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|本期目录/Table of Contents|

卵圆孔未闭结构特征对介入治疗封堵器选择的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
387-389
栏目:
结构性心脏病
出版日期:
2015-04-20

文章信息/Info

Title:
Association of anatomic features of patent foramen ovale with occluder selection for transcatheter closure
作者:
成革胜; 张玉顺; 何 璐; 王星烨; 杜亚娟
(西安交通大学第一附属医院心内二科，陕西 西安 710061)
Author(s):
CHENG Ge-sheng;  ZHANG Yu-shun;  HE Lu;  WANG Xing-ye;  DU Ya-juan
(Department of Cardiology, First Hospital Affiliated, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)
关键词:
经导管封堵; 卵圆孔未闭; 封堵器
Keywords:
transcatheter closure;  patent foramen ovale;  occluder
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 探讨卵圆孔未闭（PFO）结构特征对介入治疗封堵器选择的影响。方法 回顾性分析98例拟进行PFO封堵治疗患者临床资料，按经胸超声心动图(TTE)和（或）经食管超声心动图(TEE)检查结果分为简单PFO组和复杂PFO组，比较两组患者封堵器的选择及疗效。结果 PFO患者98（男41，女57）例，年龄8~74(41±14)岁。92例封堵成功，6例未成功，其中导丝无法到达左房4例，肺动静脉瘘1例，并发肺动脉高压患者1例。手术总成功率为94%。简单PFO组42例，复杂PFO组56例，简单PFO以18/25 mm PFO封堵器为主，复杂PFO以30/30 mm和25/35 mm PFO封堵器为主，两组间封堵器的选择有显著差异（P<0.01）。术后半年复查经胸超声心动图声学造影（cTTE），完全堵闭65例（71%），Valsalva动作后有右向左分流（RLS）27例（29%），其中少量20例(22%)，中量4例(4%)，大量3例(3%)。大量RLS均发生在复杂PFO组应用30/30 mm和25/35 mmPFO封堵器的患者。复杂PFO组有1例新发阵发性心房纤颤。结论 封堵器选择与PFO特征有关，简单PFO以18/25 mm PFO封堵器为主，复杂PFO以30/30 mm和25/35 mm PFO封堵器为主。
Abstract:
AIM To investigate the association of structural features of patent foramen ovale (PFO) with occluder selection for transcatheter closure. METHODS Retrospective assessment of 98 consecutive patients who underwent PFO closure was made and the patients were divided into simple PFO group and complex PFO group according to the results of transthoracic echocardiography (TTE) and/or transesophageal echocardiography (TEE). Occluder size and efficacy were evaluated and compared between the two groups. RESULTS In the 98 patients (41 males, 57 females; aged from 8-74 years, mean age 41±14 years), the operation was successful in 92 cases, with the success rate of 93.9%. Of the 6 unsuccessful cases: 4 cases were failure of wire getting through the atrial septum, 1 case was pulmonary arteriovenous fistula and 1 case was pulmonary hypertension. Of the 98 cases, 42 cases were simple PFO and 56 cases were complex PFO. A 18/25 mm device was selected for most cases in simple PFO and 30/30 mm and 25/35mm devices were selected for most cases in complex PFO. Statistical significance between the two groups was assumed with a P value <0.01. Complete PFO closure as assessed by contrast TTE after the Valsalva maneuver at 6 months was achieved in 65(70.7%) of the patients, whereas a minimal, moderate, and large residual shunt persisted respectively in 20(21.7%) cases, 4(4.3%) cases and 3(3.3%) cases. Patients with 30/30mm and 25/35 mm devices had considerably large residual shunts. In complex PFO group, paroxysmal atrial fibrillation occurred in 1 case. CONCLUSIONT ranscatheter PFO closure is a safe and effective treatment, and the occluder selection for transcatheter closure is associated with the structural features of patent foramen ovale. A 18/25 mm device is selected for most simple PFO and 30/30 mm and 25/35 mm devices are used for most complex PFO.

参考文献/References

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[3]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.
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[5]Eustaquio Onorato,Fscai,Francesco Casilli.Influence of PFO Anatomy on Successful Transcatheter Closure[J].Intervent Cardiol Clin,2013,2(1):51-84.
[6]李 越,翟亚楠,魏丽群,等.经食管与经胸超声心动图造影检出卵圆孔未闭右向左分流效果比较[J].中华医学超声杂志(电子版),2013,10(11):44-48
[7]Wahl A,Tai T,Praz F,et al.Late results after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism using the amplatzer PFO occluder without intraprocedural echocardiography:effect of device size[J].JACC Cardiovasc Interv,2009,2(2):116-123.

备注/Memo

备注/Memo:
收稿日期：2015-03-16.
通讯作者：张玉顺，教授，主要研究先心病的诊断和介入治疗 Email：zys2899@sina.com
作者简介：成革胜，主治医师，硕士 Email：cgs501@163.com
更新日期/Last Update: 2015-04-22