经颅多普勒超声造影和经食道超声心动图造影在诊断卵圆孔未闭中的不同价值  

The distinct value of contrast transcranial Doppler and contrast transesophageal echocardiography in the diagnosis of patent foramen ovale

作　　者：杨晓雪 王华[1] 魏亚娟[1] 翟妮娜[2] 刘保民[1] 李小鹏[1] YANG Xiao-xue;WANG Hua;WEI Ya-juan;ZHAI Ni-na;LIU Bao-min;LI Xiao-peng(Department of Ultrasound,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China;Transcranial Doppler Sonography Laboratory,Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China)

机构地区：[1]西安交通大学第二附属医院超声科,陕西西安710004 [2]西安交通大学第二附属医院神经内科,陕西西安710004

出　　处：《心脏杂志》2020年第2期168-171,共4页Chinese Heart Journal

摘　　要：目的比较经颅多普勒超声造影(contrast transcranial doppler,cTCD)和经食管超声心动图造影(contrast transesophageal echocardiography,cTEE)在诊断卵圆孔未闭(patent foramen ovale,PFO)右向左分流(right to left shunt,RLS)中的不同价值。方法回顾性分析2018年1月至2019年5月因偏头痛或不明原因脑卒中于我院神经内科就诊并明确诊断为PFO的70例患者cTCD和cTEE检查的影像学资料。结果70名患者中,cTCD在静息状态下检出67%存在分流,cTEE检出43%存在分流。在Valsalva动作(Valsalva maneuver,VM)下,两种检查对PFO-RLS的检出率均提高。cTCD对PFO-RLS的检出率高于cTEE,差异有统计学意义(96%vs 83%;x^2=12.157,P<0.05),且cTCD对RLS的半定量分级明显高于cTEE(Z=40.211,P<0.05)。cTEE可以准确评估PFO的解剖形态,RLS分流程度与PFO内径呈正相关(r=0.701,P<0.05),与PFO隧道长度无相关性(r=0)。结论c TCD和c TEE是诊断PFO-RLS互补的检查方法。cTCD由于其高检出率和无创性可用于初步筛查PFORLS,对准备进一步行PFO封堵的患者,行c TEE检查观察PFO解剖形态。AIM To access the distinct values of contrast transcranial doppler(cTCD)and contrast transesophageal echocardiography(cTEE)in the diagnosis of right to left shunt(RLS)due to patent foramen ovale(PFO).METHODS The results of 70 patients with PFO and receiving cTCD and cTEE were retrospectively analyzed.RESULTS In all 70 patients,the shunt was detected at rest by cTCD in 67%and by cTEE in 43%.The positive results of 2 techniques with Valsalva maneuver(VM)was significantly improved.The rate of PFO-RLS detection of cTCD was significantly higher than cTEE(96%vs 83%;x^2=12.157,P<0.05).The degree of semi-quantitative grading of cTCD was significantly higher than that of cTEE(Z=40.211,P<0.05).The degree of RLS show a linear increase with the PFO inner diameter(r=0.701,P<0.05).The degree of RLS show no significant correlation with the tunnel length of PFO(r=0).CONCLUSION cTCD and cTEE are complementary methods for diagnosis of PFO-RLS.The cTCD should be applied as the first choice for screening PFO owing to its good pike-up rate and noninvasion.The cTEE should be performed to accurately assess the morphologies of PFO when the closure is planned.

关 键 词：卵圆孔未闭 经颅多普勒超声造影 经食管超声心动图造影 右向左分流 

分 类 号：R541.1[医药卫生—心血管疾病] R445[医药卫生—内科学]