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|本期目录/Table of Contents|

卵圆孔未闭并发小房间隔缺损的介入治疗

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
384-386
栏目:
结构性心脏病
出版日期:
2015-04-20

文章信息/Info

Title:
Transcatheter closure in patients with patent foramen ovale accompanied with a small atrial septal defect
作者:
何 璐1成革胜1赵 洋2王星烨1杜亚娟1王英丽2张玉顺1
(1.西安交通大学第一附属医院心内二科,陕西 西安 710061;
2.延安大学咸阳医院心内科,陕西 咸阳 712000)
Author(s):
HE Lu1CHENG Ge-sheng1ZHAO Yang2WANG Xing-ye1DU Ya-juan1WANG Ying-li2ZHANG Yu-shun1
(1.Second Department of Cardiology, First Affiliated Hospital, Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi, China;
2.Department of Cardiology, Xianyang Hospital, Yan’an University, Xianyang 712000, Shaanxi, China)
关键词:
卵圆孔未闭房间隔缺损介入治疗经胸超声心动图声学造影右向左分流
Keywords:
patent foramen ovale atrial septal defect transcatheter closure contrast transthoracic echocardiography right-to-left shunt
分类号:
R541.1
DOI:
-
文献标识码:
A
摘要:
目的 评价卵圆孔未闭(PFO)并发小房间隔缺损(ASD)介入治疗的有效性和安全性。方法 PFO并发小ASD患者18(男7,女11)例,其中不明原因卒中6例,偏头痛12例, 年龄21~58(36±13)岁,均行介入治疗。结果18例PFO并发小ASD患者,PFO直径2~4(2.7±0.8)mm,ASD直径3~5(4.0±0.9)mm,10例两孔间距离<7 mm,5例8~12 mm,3例>12 mm。15例患者置入单封堵器,3例置入双封堵器。术前经胸超声心动图声学造影(cTTE)静息状态均有右向左分流(RLS),Valsalva动作(VM)后大量RLS。术后18例患者静息状态下均无RLS,15例置入单封堵器者术后:1个月VM后均为大量RLS,3个月11例为少~中量RLS及4例为大量RLS,6个月4例为大量RLS,其余11例无RLS。3例置入双封堵器者术后1个月VM后为大量RLS、3个月为中量RLS,而6个月均无RLS。6例不明原因脑卒中患者复查头颅MRI无新发梗死病灶。12例偏头痛患者,封堵术后6个月1例无明显改善,11例患者症状消失或明显减轻。HIT-6评分较术前明显减少〔(66±10)分 vs.(42±10)分,P<0.01〕。结论介入治疗PFO并发小ASD是一种安全有效的方法,但短期内仍有部分患者存在RLS,尤其是置入单封堵器者。
Abstract:
AIM To evaluate the efficacy and safety of transcatheter closure in patients with patent foramen ovale (PFO) accompanied with a small atrial septal defect (ASD). METHODSE ighteen PFO patients accompanied with a small ASD (7 males, 11 females; age 21-58 years (36±13) years, including 6 with cryptogenic stroke and 12 with migraine underwent interventional treatments. RESULTS In the 18 patients, the diameter of PFO was 2-4(2.7±0.8) mm and the diameter of ASD was 3-5(4.0±0.7) mm. The distance between two holes was <7 mm in 10 patients, 8-12 mm in 5 patients and >12 mm in 3 patients. Fifteen patients were implanted with single occluder and 3 patients with double occluders. Contrast transthoracic echocardiography (cTTE) showed that all the patients had right-to-left shunt (RLS) pre-operation at rest and that after Valsalva maneuver (VM), a large amount of RLS was indicated. Eighteen patients showed no RLS at rest post-operation. Patients implanted with single occluder showed that after operation and after Valsalva maneuver (VM), a large amount of RLS was indicated in all the patients at 1 month, a small to moderate amount of RLS was found in 11 patients and a large amount of RLS in 4 patients at 3 months, a large amount of RLS in 4 patients and no RLS in the other 11 patients at 6 months. In the 3 patients implanted with double occluders, after VM a large amount of RLS was found at 1 month, a moderate amount of RLS at 3 months and no RLS at 6 months. No fresh infarction lesions were found by brain MRI in the follow-ups for the 6 patients with cryptogenic stroke. Among the 12 patients with migraine, 11 showed significantly improved migraine symptoms at 6 months after the closure procedure. HIT-6 score significantly decreased compare with that pre-operation (66.5±10.4 vs. 42.3±9.5, P<0.01). CONCLUSIONT ranscatheter closure of PFO accompanied with a small ASD is safe and effective, even though RLS still occurs in some patients, especially those implanted with single occluder.

参考文献/References

[1]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):1092-100.
[2]Caputi L,Butera G,Anzola GP,et al.Residual shunt after patent foramen ovale closure: preliminary results from Italian patent foramen ovale survey[J].J Stroke Cerebrovasc Dis,2013,22(7):e219-e226.
[3]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.
[4]杜亚娟,张玉顺,成革胜.TTE结合cTTE在成人PFO诊断及分流方向判定中的应用研究[J].中国超声医学杂志,2014,30(9):800-803.
[5]Kosinski M,Bayliss MS,Bjorner JB,et al.A six-item short-form survey for measuring headache impact:the HIT-6[J].Qual Life Res,2003,12(8):963-974.
[6]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.
[7]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.
[8]Franke J,Boehm P.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
[9]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.

备注/Memo

备注/Memo:
收稿日期:2015-03-13.
基金项目:陕西省科技统筹创新工程计划项目资助(2014KTCL03-11)
通讯作者:张玉顺,教授,主要从事结构性心脏病的介入诊断与治疗 Email:zys2889@sina.com
作者简介:何璐,主治医师,博士 Email:helu926@foxmail.com
更新日期/Last Update: 2015-04-22