Key result
RT3DTEE correlates better than 2DTEE with compressed occluder size during LAAC, with rehydration increasing dimensions.
Why the study?
The value of real time three-dimensional transesophageal echocardiography (RT3DTEE) in percutaneous closure of the left atrial appendage and the intraoperative change in LAA size were not well established.
Does RT3DTEE provide better correlation with LAA occluder size and better visualization than 2DTEE during percutaneous LAAC?
Observational (n=32)
Does RT3DTEE provide better correlation with LAA occluder size and better visualization than 2DTEE during percutaneous LAAC?
RT3DTEE during LAAC provides a closer correlation to LAA occluder size than 2DTEE, and LAA size increases significantly during the operation due to intravenous rehydration.
May support RT3DTEE for LAA sizing during LAAC; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVE: The aim of this study was to investigate the value of real time three-dimensional transesophageal echocardiography (RT3DTEE) in percutaneous closure of the left atrial appendage (LAAC). In addition, this study also explored the change in the size of the left atrial appendage (LAA) from 24 hours before the operation to just before implantation during the operation. METHODS AND RESULTS: In a retrospective study, 32 patients underwent two-dimensional transesophageal echocardiography (2DTEE) and RT3DTEE 24 hours prior to operation and during operation. The maximal LAA orifice diameter (by 2DTEE, 22.7 ± 2.7 vs 24.6 ± 2.2 mm, P < 0.01; by RT3DTEE, 24.2 ± 2.9 vs 25.8 ± 2.7 mm, P < 0.01), the maximal landing zone diameter (by 2DTEE, 19.0 ± 2.8 vs 20.4 ± 2.8 mm, P < 0.01; by RT3DTEE, 20.4 ± 2.7 vs 22.6 ± 3.0 mm, P < 0.01), and the maximal depth diameter (by 2DTEE, 25.2 ± 3.2 vs 26.5 ± 3.0 mm, P < 0.01; by RT3DTEE, 26.4 ± 3.2 vs 27.5 ± 3.7 mm, P < 0.01) all increased significantly during the operation. The highest correlation (R) between the maximal landing zone diameter and the compressed occluder diameter was determined for RT3DTEE measurements during the operation (R = 0.90), whereas the landing zone diameter (R = 0.80) measured by 2DTEE was less correlated. In addition, our study showed that RT3DTEE was of great value in discriminating the LAA orifice shape, allowing differentiation of the LAA morphology and identification of the number of LAA lobes. CONCLUSIONS: A certain amount of intravenous rehydration just before and during operation increased the LAA size significantly. The measurements by RT3DTEE showed a closer correlation to LAA occluder size than those by 2DTEE. The LAA displayed by RT3DTEE was more visible than that by 2DTEE.
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Zhang et al. (2019) conducted an observational in Percutaneous closure of the left atrial appendage (n=32). Real time three-dimensional transesophageal echocardiography (RT3DTEE) vs. Two-dimensional transesophageal echocardiography (2DTEE) was evaluated on Correlation between maximal landing zone diameter and compressed occluder diameter. RT3DTEE measurements during LAAC showed a higher correlation with compressed occluder diameter (R=0.90) compared to 2DTEE (R=0.80), and intravenous rehydration significantly increased LAA size.
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