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|本期目录/Table of Contents|

卵圆孔未闭处理策略中国专家建议

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
373-379
栏目:
专家共识
出版日期:
2015-04-20

文章信息/Info

Title:
Recommendations from Chinese experts on management of patients with patent foramen ovale
作者:
张玉顺;  朱鲜阳
(中国医师协会心血管内科医师分会)
Author(s):
-
(Chinese College of Cadiovascular Physicians)
关键词:
卵圆孔未闭; 封堵; 卒中
Keywords:
patent foramen ovale;  cryptogenic stroke;  transcatheter closure
分类号:
R541.7；R543.3
DOI:
-
文献标识码:
A
摘要:
据估算，约1/4的成人存在卵圆孔未闭（PFO）。长期以来认为PFO不会造成临床后果。近年来，越来越多的研究发现，PFO患者发生脑卒中、偏头痛、外周动脉栓塞、减压病等风险较正常人群呈数倍升高，其致病作用才引起了广大专家和学者的关注。经皮PFO封堵术安全、有效，但PFO人群基数大，为规范PFO封堵术的临床应用，在借鉴国内外最新研究的基础上，结合我国具体情况，国内本领域专家形成了《卵圆孔未闭处理策略中国专家建议》，以供参考。
Abstract:
Patent foramen ovale (PFO) is a common development anomaly that allows for the passage of blood and other substances from the right-sided (venous) to the left (arterial) circulation. During recent years, the pathogenic effects of PFO have aroused the attention of experts and scholars. PFO is associated with cryptogenic stroke, migraine and platypnea orthodeoxia syndrome, but uncertainty remains about the exact relationship and the best management. Percutaneous closure of PFO is safe and effective, and this procedure has been definitely proven to be better than medical therapy. Paradoxical embolism is a rare event occurring over decades rather than years. None of the 4 randomized trials published carried enough patients or was followed up for long enough to reach superiority endpoints. All data, however, point to a benefit of PFO closure. They are outweighed by the supposedly prevented events of paradoxical embolisms, such as stroke, transient ischemic attacks, or other systemic embolisms. Medical treatment with perhaps the exception of lifelong oral anticoagulation provides less protection. A 10-year follow-up of a comparative study reports that the annual mortality in the patients with PFO closure (0.4%) is significantly lower than that in those with medical treatment (1.1%, P<0.05). However, the evidence-based research is still controversia.

