CCTA and LAAC
PDL is a common phenomenon post LAAC. TEE used to be the most common
used method for the preoperative and postoperative evaluation of LAAC,
including the detection of post procedure PDL. In recent years, studies
demonstrated that CCTA could be a promising alternative to TEE on the
preoperative and postoperative evaluation of
LAAC[9]. The high spatial resolution and
multi-planar reconstruction capability of CCTA can therefore effectively
evaluate the relevant preoperative indicators, and the postoperative
complications post LAAC.
CCTA examination before LAAC can assist the three-dimensional
electrophysiological mapping system to construct the LA model during
catheter ablation [10]. In addition, preoperative
CCTA can measure the maximum diameter of LAA orifice to select the
appropriate size of the Watchman device. In our study, the preoperative
TEE defined average value of the
maximum diameter of LAA orifice was 22.6 ± 3.2 mm, while the value
defined by CCTA was 27.8 ± 5.2 mm(P < 0.001), suggesting that
the maximum diameter of LAA orifice measured by TEE was underestimated.
Previous study also showed comparable measurement results of LAA orifice
derived either form CCTA with DSA or intracardiac echocardiography
(ICE), while there was poor consistence on measurement results of LAA
orifice derived from TEE and other modalities[11].
In line with previous report[12], smaller LAA
orifice was also demonstrated in our study. Above results thus suggest
that there is a potential risk to select smaller LAAC device, if the
choice was made surely on preoperative TEE measurement, which might
evidently increase the risk of postoperative PDL. Thus, preoperative
CCTA should be integrated into the preoperative algorithm to reduce the
risk of PDL.
In our study, postoperative CCTA was done to evaluate the presence of
PDL and device endothelialization at
6 months post LAAC. Previous study found that the detection efficacy on
detecting post LAAC PDL was higher by CCTA than by TEE (51.0% vs.
34.3%, P = 0.016)[13].