Roles of real-time three-dimensional transesophageal echocardiography in peri-operation of transcatheter left atrial appendage closure

Abstract

Left atrial appendage (LAA) closure is a new treatment option for the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Conventional 2-dimensional transesophageal echocardiography (2D TEE) has some limitations in the imaging assessment of LAA closure. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) allows for detailed morphologic assessment of the LAA. In this study, we aim to determine the clinical values of RT-3D TEE in the periprocedure of LAA closure.Thirty-eight persistent or paroxysmal AF patients with indications for LAA closure were enrolled in this study. RT-3D TEE full volume data of the LAA were recorded before operation to evaluate the anatomic feature, the landing zone dimension, and the depth of the LAA. On this basis, selection of LAA closure device was carried out. During the procedure, RT-3D TEE was applied to guide the interatrial septal puncture, device operation, and evaluate the occlusion effects. The patients were follow-up 1 month and 3 months postclosure.Twenty-eight (73.7%) patients with AF received placement of LAA occlusion device under RT-3D TEE. Eleven cases with single-lobe LAAs were identified using RT-3D TEE, among which 4 showed limited depth. Seventeen cases showed bilobed or multilobed LAA. Seven cases received LAA closure using Lefort and 21 using LAmbre based on the 3D TEE and radiography. The landing zone dimension of the LAA measured by RT-3D TEE Flexi Slice mode was better correlated with the device size used for occlusion (r = 0.90) than 2D TEE (r = 0.88). The interatial septal puncture, the exchange of the sheath, as well as the release of the device were executed under the guidance of RT-3D TEE during the procedure. The average number of closure devices utilized for optimal plugging was (1.11 ± 0.31). There were no clinically unacceptable residual shunts, pericardial effusion, or tamponade right after occlusion. All the patients had the device well-seated and no evidence of closure related complications in the follow-up.Assessment of LAA morphology by RT-3D TEE contributes to the decision of device selection for the closure. 3D TEE is a reliable imaging modality to guide device operation and assess on-site closure.

Role of real time‑three dimensional transesophageal echocardiography in left atrial appendage closure with LACBES� devices

“…Co-axiality is also critical to adjust the device's angle and direction. Previous studies have demonstrated that a full view of the atrial septum can be easily obtained by RT-3D TEE, which facilitates the determination of the optimal puncture site (10,12,13). With the guidance of RT-3D TEE, no inappropriate puncture, puncture-related complications or undesirable co-axiality occurred in the present study.…”

“…However, device sizing parameters evaluated by 2D-TEE or LAA contrast angiography were slightly smaller than the size of the implanted device. Previously, Zhou et al (12) investigated the clinical value of 3D TEE in the periprocedure of LAA closure using LeFort or LAmbre devices, both of which are locally developed devices and available in China. In accordance with the present findings, the landing zone measured by RT-3D TEE Flexi Slice mode was strongly correlated with the size of the closure device.…”

“…A larger scale multicenter study is desirable. Secondly, although RT-3D TEE is a more reliable and effective imaging method to guide LAAC than 2D TEE, 3D TEE is prone to artifacts from arrythmia and ventilation (11,12). Particular attention should be paid to acquire 3D images and avoid motion artifacts during the procedure when patients are generally anesthetized and ventilated.…”

Feasibility and Safety of Left Atrial Appendage Closure Using the LAmbre Device in Patients with Nonvalvular Atrial Fibrillation with or Without Prior Catheter Ablation

“…18) Until now, clinical data on LAmbre device use is rare. 19,20) In the present study, we reported the feasibility and safety of LAAC with LAmbre in the presence or absence of prior CA procedures.…”

Evaluation of endothelialization of left atrial appendage occluder by three-dimensional transesophageal echocardiography and its influence factors

“…RT-3D-TEE was used for preoperative evaluation and intraoperative monitoring in this study. Several studies have found that the accuracy of 3D-TEE was higher than that of 2D-TEE in pre-LAAC evaluation [14,15], and that 3D-TEE was highly correlated with measurements by intraoperative angiocardiography, therefore can be routinely used for intraoperative monitoring of LAAC [16]. In this study, we found correlation between the inner diameters of LAA ostium measured in 0°, 90° and 135° section by preoperative TEE and the maximum diameter measured by angiocardiography (P < 0.05), and the TEE measurement in 135° section was closest to the angiocardiography measurement.…”