scholarly journals Prolonged transesophageal echocardiography during percutaneous closure of the left atrial appendage without general anesthesia: the utility of the Janus mask

2016 ◽  
Vol 63 (8) ◽  
pp. 962-965 ◽  
Author(s):  
Alberto Zangrillo ◽  
Patrizio Mazzone ◽  
Carmine D. Votta ◽  
Nicola Villari ◽  
Paolo Della Bella ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Percutaneous Closure ◽  
Atrial Appendage

Abstract 13097: Feasibility and Safety of Trans-nasal Transesophageal Echocardiography Guiding Left Atrial Appendage Closure Without General Anesthesia

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mingxing XIE ◽  
Sun Wei ◽  
Wang Bin ◽  
He Liin ◽  
Lv Qing ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Local Anesthesia ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Alternative Therapy ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
The Real

Background: Percutaneous left atrial appendage closure (LAAO), may be an alternative therapy to non-valvular atrial fibrillation (AF) patients. And the transesophageal echocardiography (TEE) is the mainstay of the imaging technology to guide LAAO procedures. However, in the local anesthesia state, LAAO cannot be accomplished under the real-time guidance of conventional TEE with the standard adult TEE probe. The aim of the study was to explore the feasibility and safety of trans-nasal TEE with the microprobe to guide LAAO without general anesthesia. Methods: A total of 30 non-valvular AF participants were enrolled in the study. All participants both underwent conventional TEE examination with the standard adult TEE probe before LAAO, and the real-time guidance of trans-nasal TEE with the microprobe intraoperatively under local anesthesia. Results: There weren’t significant difficulties to insert the microprobe into the esophagus through the nares. All patients tolerated the trans-nasal approach well. Image quality by the microprobe was reviewed as good (67.3%) and acceptable (36.7%) by two different echocardiographers. The devices were successfully implanted in all participants. No observed significant residual peri-device leaks by the microprobe at the time of the procedure and by the standard TEE on a median of 55 days (interquartile range: 48 to 66 days) postoperatively. 2(7%) patients had mild epistaxis after the procedure, and there were no other severe complications. Conclusion: The present study preliminarily showed the feasibility and safety of the trans-nasal micro-TEE and suggested it may become an alternative to conventional TEE to guide LAAO procedure without general anesthesia.

scholarly journals Safety and effects of volume loading during transesophageal echocardiography in the pre-procedural work-up for left atrial appendage closure

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Afonso B. Freitas-Ferraz ◽  
Mathieu Bernier ◽  
Kim O’Connor ◽  
Jonathan Beaudoin ◽  
Jean Champagne ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Maximum Diameter ◽  
Volume Loading ◽  
Fluid Bolus ◽  
Work Up ◽  
Device Size ◽  
Laa Closure

Abstract Background In patients undergoing left atrial appendage (LAA) closure, an accurate sizing of the LAA is key to optimize device sizing, procedural success and reduce complications. Previous studies have shown that intraprocedural volume loading increases LAA dimensions and improves device sizing. However, the safety and effects on LAA and device sizing of administering a fluid bolus during pre-procedural transesophageal echocardiography (TEE) are unknown. The aim of this study was to determine the safety and impact on LAA dimensions and device sizing of an intravenous (IV) fluid bolus administered during TEE in the setting of the pre-procedural work-up for LAA closure. Methods The study included a total of 72 patients who underwent TEE to assess suitability for LAAC and received a 500 ml IV bolus of normal saline. The LAA landing zone (LZ) and depth were measured by TEE before and after volume loading, and these measurements were used to predict the device size implanted during a subsequent percutaneous LAAC procedure. Results There were no complications associated with volume loading. The baseline mean LZ was 19.6 ± 3.6 mm at 90o, and 20.2 ± 4.1 mm at 135o. Following fluid bolus, the maximum diameter increased 1.5 ± 1.0 mm at 90o (p<0.001), and 1.3 ± 1.0 mm at 135o (p<0.001). The baseline mean depth of the LAA was 26.5 ± 5.5 mm at 90o, and 23.9 ± 5.8 mm at 135o. After fluid bolus, the mean depth increased by 1.5 ± 1.8 mm (p<0.001) and 1.6 ± 2.0 (p<0.001), at 90o and 135o, respectively. Sizing based on post-bolus measurements of the LZ significantly improved the agreement with the final device size selection during the procedure in 71.0% of cases (vs. 42.0% with pre-bolus measurements). Conclusions Volume loading during ambulatory TEE as part of the pre-procedural work-up of LAAC is safe and significantly increases LAA dimensions. This strategy may become the new standard, particularly in centers performing LAAC with no TEE guidance, as it improves LAA sizing and more accurately predicts the final device size.

P3731The improvement in left atrial strain among patients undergoing percutaneous left atrial appendage closure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ijuin ◽  
A Hamadanchi ◽  
F Haertel ◽  
L Baez ◽  
C Schulze ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Lateral Wall ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Left Atrial Strain

Abstract Background Percutaneous left atrial appendage closure (LAAC) is being established as an alternative option for atrial fibrillation (AF) patients with high bleeding risk. Few studies reported the influence of percutaneous LAAC on left atrial (LA) performance, but most of the studies demonstrated no remarkable changes in their parameters after the procedure. Method The study included 95 patients (age: 75±6.7 years, 67% male) whom underwent percutaneous LAAC in a single center between September 2012 and November 2018. LA strain was evaluated at three different time intervals by transesophageal echocardiography (baseline, 45 days and 180 days after procedure). All data were analyzed using a dedicated. 70 patients had atrial fibrillation whereas 25 were in sinus rhythm. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segment of lateral wall in mid-esophageal 4 chamber view. The validity of lateral wall left atrial analysis was recently shown by our group. PACS was obtained in patients with sinus rhythm during exams. Results Compared to baseline, PALS was significantly increased after 45 days (12.4±8.4% vs 16.0±10.7%, p=0.001) and remained stable after 180 days (13.8±9.0% vs 17.0±12.4%, p=0.098). Even in only patients with atrial fibrillation during exams, it was increased (10.8±7.7% vs 13.4±7.1%, p=0.012 and 8.5±5.1% vs 13.9±8.1%, p=0.014). Similarly, compared with the baseline, PACS was significantly increased after 45 days and 180 days (5.8±3.9% vs 10.6±7.6%, p=0.001 and 4.5±2.6% vs 7.9±3.1%, p=0.036). The Changes in PALS and PACS Conclusion Our study has demonstrated for the first time the improvement in LA strain following LAAC within 45 days of implantation by transesophageal echocardiography and these values were maintained at least for 6 months. Further appraisal is warranted for confirmation of these preliminary findings.

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