声心动图（TEE）全程监测,引导房间隔穿刺,测量左心耳入口直径,帮助选择左心耳封堵器型号,监测引导封堵器封堵过程,并及时评价疗效,观察有无并发症的发生.术后采用TTE进行复查及定期随访,随访时间为术后即时、术后24 h、7d或出院时、3个月、6个月、1年.结果 6例患者均封堵成功,其中3例采用LAmbre封堵器,3例采用Watchman封堵器,左心耳入口处直径（22.4±3.3）mm,封堵器型号（28.0±2.8） mm,1例术后封堵器下缘2 mm残余漏.无明显并发症发生.6例患者术后即刻、24 h、7 d TTE复查显示封堵效果良好.结论 对于非瓣膜病房颤有抗凝禁忌证的高龄患者,左心耳封堵术是一种可行的预防血栓栓塞的替代治疗方法,综合超声心动图的应用可以使左心耳封堵术更加安全有效,具有重要作用.
Objective To explore the value and methods of echocardiographic application in percutaneous left atrial appendage（LAA） closure for stroke prevention in patients with nonvalvular atrial fibrillation.Methods 6 male patients with nonvalvular atrial fibrillation were enrolled for percutaneous LAA closure,the mean age was （68.7 ± 5.6） years old,the mean CHADS2 （congestive heart failure,hypertension,age≥75 years,diabetes mellitus,and prior stroke or transient ischemic attacks） score was 3.2 ± 1.0.Rheumatic valvular diseases were excluded by transthoracic eehocardiography（TTE） before closure procedure.Transesophageal echocardiography（TEE） was performed to guide the punctures of the atrial septum and then monitored the operation all through the closure procedure.Diameter of LAA orifice was measure by TEE to help choosing the closure device.Immediate results of closure and complications were inspected by TEE simultaneously.24 hours,7 days,3 months,6 months and 1 year follow-up were performed using TTE.Results All the 6 patients underwent LAA closure successfully.3 LAmbre（Lifetech Scientific,Shenzhen） devices and 3 Watchman（Boston Scientific,Natick,Massachusetts） devices were implanted respectively in the 6 patients.Mean diameter of the LAA orifice was （22.4 ± 3.3）mm,and mean size of the closure devices was （28.0 ± 2.9） mm.2 mm in width residual flow at the inferior edge of closure device existed in 1 ease.No complication was observed.Post-procedure 24 hours and 7 days post-procedure followup showed optimal results in all cases.Conclusions Implantation of both LAA closure devices can be performed with high success rates in patients with nonvalvula ratrial fibrillation,with high risk for stroke,and who either had contraindication or were not willing to accept oral antieoagulation.Echocardiography plays a core role all through the closure procedure and can make it safer and more efficient.
出处
《中华超声影像学杂志》
CSCD
北大核心
2014年第12期1026-1029,共4页
Chinese Journal of Ultrasonography
关键词
超声心动描记术
心房颤动
心耳
心间隔封堵装置
Echocardiography
Atrial Fibrillation
Atrial appendage
Septal occluder device
