The Evaluation Of Left Atrial Appendage Occlusion By Transthoracic Echocardiography And Transesophageal Echocardiography

Objectives:The aim of the study is to evaluate the structure and the function of left atrial and the left ventricle of the patients by transthoracic echocardiography and transesophageal echocardiography during and after left atrial appendage occlusion,compare with the date measured at preoperation,and then to evalute the effection of left atrial appendage occlusion.Methods:28 patients with atrial fibrillation were enrolled.All the patients must sign informed consent before performing the operation,and we retrospectively registered all the patients.Transesophageal echocardiography shall be performed for patients 1-3 days before operation to exclude thrombogenesis of left atrial appendage and to measure left upper pulmonary vein blood flow velocity,then the entrance diameter of the left atrial appendage,the length of the left atrial appendage and the waist diameter of the left atrial appendage was measured at the angles of 0° 、45°,90°,and 135° by transesophageal echocardiography.And transthoracic echocardiography was performed to measure left atrial end-systolic anteroposterior diameter,left ventricular end-diastolic anteroposterior diameter,left ventricular ejection fraction,mitral valve diastolic peak velosity,and mitral regurgitation volume;Transesophageal echocardiography was employed in the operation of the left atrial appendage occlusion to lead the operation;On postoperative 30 days ±7days,postoperative 3 months ±7 days,postoperative 6 months ±7days,and postoperative12 months ±15 days transthoracic echocardiography was performed to measure left atrial end-systolic anteroposterior diameter,left ventricular end-diastolic anteroposterior diameter,left ventricular ejection fraction,mitral valve diastolic peak velosity,and mitralregurgitation volume in all the patients,and on postoperative 3 months ±7 days and postoperative 12 months ±15 days,transesophageal echocardiography was used to observe position and morphology of the occluder at the angles of 0°,45°,90°,and 135°,Minimal residual flow around the device as determined by color Doppler was noted in all patients in the absence of fluoroscopically detectable leak,and to measure left upper pulmonary vein blood flow velocity.All the above data was measured based on 3 cardiac cycles,and the electrocardiogram was uesd to distinguish cardiac systole and cardiac diastole.Results:Transesophageal echocardiography play an important role in choosing the occluder during left atrial appendage occlusion.The position and morphology of occluder in 28 patients were all well placed with postoperative 30 days ±7 days,postoperative 3 months ±7 days,postoperative 6 months ±7 days,and postoperative 12 months ±15 days follow-up.Of the 28 patients,3 patients always developed residual shunt around the occluder during follow-up after the operationthe,and the residual shunt width on postoperative 12 months ± 15 days were less than 3mm around occluder,and 1patient the residual shunt disappeared on 12 months ±15 days;In 1 patient,it was found that the lateral margin of occluder disc was bulged to left upper pulmonary vein,however,the bulged occluder disc showed no pressing signs on left upper pulmonary vein at this direction.Left atrial diameter,left ventricular diameter,left ventricular ejection fraction,left upper pulmonary vein blood flow velocity,volume of mitral regurgitation,mitral diastolic blood flow velocity showed no significant change before,during and after left atrial appendage occlusion(P>0.05).Conclusions:Transthoracic echocardiography and transesophageal echocardiography play an important role in evaluating the structure and the function of the left atrial and the left ventricle of the patients with atrial fibrillation before,during and after left atrial appendage occlusion.Left atrial appendage occlusion play an important clinical role in preventing stroke,and further more studies are needed to prove its effection.