参考文献/References

[1]Hagen PT,Scholz DG,Edwards WD.Incidence and size of patent foramen ovale during the first 10 decades of life:an autopsy study of 965 normal hearts[J].Mayo Clin Proc,1984,59(1):17-20.
[2]Furlan AJ,Reisman M,Massaro J,et al.Closure or medical therapy for cryptogenic stroke with patent foramen ovale[J].N Engl J Med,2012,366(11):991-999.
[3]Carroll JD,Saver JL,Thaler DE,et al.Closure of patent foramen ovale versus medical therapy after cryptogenic stroke[J].N Engl J Med,2013,368(12):1092-1100.
[4]Meier B,Kalesan B,Mattle HP,et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism[J].N Engl J Med,2013,368(12):1083-1091.
[5]Mckenzie JA,Edwards W,Hagler DJ.Anatomy of the patent foramen ovale for the interventionalist[J].Catheter Cardiovase Interv,2009,73(6):821-826.
[6]Onorato E,Casilli F.Influence of PFO anatomy on successful transcatheter closure[J].Invervent Cardiol Clin,2013,2(1):51-84.
[7]Rana BS,Shapiro LM,McCarthy KP,et al.Three-dimensional imaging of the atrial septum and patent foramen ovale anatomy: defining the morphological phenotypes of patent foramen ovale[J].Eur J Echocardiogr,2010,11(10):i19-i25.
[8]Schuchklenz HW,Weihs W,Hoener S,et al.The association betweenthe diameter of a patent foramen oval and the risk of cerebrovascular events[J].Am J Med,2000,109(6):456-462.
[9]Homma S,Di Tullio MR,Sacco RL,et al.Characteristics of patent foraman ovale associated with cryptogenic stroke[J].Stroke,1994,25(3):582-586.
[10]Hanna JP,Ping Sun J,Furlan AJ,et al.Patent foramen Ovale and brain infarct:echocardiographic predictors, recurrence, and prevent[J]. Stroke,1994,25(4):782-786.
[11]Agmon Y,Khanderia BK,Meissner I,et al.Frequency of atrial septal aneurysms in patients with cerebral ischemic events[J].Circulation,1999,99(15):1942-1944.
[12]De Castro S,Cartoni D,Fiorelli M,et al.Morphological and functional characteristics of patent foramen ovale and their embolic implications[J].Stroke,2000,31(10):2407-2413.
[13]Rana BS,Thomas MR,Calvert PA,et al.Echocardiographic evaluation of patent foramen ovale prior to device closure[J].J Am Coll Cardiol Img, 2010, 3(7):749-760.
[14]Ha JW,Shin MS,Kang S,et al.Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging[J].Am J Cardiol,2001,87(5):669-671.
[15]Zuber M,Cuculi F,Oechslin E,et al.Is transesophageal echocardiography still necessary to exclude patent foramen ovale?[J].Scand Cardiovasc J,2008,42(3):222-225.
[16]Soliman OI,Geleijnse ML,Meijboom FJ,et al.The use of contrast echocardiography for the detection of cardiac shunts[J].Eur J Echocardiogr,2007,8(3):S2-S12.
[17]Jauss M,Zanette E.Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography[J].Cerebrovasc Dis,2000,10(6):490-496.
[18]Kim BJ,Sohn H,Sun BJ,et al.Imaging characteristics of ischemic strokes related to patent foramen ovale[J].Stroke,2013,44(12):3350-3356.
[19]Thaler DE,Ruthazer R,Di Angelantonio E,et al.Neuroimaging findings in cryptogenic stroke patients with and without patent foramen ovale[J].Stroke 2013,44(3):675-680.
[20]Kent DM,Ruthazer R,Weimar C,et al.An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke[J].Neurology,2013,81(7):619-625.
[21]Sacco RL,Ellenberg JH,Mohr JP,et al.Infarcts of undetermined cause:the NINCDS Stroke Data Bank[J].Ann Neurol,1989,25(4):382-390.
[22]Sattirju S,Masri SC,Liao K,Missov E.Three-dimensional transesophageal echocardiography of a thrombus entrapped by a patent foramen ovale[J].Ann Thorac Surg,2012,94(4):e101-e102.
[23]Hust MH,Staiger M,Braun B.Migration of paradoxic embolus through a patent foramen ovale diagnosed by echocardiography:successful thrombolysis[J].Am Heart J,1995,129(3):620-622.
[24]Homma S,Sacco RL.Patent foramen ovale and stroke[J].Circulation,2005,112(7):1063-1072.
[25]Alsheikh-Ali AA,Thaler DE,Kent DM.Patent foramen ovale in cryptogenic stroke:incidental or pathogenic?[J].Stroke,2009,40(7):2349-2355.
[26]Meissner I,Khandheria BK,Heit JA,et al.Patent foramen ovale:innocent or guilty?Evidence from a prospective population-based study[J].J Am Coll Cardiol,2006,47(2):440-445.
