Application of Transesophogeal Echocardiography in Percutaneous Left Atrial Appendage Occlusion

Yin Huang,Xiaobo Chen,Ziqing Gao,Yongquan Huang

doi:10.13189/ijccd.2020.070201

Abstract

Objective: To evaluate the use of transesophogeal echocardiography (TEE) for percutaneous left atrial appendage (LAA) occlusion. Methods: LAA occlusion was performed in 20 atrial fibrillation (AF) patients with non-valvular lesions, including nine males and 11 females. TEE was used for the preoperative measurement of the maximal LAA orifice diameter and LAA depth and the guidance of atrial septum puncture. The release of the occluder during the occlusion procedure was also performed under TEE monitoring. Results: All 20 patients underwent successful occlusion of the LAA under the guidance of TEE. There were two (10.0%) cases with mild residual shunt after occlusion, among which only one (5.0%) patient still retained slight residual shunt at one month postoperative. All the other (95.0%) patients revealed no residual shunt. There was no difference between the maximal LAA orifice diameter (22.75 ± 4.85 mm vs. 22.15 ± 4.23) and LAA depth (36.60 ± 5.51 vs. 35.00 ± 4.76) derived from TEE and the digital subtraction angiography (DSA) measurement. Both the max orifice diameter and LAA depth measured by TEE were strongly correlated with that measured by DSA, with r = 0.75, P < 0.001 and r = 0.82, P < 0.001, respectively. Conclusions: TEE can accurately estimate the maximal LAA orifice diameter and LAA depth and provide an important reference for preoperative occluder size selection. It can also be used for intraoperative guidance and assessing results during the operation. TEE is of great importance for LAA occlusion.

Highlights

Atrial fibrillation (AF), one of the most common arrhythmias, is a serious cardiac condition and a growing health problem [1]
This study evaluated the use of transesophogeal echocardiography (TEE) in patients with non-valvular lesions of AF who underwent left atrial appendage (LAA) occlusion
Exclusion criteria: (1) thrombosis in the left atrium or other heart chambers; (2) the maximum orifice diameter of the LAA is smaller than 17 mm or larger than 31 mm, or larger than the maximum depth of the LAA; (3) left ventricular systolic function is lower than 30%; (4) atrial septal defect, or other congenital heart disease; (5) contraindications for TEE examination

Summary

Introduction

Atrial fibrillation (AF), one of the most common arrhythmias, is a serious cardiac condition and a growing health problem [1]. From 2010 to 2030, the incidence of AF is expected to double [2]. AF post-diagnosis survival rates have not improved despite their steady increase in prevalence. The overall estimated five-year mortality after AF diagnosis is only 41% [3]. One reason for poor prognosis is AF often leads to thrombus formation. The left atrial appendage (LAA) is the most common site for thrombosis, accounting for 91% of left heart thrombi in patients with nonrheumatic AF [4], which is defined as rhythmic disturbance in the absence of rheumatic mitral stenosis, mechanical or bioprosthetic heart valve, or mitral valve repair [5]

Methods

Results

Conclusion