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JACC- Cardiovasc Inte:3D血管造影指导的LAA封堵前景广阔

2018-01-22 国际循环编辑部 国际循环

近期发表的一项初步探索性研究显示,与TEE或心房颤动(AF)病史相比,采用3D血管造影测量左房容积能有助于更好地预测肺静脉电隔离后AF的复发,故3D旋转血管造影指导的左心耳(LAA)封堵有望替代目前普遍使用的二维经TEE指导的LAA。

临床实践中,行左心耳(LAA)封堵时所应用的器械尺寸通常要比二维经食管超声心动图(TEE)所测得的尺寸大。近期发表的一项初步探索性研究显示,与TEE或心房颤动(AF)病史相比,采用3D血管造影测量左房容积能有助于更好地预测肺静脉电隔离后AF的复发,故3D旋转血管造影指导的左心耳(LAA)封堵有望替代目前普遍使用的二维经TEE指导的LAA。

研究者比利时OLV医院的Tom De Potter等对20例在3D旋转血管造影及透视指导下行LAA封堵的患者进行分析,共计19例患者顺利完成手术,仅一例患者因极度肥胖导致的通路问题而终止。对上述患者3D血管造影及TEE结果行回顾性对比分析可见,与TEE相比,3D血管造影所示的LAA最大开口直径更大(24.3 mm vs.21 mm,R2=0.64,P<0.05)。有一例患者因TEE所示的最大开口直径为27 mm,3D血管造影所示最大直径达30.5 mm,被认为无法植入而未进行器械植入。此外,随访6周期间,未见安全性问题及新的症状报告。

综上可见,与TEE相比,3D血管造影通常所示的LAA开口直径更大,且通常不需要全麻,有望成为替代TEE指导LAA封堵的新方法。不过,鉴于该研究样本量较小,未来有必要进一步在更多中心开展大规模研究验证其结果。

原始出处:
Tom De Potter, et al. A Pilot Study for Left Atrial Appendage Occlusion Guided by 3-Dimensional Rotational Angiography Alone. JACC: Cardiovascular Interventions Jan 2018, 11 (2) 223-224; DOI: 10.1016/j.jcin.2017.08.053

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    2018-04-22 hbwxf
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    2018-11-22 quxin068
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    2018-01-24 sodoo

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