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目的:应用经食道二维(2D TEE)及实时三维超声(RT 3DTEE)评估封堵前左心耳形态和测值,指导Watchman封堵器术中的应用情况,评估封堵器的封堵效果,并验证经食道实时三维与二维超声心动图对左心耳封堵术实施的指导价值。方法:10例因房颤于我院行左心耳封堵术的患者(男5例,女5例,年龄45~84岁),术中于全麻下进行经食道超声监测,术前于0°、45°、90°、135°切面测量左心耳锚定区直径和深度,使用实时三维超声测量左心耳开口内径的最大径,使用选择性造影测量左心耳开口内径。封堵器释放后于0°、45°、90°、135°度观察封堵器边缘是否有异常分流,记录观察到分流的切面。记录封堵器型号,术后使用经食道三维测量封堵器内径,计算其压缩比。结果:其中1例患者因心包渗液行左心耳结扎术,9例患者均于超声监测下成功实施Watchman左心耳封堵术,术中监测3例封堵器边缘存在残余分流。结论:经食道超声心动图在Watchman封堵术中具有重要的指导意义,二维及实时三维超声心动图测量值与选择性造影及封堵器的选择有很好的一致性,Watchman封堵器可以有效的封闭左心耳。
OBJECTIVE: To evaluate the application of the Watchman occluder technique and assess the occlusion effect of the occluder by using 2D TEE and RT 3DTEE to assess the morphology and measurement of left atrial appendage before occlusion. And to verify the real-time three-dimensional transesophageal and two-dimensional echocardiography of the guidance of the implementation of left atrial appendage closure. Methods: Ten patients (5 males and 5 females, aged 45-84 years) with atrial fibrillation undergoing auricular closure in our hospital underwent trans-esophageal sonography under general anesthesia. The diameter and depth of the left atrial appendage anchoring area were measured by °, 45 °, 90 ° and 135 ° sections. The maximum diameter of the inner diameter of the left atrial appendage was measured by real-time three-dimensional ultrasound, and the diameter of the left atrial appendage was measured by selective contrast. After the occluder was released at 0 °, 45 °, 90 °, 135 ° to observe the occluder edge abnormal diversion, record the observed shunt section. Record occluder model, three-dimensional transesophageal occluder diameter measured after surgery, calculate the compression ratio. Results: One of the patients underwent left atrial appendage ligation with pericardial effusion. All 9 patients underwent echocardiographic monitoring of Left auricular closure with Watchman. Three residual occlusions were detected at the edge of the occluder. Conclusion: Transesophageal echocardiography plays an important guiding role in the closure of Watchman. The two-dimensional and real-time three-dimensional echocardiographic measurements are in good agreement with selective angiography and occluder selection. Watchman occluder Can effectively close the left atrial appendage.