Abstract:
Left atrial appendage occlusion (LAAO) is rapidly growing as valid stroke prevention therapy in atrial fibrillation. Cardiac imaging plays an instrumental role in preprocedural planning, procedural execution, and postprocedural follow-up. Recently, cardiac computed tomography (CCT) has made significant advancements, resulting in increasing use both preprocedurally and in outpatient follow-up. It provides a noninvasive, high-resolution alternative to the current standard, transesophageal echocardiography, and may display advantages in both the detection and characterization of device-specific complications, such as peridevice leak and device-related thrombosis. The implementation of CCT in the follow-up after LAAO has identified new findings such as hypoattenuated thickening on the atrial device surface and left atrial appendage contrast patency, which are not readily assessable on transesophageal echocardiography. Currently, there is a lack of standardization for acquisition and interpretation of images and consensus on definitions of essential findings on CCT in the postprocedural phase. This paper intends to provide a practical and standardized approach to both acquisition and interpretation of CCT after LAAO based on a comprehensive review of the literature and expert consensus among European and North American interventional and imaging specialists.
摘要:
左心耳闭塞(LAAO)作为有效的房颤卒中预防疗法正在迅速发展。心脏成像在术前计划中起着重要作用,程序执行,以及程序后的后续行动。最近,心脏计算机断层扫描(CCT)取得了重大进展,导致术前和门诊随访中的使用增加。它提供了一种非侵入性的,高分辨率替代当前标准,经食管超声心动图,并且可能在设备特定并发症的检测和表征方面显示出优势,如周围装置渗漏和装置相关的血栓形成。在LAAO后的随访中实施CCT发现了新的发现,如心房装置表面减薄型增厚和左心耳造影剂通畅,在经食管超声心动图上不容易评估。目前,在手术后阶段,缺乏图像获取和解释的标准化以及对CCT基本发现定义的共识。本文旨在基于对文献的全面回顾以及欧洲和北美介入和成像专家的专家共识,为LAAO之后CCT的获取和解释提供一种实用且标准化的方法。