Application of Transesophogeal Echocardiography in Percutaneous Left Atrial Appendage Occlusion

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.