经导管封堵卵圆孔未闭预防脑的矛盾栓塞  

Transcatheter Closure of Patent Foramen Ovale With Amplatzer Devices

作　　者：王广义[1] 郭军[1] 王峙峰[1] 智光[1] 盖鲁粤[1] 李越[2] 温朝阳[2] 

机构地区：[1]中国人民解放军总医院心内科,北京市100853 [2]中国人民解放军总医院超声科,北京市100853

出　　处：《中国循环杂志》2005年第1期17-20,共4页Chinese Circulation Journal

摘　　要：目的:经导管封堵卵圆孔未闭(PFO)预防脑的矛盾栓塞并评价其疗效。 方法:本组共32例,年龄15-68(50.2±8.1)岁,体重40-72(53.7±4.3)kg。均经临床及经胸超声心动图(TTE)或经食道超声心动图(TEE)检查证实为PFO合并右向左分流伴脑缺血事件、单纯PFO、PFO合并房间隔瘤或房间隔瘤合并多孔房间隔缺损(房缺)。32例术前均有不同程度的偏头痛,不明原因的晕厥22例,用力性晕厥3例,短暂性语言障碍3例,缺血性脑梗塞4例。20例声学造影显示微泡从右心房进入左心房。PFO合并房间隔瘤、房间隔瘤合并多孔房缺的患者在TTE或TEE下测量房间隔的伸展径,选用房缺封堵器进行介入治疗;对单纯PFO的患者选用PFO封堵器经9-12F的鞘管置入,进行介入治疗。 结果:本组技术成功率为100％。所有患者均能成功置放封堵器。术后24 h,1个月,3个月,6个月,12个月行TTE检查未见封堵器移位。术后1个月复发偏头痛患者1例,1例房间隔瘤患者术后3个月用力时发生头晕症状。 结论:经导管封堵PFO是一种较有效的非手术方法,可用于预防脑的矛盾栓塞。Objective:To evaluate the feasibility of transcatheter closure of patent foramen ovale(PFO)to prevent paradoxical embolism with Amplatzer occluder device. This paper, however, is to report on our clinical experience with this device.Methods:Between March 2000 to October 2004,32 patients ( average age 50.2±8. 1 years; range, 15-68 years; average weight 3. 7±4. 3 kg; range 40-72 kg) was diagnosed as having PFO. Transthoracic echocardiography (TTE) or transesophageal echocardiography(TEE) demonstrated PFO with right to left shunt,PFO alone and PFO with atrial septal aneurysm and 1 or with fenestrated atrial seplal defects(ASD). All patients had different degrees of migraine 22 had cryptogenic syncope ,3 had exertional syncope and transient language disorder,and 4 had ischemic cerebral infarction. Right atrial Echo angiography showed microbub-ble from right atrium into left atrium in 20 patients. ASD devices were selected after atrial septal stretching diameter was measured by TTE and TEE. In case of PFO with atrial septal aneurysm or atrial septal aneurysm with fenestrated ASD. The special PFO device was selected for patients with PFO alone. Devices were placed correctly in all patients. F9-12 catheters were used for deliveryof the device in all patients.Results :The success rate of the technique was 100% for this group. At 24 hours and 1,3 ,6,12 months after procedure, complete closure of PFO was found in all patients. Recurrent migraine occurred in one patient at one month after procedure and exer-lional dizziness occurred in one patient at 3 months after procedure.Conclusion: Transcatheter closure of patent foramen ovale with Amplatzer devices was a relatively efficient nonsurgical method.

关 键 词：栓塞 经导管封堵 卵圆孔未闭 对照组 患者 适应证 不明原因 矛盾 文献 严格 

分 类 号：R541[医药卫生—心血管疾病] R743[医药卫生—内科学]