卵圆孔未闭介入封堵治疗及近期随访研究  

Transcatheter Closure and its Short-term Follow-up Study in Patients With Patent Foramen Ovale

作　　者：李世军[1] 岳庆雄[1] 王苏平[1] 潘晓芳[1] 赵红玲[1] 王琳[1] 庞占琪[1] 董赫[1] 杨健[1] 李亚文[1] 马奔[1] 孙喜琢[1] 

机构地区：[1]大连医科大学附属大连市中心医院心脏电生理科,辽宁省大连市116033

出　　处：《中国循环杂志》2014年第6期448-452,共5页Chinese Circulation Journal

基　　金：大连市领军人才支持项目(2012)

摘　　要：目的:评价卵圆孔未闭(PFO)封堵治疗的有效性、安全性及术后残余分流发生情况。方法:对24例卵圆孔未闭患者进行封堵治疗[包括偏头痛15例,其中头颅电子计算机断层摄影术(CT)提示双侧皮层及皮层下多发小灶脑梗死3例,不明原因卒中9例,偏头痛合并卒中3例]。分别在术后即刻行经胸壁超声心动图右心声学造影联合经颅多普勒超声发泡试验(c-TCD)检查,在术后3天、1个月、3个月行经颅多普勒超声发泡试验及经胸壁超声心动图检查,在术后第6个月行经胸壁超声心动图右心声学造影联合经颅多普勒超声发泡试验及头颅电子CT检查。偏头痛患者在术前及术后1、3、6个月行头痛影响测定-6(HIT-6)评分。结果:共21例成功封堵,3例不明原因卒中患者未能通过未闭的卵圆孔,放弃封堵治疗。封堵术后3天、1个月、3个月、6个月经颅多普勒超声发泡试验提示右向左残余分流分别为7例、4例、3例、3例。封堵术后经胸壁超声心动图右心声学造影检查提示残余分流少量、中量、大量封堵术后即刻分别为8例、1例、0例和6个月分别为1例、1例、1例。所有患者复查头颅电子CT无新发梗死病灶。21例中有15例出现偏头痛,其中14例患者封堵术后6个月偏头痛症状明显改善(P<0.001)。所有封堵患者无卒中再发。结论:介入封堵治疗卵圆孔未闭可预防卒中再发及改善偏头痛症状,但短期内仍有部分患者存在残余右向左分流,有待于进一步研究。Objective： To evaluatethe efficacy, safety and residual shunt of transcatheter closure in patients with patent foramen ovale （PFO）. Methods： A total of 24 PFO patients received transcatheter closure in our hospital were summarized including 15 patients with migraine, 9 with stroke, 3 with small infacts and 3 with migraine and stroke. The transthoracic echocardiography and contrast transeranial Doppler （c-TCD） were examined immediately after transcatheter closure and at 3 days, 1, 3 months after closure. The above examination with head CT were checked in all patients at 6 months after closure. HIT-6 score was measured before and at 1,3, 6 months safter closure in migraine patients. Results： Successful transcatheter closure obtained in 21 patients and 3 stroke patients failed the closure. At 3 days, 1, 3, 6 months after closure, c-TCD indicated that the residual shunt occurred in 7, 4, 3, 3 eases; the small, moderate, large amount of residual shunt at immediately after closure occurred in 8, 1, 0 cases, and at 6 months after closure occurred in 1, 1, 1 cases respectively. Head CT showed that no patients had new ischemia lesion and no stroke after the closure. There were 15/21 patients suffered from migraine and 14/15 had obviously improved symptoms at 6 months after closure, P〈0.001. Conclusion： Transcatheter closure may prevent stroke recurrence and improve the migraine symptoms in PFO patients, while short-term residual shunt occurred in some patients which needs further investigation.

关 键 词：卵圆孔未闭 介入封堵治疗 多普勒发泡试验 经胸壁超声心动图右心声学造影 残余分流 

分 类 号：R541[医药卫生—心血管疾病]