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Title:: Clinical study of transcatheter closure of patent foramen ovale with cryptogenic stroke

作者:: 成革胜; 张玉顺; 何璐; 杜亚娟; 王星晔; (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):: CHENG Gesheng; ZHANG Yushun; HE Lu; DU Yajuan; WANG Xingye; (Second Department of Cardiology, First Affiliated Hospital, Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China)

关键词:: 经导管封堵; 卵圆孔未闭; 卒中

Keywords:: transcatheter closure; patent foramen ovale; cryptogenic stroke

分类号:: R541

DOI:: -

文献标识码:: A

摘要:: 目的:探讨封堵治疗卵圆孔未闭（patent foramen ovale，PFO）并发不明原因缺血性脑卒中患者的临床疗效及安全性。方法:26例缺血性脑卒中患者，均经头颅CT或磁共振成像（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。经颅多普勒超声(TCD)声学造影判断有右向左分流，经胸超声心动图(TTE)和（或）经食管超声心动图（TEE)证实为PFO或PFO并发房间隔瘤。所有患者均行PFO封堵治疗。结果:26例患者，静息超声测量PFO大小为10～4.6(2.8±1.2) mm，其中5例PFO并发房间隔瘤。TCD声学造影分流量Ⅰ级6例，Ⅱ级9例，Ⅲ级以上11例。24例封堵成功，技术成功率为92%，所用封堵器18 mm 6个、25 mm 7个、30 mm 8个及35 mm 3个。未成功病例2例，主要原因为导丝无法到达左房。术后随访6个月～1年，TTE检查未见封堵器移位及心房水平残余分流，TCD声学造影检查均无右向左分流，所有患者无再发缺血性脑梗死。结论:经导管封堵PFO是一种安全有效的治疗方法，可有效减少缺血性脑卒中的再发生。。

Abstract:: AIM:To evaluate the therapeutic efficacy and safety of transcatheter closure of patent foramen ovale (PFO) with cryptogenic stroke. METHORDS: Infarction lesions were confirmed by CT or MRI in 26 patients of PFO with ischemic stroke (aged 35±12 years, ranging from 7 to 52 years) and other identifiable causes, such as aorta and cerebral vascular disease or left ventricular system disease were excluded. TCD displayed right to left shunting through PFO during Valsalva and TTE/TEE confirmed atrial septum aneurysm (ASA). All patients underwent transcatheter closure of patent foramen ovale. RESULTS: TEE showed that the average diameter of PFO in the 26 patients was 3±1 mm (ranging from 1 to 5 mm) and 5 cases were defined as PFO with ASA. TCD and bubble test assessed the degree of shunting, including 6 cases of grade 1, 9 cases of grade 2, and 11 cases of above grade 3. Twentyfour cases were successfully occluded, with the success rate of 923%. The size of occluder was from 18 to 35mm, including 6 cases of 18mm, 7 cases of 25mm, 8 cases of 30mm and 3 cases of 35mm. The main cause for the two unsuccessful cases was the failure of the wire to get through the atrial septum. No displacement of occluder and no residual shunt were observed by TTE during the 6month to 1year followup. No recurrence of ischemic cerebral infarction occurred. CONCLUSION: Transcatheter interventional occlusion of PFO is a safe and effective, which effectively reduces the recurrence of ischemic stroke.

参考文献/References

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卵圆孔未闭并发不明原因脑卒中患者封堵治疗的疗效和安全性

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

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