The value of the left atrial appendage orifice perimeter of 3D model based on 3D TEE data in the choice of device size of LAmbre™ occluder

Jia, Dan; Zhou, Qing; Song, Hongning; Zhang, Lan; Chen, Jinling; Liu, Yu; Kong, Bin; He, Fazhi; Wang, Yijia; Yang, Yuanting

doi:10.1007/s10554-019-01627-4

Cited by 11 publications

(8 citation statements)

References 24 publications

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“…In our study, we used successfully implanted devices as the reference to compare predicted device sizes based on CT measurements and were able to present the superior accuracy of the perimeter-derived diameter compared with other parameters. More recently, Jia et al compared the parameters measured using three-dimensional printed models and found a good correlation between the perimeter of the LAA orifice and LAmbre™ device size 24 . However, the ability of 3D printing to reflect actual cardiac anatomy may be limited, as the volume within the chambers changes throughout the cardiac cycle.…”

Section: Discussionmentioning

confidence: 99%

Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

Cho

Kim

Lee

et al. 2021

Sci Rep

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The complex structure of the left atrial appendage (LAA) brings limitations to the two-dimensional-based LAA occlusion (LAAO) size prediction system using transesophageal echocardiography. The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac computed tomography (CT); however, there is lack of data regarding which parameter to choose from CT-based images during pre-procedural planning of LAAO. We aimed to assess the accuracy of measurements derived from cardiac CT images for selecting LAAO devices. We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes. The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = − 0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = − 4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = − 1.6 ± 2.6 mm, area-derived diameter = − 2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference < 0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement. The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.

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Section: Discussionmentioning

confidence: 99%

Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

Cho

Kim

Lee

et al. 2021

Sci Rep

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“…The average diameters and derived diameter from the perimeter from CT datasets reconstructed through 3D‐printing technology fitted the size of implanted Amulet device occluders fully in fifteen cases 14 . 3D‐printing LAA model was used to guide the size selection of LAmbre occluders, providing optimized size selections in selected patients, especially in those with eccentric orifice 15 . TEE as the major tool for LAA assessment in clinical practice could provide LAA perimeter measurement based on 3D echocardiographic datasets with high accuracy equivalent to MDCT 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The increase of LAA dimensions after volume loading should be considered for accurate device sizing 12,16,21 . Several studies suggested a larger compression ratio to reduce the occurrence of residual leakage, 15 but others showed that too large occluders may also be poorly coupled to the LAA wall and was associated to producing residual leakage 22 . Chronic clinical complications of LAA closure still merit further investigations.…”

Section: Discussionmentioning

confidence: 99%

“…3D‐printing LAA model was used to guide the size selection of LAmbre occluders, providing optimized size selections in selected patients, especially in those with eccentric orifice 15 . TEE as the major tool for LAA assessment in clinical practice could provide LAA perimeter measurement based on 3D echocardiographic datasets with high accuracy equivalent to MDCT 15 . PDD measured through 3DTEE was the most accurate parameter for device size selection for the ACP or AMPLATZER Amulet devices compared with the maximum diameter measured by 2DTEE and 3DTEE 16 .…”

Section: Discussionmentioning

confidence: 99%

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Reference value of perimeter‐derived diameter assessed by three‐dimensional transesophageal echocardiography in left atrial appendage occluder size selection