[27]Di Tullio MR,Jin Z,Russo C,et al.Patent foramen ovale, subclinical cerebrovascular disease,and ischemic stroke in a population-based cohort[J].J Am Coll Cardiol,2013,62(1):35-41.
[28]Windecker S,Wahl A,Nedeltchev k,et al.Comparison of medical treatment with percutaneous closure of Patent foramen ovale in patients with cryptogenic stroke[J].J Am Coll Cardiol,2004,44(4):750-758.
[29]Wahl A,Juni P,Mono ML,et al.Long-term propensity score-matched Comparison of percutaneous closure of Patent foramen oval with medical treatment after paradoxical embolism[J].Circulation,2012,125(6):803-812.
[30]Gafoor S,Franke J,Boehm P,et al.Leaving no hole unclosed:left atrial appendage occlusion in patients having closure of patent foramen ovale or atrial septal defect[J].J Interv Cardiol,2014,27(4):414-422.
[31]Pandit A,Aryal MR,Pandit AA,et al.Amplatzer PFO occlude device may prevent recurrent stroke in patients with patentforamen ovale and cryptogenic stroke:a meta-analysis of randomized trials[J].Heart Lung Circ,2014,23(4):303-308.
[32]Khan AR,Bin Abdulhak AA,Sheikh MA,et al.Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke[J].J Am Coll Cardiol Intv,2013,6(12):1316-1323.
[33]Hornung M,Bertog SC,Franke J,et al.Long-term results of a randomized trial comparing three different devices for percutaneous closure of a Patent foramen ovale[J].Eur Heart J,2013,34(43):3362-3369.
[34]Stortecky S,da Costa BR,Mattle HP,et al.Percutaneous closure of Patent foramen oval in patients with cryptogenic embolism:a network meta-nalysis[J].Eur Heart J,2015,36(2):120-128.
[35]Del Sette M,Angeli S,Leandri M,et al.Migraine with aura and right-to-left shunt on transcranial Doppler:a case-control study[J].Cerebrovasc Dis,1998, 8(6):327-330.
[36]Lip PZY, Lip GYH. Patent foramen oval and migraine attacks:a systematic review[J].Am J Med,2014,127(5):411-420.
[37]Yang Y,Guo ZN,Wu J,et al.Prevalence and extent of right-to-left shunt in migraine:a survey of 217 Chinese patients[J].Eur J Neurol,2012,19(10):1367-1372.
[38]Davis D,Gregson J,Willeit P,et al.Patent foramen ovale,ischemic stroke and migraine:systematic review and stratified meta-analysis of association studies[J].Neuroepidemiology,2013,40(1):56-67.
[39]De Heij AH,Luermans JGLM,Thijis V,et al.Patent foramen ovale with atrial septal aneurysm is a strong independent predictor for migraine with aura: a large prospective observational study[J].Eur Heart J,2010,31(s1): 865-865.
[40]Reisman M,Christofferson RD,Jesurum J,et al.Migraine Headache Relief After Transcatheter Closure of PFO[J].J Am Coll Cardiol,2005,45(4):493-495.
[41]Rigatelli G,Dell'Avvocato F,Cardaioli P,et al.Improving migraine by means of primary transcatheter patent foramen ovale closure: long-term follow-up[J].Am J Cardiovas Dis,2012,2(2):89-95.
[42]Kimmelstiel C,Gang C,Thaler D.Is patent foramen ovale closure effective in reducing migraine ?A control study[J].Catheter Cardiovasc Interv,2007,69(5):740-746.
[43]Dowson A,Mullen MJ,Peatfield R,et al.Migraine Intervention With STARFlex Technology(MIST)trial:a prospective,multicenter,double-blind,sham-controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache[J].Circulation,2008,117(11):1397-1404.
[44]Butera G,Biondi-Zoccai GG,Carminati M,et al.Systematic review and meta-analysis of currently available clinical evidence on migraine and patent forman ovale percutaneous Closure:much do about nothing?[J].Catheter Cardiovasc Interv,2010,75(4):494-504.
[45]Homma S,Sacco RL,Di Tullio MR,et al.PFO in Cryptogenic Stroke Study(PICSS)Investigators.Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study[J].Circulation,2002,105(22):2625-2631.
[46]Mas JL,Arquizan C,Lamy C,et al.Patent foramen ovale and atrial septal aneurysm study group.Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm,or both[J].N Engl J Med, 2001, 345(24):1740-1746.

备注/Memo

备注/Memo:
收稿日期：2015-03-13.
通讯作者： 张玉顺，教授，主要从事先天性心脏病介入治疗研究 Email:zys2889@sina.com
共同通讯作者：朱鲜阳，主任医师，主要从事先天性心脏病介入治疗研究 Email:xyangz@yahoo.com.cn
更新日期/Last Update: 2015-04-22