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

Abstract

Background This study evaluated surface endothelialization of Watchman occluder (Boston Scientific) through comparing relevant indicators before and left atrial appendage closure (LAAC) in 68 nonvalvular atrial fibrillation (AF) patients.Methods Patients were monitored preoperatively by transthoracic echocardiography (TTE), transesophageal two-dimensional and three-dimensional echocardiography (2D-TEE, 3D-TEE), intraoperatively by 3D-TEE and angiocardiography, and followed at 3 and 6 months after operation by TEE.Result It showed that the inner diameters of LAA ostium measured by TEE at 0°, 90° and 135° before operation were correlated with corresponding maximum diameters measured by angiocardiography. The depth of LAA ostium measured at 90° was correlated with the maximum depth measured by angiocardiography. The left atrial diameter, left ventricular diameter and left ventricular free wall E/E' decreased postoperatively. Compared T-test showed that BNP level and persistent AF might be risk factors for spontaneous echo contrast (SEC) or thrombosis of LAA. Multiple linear regression identified persistent AF, preoperative LAA spontaneous echo contrast or recent thrombotic event, and history of embolism in other parts were the influence factors of occluder endothelialization. Conclusion: BNP level and persistent AF may be risk factors of left atrial appendage thrombosis. Treatment of AF and thrombus in left atrial appendage or other parts are beneficial to the prognosis of LAAC patients.