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|本期目录/Table of Contents|

TEE联合cTCD检测小型卵圆孔未闭RLS

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第3期
页码:
277-279283
栏目:
出版日期:
2013-06-25

文章信息/Info

Title:
TEE combined with TCD detection of small patent foramen ovale and RLS
作者:
张玉顺; 何 璐; 成革胜; 何旭梅; 杜亚娟
(西安交通大学医学院第一附属医院心内二科，陕西 西安 710061)
Author(s):
ZHANG Yu shun;  HE Lu;  CHENG Ge shen;  HE Xue mei;  DU Ya juan
(Department of Cardiology, First Affiliated Hospital to Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)
关键词:
卵圆孔未闭; 经食管超声心动图; 经颅多普勒超声; 右向左分流
Keywords:
patent foramen ovale;  transesophageal echocardiography;  transcranial Doppler;  righttoleft shunt
分类号:
R541
DOI:
-
文献标识码:
A
摘要:
目的:探讨经食管超声心动图（transesophageal echocardiography，TEE） 联合经颅多普勒超声声学造影 （contrast transcranial Doppler，cTCD）对小型卵圆孔未闭（patent foramen ovale，PFO）右向左分流（righttoleft shunt，RLS）的检测。方法:单纯小型PFO患者32（男18，女14）例，年龄16～52(354±146)岁。其中并发隐性脑卒中21例、短暂脑缺血发作(TIA) 6例和偏头痛5例。隐性脑卒中均经头颅CT或MRI证实有脑梗死病灶，排除其他脑梗死原因，如主动脉和脑血管病变，及左心系统疾病等。TEE检查PFO裂隙宽度<2 mm,均不并发房间隔瘤。结果:32例患者，TEE测量PFO裂隙宽度为06～20(14±05) mm，彩色多普勒均无RLS。cTCD分流量Ⅰ级4例（12.5%），Ⅱ级11例（34.4%），Ⅲ级9例（28.1%）以及Ⅳ级8例（25%）。4例（125%）PFO无RLS，20例（62.5%）Valsalva动作后发生RLS，8例（25%）静息状态就有RLS。32例有28例行介入封堵治疗，其中cTCD Ⅲ级以上的17例均顺利完成手术，平均手术时间(23.5±7.3) min。cTCDⅡ级11例患者有5例为10个以下微栓子信号，均未封堵成功，6例有10～20个微栓子信号均封堵成功，但平均手术时间为(65.5±18.4) min，明显长于cTCD Ⅲ级以上组（P<0.01）。结论:同时测定PFO大小和RLS，才能准确反映PFO反常栓塞的临床状况。
Abstract:
AIM:To compare the abilities of transesophageal echocardiography(TEE) and contrast transcranial Doppler (cTCD) to detect a righttoleft shunt(RLS) and small patent foramen ovale(PFO). METHODS: A total of 32 patients(18 men and 14 women), age 16 to 52 (mean 354±146) years old with small PFO were evaluated. Among them, 21cases were cryptogenic stroke, 5 cases were transient ischemic attack and 5 cases were migraine. The cryptogenic stroke with infarction lesions was comfired by CT or MRI without other identifiable cause, such as aorta and cerebral vascular disease, left ventricular system disease in patients. The average diameter of PFO was less than 2 mm, and atrial septum aneurysm may not be identified. RESULTS: The average diameter of PFO in 32 patients was 06 to 20 (14±05) mm by TEE without RLS by color Doppler.The degree of RLS was evaluated by cTCD,including 4 cases (125%) of grade Ⅰ,11 cases (344%) of grade Ⅱ, 9 cases(282%) of grade Ⅲ and 8 cases(25%) of gradeⅣ. In all, 4 of 32 cases(125%) without RLS, 20 cases(625%) with RLS after Valsalva maneuver and 8 cases(25%) with RLS at rest. 32 patients with 28 cases of transcatheter closure treatment, which the cTCD III more than 17 cases were successfully completed surgery, mean operative time was (235±73) min, cTCD II level 11 patients in 5 patients less than 10 microemboli signals are not successful closure, six cases of 10 to 20 microemboli signals are occluded successfully, but the average operative time was (655±184) min obvious longer than the cTCD level III group (P<001). CONCLUSIONS: Simultaneous determination of the PFO size and RLS volume, in order to accurately reflect the clinical status of the PFO paradoxical embolism.

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备注/Memo

备注/Memo:
收稿日期：2013-04-08.
通讯作者：张玉顺，主任医师，主要从事先天性心脏病介入治疗研究Email:zys2889@sina.com
更新日期/Last Update: 2013-07-16