Rotational method simplifies 3-dimensional measurement of left atrial appendage dimensions during transesophageal echocardiography

Abstract

BackgroundNot all echo laboratories have the capability of measuring direct online 3D images, but do have the capability of turning 3D images into 2D ones “online” for bedside measurements. Thus, we hypothesized that a simple and rapid rotation of the sagittal view (green box, x-plane) that shows all needed left atrial appendage (LAA) number of lobes, orifice area, maximal and minimal diameters and depth parameters on the 3D transesophageal echocardiography (3DTEE) image and LAA measurements after turning the images into 2D (Rotational 3DTEE/“Yosefy Rotation”) is as accurate as the direct measurement on real-time-3D image (RT3DTEE).MethodsWe prospectively studied 41 consecutive patients who underwent a routine TEE exam, using QLAB 10 Application on EPIQ7 and IE33 3D-Echo machine (BORTHEL Phillips) between 01/2013 and 12/2015. All patients underwent 64-slice CT before pulmonary vein isolation or for workup of pulmonary embolism. LAA measurements were compared between RT3DTEE and Rotational 3DTEE versus CT. ResultsRotational 3DTEE measurements of LAA were not statistically different from RT3DTEE and from CT regarding: number of lobes (1.6 ± 0.7, 1.6 ± 0.6, and 1.4 ± 0.6, respectively, p = NS for all); internal area of orifice (3.1 ± 0.6, 3.0 ± 0.7, and 3.3 ± 1.5 cm2, respectively, p = NS for all); maximal LAA diameter (24.8 ± 4.5, 24.6 ± 5.0, and 24.9 ± 5.8 mm, respectively, p = NS for all); minimal LAA diameter (16.4 ± 3.4, 16.7 ± 3.3, and 17.0 ± 4.4 mm, respectively, p = NS for all), and LAA depth (20.0 ± 2.1, 19.8 ± 2.2, and 21.7 ± 6.9 mm, respectively, p = NS for all).ConclusionRotational 3DTEE method for assessing LAA is a simple, rapid and feasible method that has accuracy similar to that of RT3DTEE and CT. Thus, rotational 3DTEE (“Yosefy rotation”) may facilitate LAA closure procedure by choosing the appropriate device size.

Novel sizing role of 3D transesophageal echocardiography in a novel left atrial appendage clip device for patients undergoing video-assisted atrial fibrillation ablation: a cohort study

“…In addition, 3D-TEE has been shown to be superior to 2D-TEE for various types of LAA orifice shapes. Recently, research has shown that the perimeter-derived circumferential orifice diameter had the best performance in occlusion sizing among three 3D-TEE parameters ( 22 ). Consistently, our study found that the novel 3D-TEE measurement was superior in LAA clipping via VATS compared with the 2D-TEE or VATS direct measurements.…”

Left Atrial Appendage Occlusion Guided Only by Transesophageal Echocardiography

“…Three-dimensional TEE can be used to quickly obtain a perpendicular LAA section, and the multisection surface can display the diameter of the LAA opening in real time, reduce the steps required during surgery, and shorten the measurement time. It can directly image the complex anatomical structure of the LAA and display its shape, internal structure, and thrombus [19] in 3D images. Therefore, it plays an important role in screening patients, selecting a suitable plugging device, and ensuring the sealing effect.…”

Evaluation of the left atrial appendage by real time three‐dimensional transesophageal echocardiography online

“…Yosefy et al advocated that rotational 3DTEE method had the similar accuracy as those of RT3DTEE (measured directly from the original 3D views) and CT in assessing LAA. The aim of this study was to investigate whether or not online RT3DTEE methods can provide the same information of LAA as that of off‐line.…”