et al. 2020

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Background The aim of this study was to investigate the utility of perimeter‐derived diameter (PDD) measured by three‐dimensional (3D) transesophageal echocardiography (TEE) in predicting the size of left atrial appendage (LAA) occluder. Methods and results Left atrial appendage landing zone diameter (LZD) was measured by two‐dimensional (2D) TEE, 3DTEE, and digital subtraction angiography (DSA) as LZD‐2Dmax, LZD‐2Dmean, LZD‐3Dmax, LZD‐3Dmean, LZD‐PDD, LZD‐DSAmax, respectively, before and during transcatheter LAA closure with Watchman devices in 100 patients. A difference of one or more device size intervals between the predicted size and the size actually implanted was defined as mismatching. Seventy‐eight patients were followed up by TEE to obtain occluder compression ratio. The correlation between LZD and the final implanted occluder size was 0.559, 0.641, 0.754, 0.760, 0.782, and 0.848 for LZD‐2Dmax, LZD‐2Dmean, LZD‐3Dmax, LZD‐3Dmean, LZD‐PDD and LZD‐DSAmax, respectively (P < .001). Matching ratio between the size predicted by retrospective measurements of LZD and the device size actually implanted was 65%, 57%, 66%, 63%, 70%, and 83% for LZD‐2Dmax, LZD‐2Dmean, LZD‐3Dmax, LZD‐3Dmean, LZD‐PDD and LZD‐DSAmax, respectively. There was no significant difference in LZD value, matching ratio, and compression ratio between the patients with eccentric and noneccentric LAA landing zone (P > .05). Compression ratio of the mismatching subjects was higher than that in the matching subjects when evaluated by LZD‐2Dmean, LZD‐3Dmean, and LZD‐PDD (P < .05). Conclusions Landing zone diameter derived from LAA perimeter measured by preprocedure 3DTEE showed reference value for LAA occluder size selection, providing superior correlation and matching ratio with the final implanted size and indicating the adjustment of oversizing.

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“…More recently, Jia et al compared the parameters measured using three-dimensional printed models and found a good correlation between the perimeter of the LAA ori ce and LAmbre TM device size. [21] However, the ability of 3D printing to re ect actual cardiac anatomy may be limited, as the volume within the chambers changes throughout the cardiac cycle. Our study used successfully implanted devices as the reference to compare predicted device sizes based on CT measurements.…”

Section: Perimeter-derived Diametermentioning

confidence: 99%

Pre-procedural Determination of Device Size in Left Atrial Appendage Occlusion Using Three-dimensional Cardiac Computed Tomography

Cho¹,

Kim²,

Lee³

et al. 2021

Preprint

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Background: The two-dimensional-based LAAO size prediction system using transesophageal echocardiography is limited by the complex structure of the left atrial appendage (LAA). The LAA anatomy can be evaluated more precisely using three-dimensional images from cardiac CT; however, a CT-based sizing method has not been established. We aimed to assess the accuracy of measurements derived from cardiac computed tomography (CT) images for selecting left atrial appendage occlusion (LAAO) devices.Methods: We retrospectively reviewed 62 patients with Amplatzer Cardiac Plug and Amulet LAAO devices who underwent implantation from 2017 to 2020. The minimal, maximal, average, area-derived, and perimeter-derived diameters of the LAA landing zone were measured using CT-based images. Predicted device sizes using sizing charts were compared with actual successfully implanted device sizes.Results: The mean size of implanted devices was 27.1 ± 3.7 mm. The perimeter-derived diameter predicted device size most accurately (mean error = -0.8 ± 2.4 mm). All other parameters showed significantly larger error (mean error; minimal diameter = -4.9 ± 3.3 mm, maximal diameter = 1.0 ± 2.9 mm, average diameter = -1.6 ± 2.6 mm, area-derived diameter = -2.0 ± 2.6 mm) than the perimeter-derived diameter (all p for difference <0.05). The error for other parameters were larger in cases with more eccentrically-shaped landing zones, while the perimeter-derived diameter had minor error regardless of eccentricity. When oversizing was used, all parameters showed significant disagreement.Conclusions: The perimeter-derived diameter on cardiac CT images provided the most accurate estimation of LAAO device size regardless of landing zone eccentricity. Oversizing was unnecessary when using cardiac CT to predict an accurate LAAO size.

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The value of the left atrial appendage orifice perimeter of 3D model based on 3D TEE data in the choice of device size of LAmbre™ occluder

Cited by 11 publications

References 24 publications

Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

Pre-procedural determination of device size in left atrial appendage occlusion using three-dimensional cardiac computed tomography

Reference value of perimeter‐derived diameter assessed by three‐dimensional transesophageal echocardiography in left atrial appendage occluder size selection

Pre-procedural Determination of Device Size in Left Atrial Appendage Occlusion Using Three-dimensional Cardiac Computed Tomography

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