Clinical application value of transesophageal echocardiography and LAA CTA before percutaneous left atrial appendage closure with the Watchman occluder

Abstract

Objective To evaluate the clinical application value of 2-dimentional transesophogeal echocardiography (2D-TEE), real-time 3-dimensional transesophogeal echocardiography(RT-3D TEE) and left atrial appendage CT angiography (LAA CTA) before percutaneous left atrial appendage closure (LAAC) with the Watchman occluder. Methods Consecutive 50 atrial fibrillation (AF) patients underwent 2D-TEE, RT-3D TEE and LAA CTA examination before LAAC. The number of LAA lobes, the diameter of landing zone (DLZ) and the depth of LAA were measured by using different methods. The correlation between LAA landing zone diameters measured by different methods and device size were calculated. Results Among 50 patients, there was no significant difference in lobe nubmers between RT-3D TEE and LAA CTA (P>0.05). The maximum diameter of landing zone(DLZ) from LAA CTA was greater than those from RT-3D TEE and 2D-TEE (t=3.977, 5.373, both P<0.05), and DLZ from RT-3D TEE was greater than that from 2D-TEE (t=2.124, P<0.05). The value measured by RT-3D TEE was greater than that by 2D-TEE for the LAA minimum DLZ (t=2.142, P<0.05). LAA depth: CTA value was greater than 2D-TEE and RT-3D TEE values(t=2.674, 4.066, both P<0.05), and 2D-TEE value was greater than RT-3D TEE value(t=2.114, P<0.05). The correlation coefficient of LAA maximum, minimum DLZ and LAA depth between 2D-TEE and RT-3D TEE were 0.638, 0.734, 0.647 (all P=0.000), and 0.517, 0.338 and 0.591 between RT-3D TEE and LAA CTA, respectively (all P<0.05), and 0.503, 0.359 and 0.610 between 2D-TEE and LAA CTA, respectively (all P<0.05). LAA DLZ of LAA angiography (LAA-A) was (22.6±3.5)mm. Fourty-seven AF patients achieved successful LAA occlusion with Watchman device and the size of closure was (27.5±3.3)mm. Correlation coefficient between the size of device and LAA maximum DLZ by RT-3D TEE, 2D-TEE and LAA CTA were 0.693, 0.647, 0.586, respectively (all P=0.000). Correlation between LAA-A and the size of device was the closest (r=0.914, P=0.000). Conclusions The difference in LAA size measured by TEE and LAA CTA could be significant, and need to be considered before the LAAC. 2D-TEE, RT-3D TEE and CTA LAA measurements all could play important roles in the selection of proper Watchman device size, and the maximum DLZ of RT-3D TEE has the closest correlation with Watchman device size. Key words: Echocardiography, transesophageal; Left atrial appendage occlusion; Computed tomography angiography; Watchman occluder