对比增强经颅多普勒超声声学造影对卵圆孔未闭介入封堵的评估  

Evaluation of contrast enhanced transcranial doppler for interventional treatment of patent foramen ovale

作　　者：沈群山[1] 郑璇[1,2] 黎枫[1] 李丁扬 金博文 邓晓娴[1] 龙恺[1] 姚艺[1] 张航[1] 余洁 景驰 张刚成[1] SHEN Qun-shan;ZHENG Xuan;LI Feng;LI Ding-yang;JIN Bo-wen;DENG Xiao-xian;LONG Kai;YAO Yi;ZHANG Hang;YU Jie;JING Chi;ZHANG Gang-cheng(Center for Congenital Heart Diseases,Wuhan Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院先心病中心,湖北武汉430022 [2]武汉亚洲心脏病医院分子心脏病学实验室

出　　处：《中国介入心脏病学杂志》2021年第5期271-274,共4页Chinese Journal of Interventional Cardiology

基　　金：湖北省卵圆孔未闭相关隐源性脑卒中登记注册研究(WX17D43)。

摘　　要：目的探讨对比增强经颅多普勒超声声学造影(c-TCD)在卵圆孔未闭(PFO)患者介入封堵中的评估作用。方法回顾性分析2017年1月至2019年12月武汉亚洲心脏病医院192例行PFO介入封堵患者的临床资料,采用logistic二分类回归分析研究c-TCD、经胸超声心动图声学造影(c-TTE)及经食管超声心动图(TEE)测量的PFO大小,与PFO介入封堵的相关性。结果192例接受PFO介入封堵患者PFO平均长度(11.90±4.56)mm,平均宽度(1.90±0.62)mm,c-TCD分流量Ⅰ、Ⅱ、Ⅲ级占比分别为18.8%、20.3%、60.9%;c-TTE分流量Ⅰ、Ⅱ、Ⅲ级占比分别为4.2%、16.1%、79.7%。介入封堵过程中共15例PFO常规通过难度较大,行穿刺鞘管辅助。logistic回归分析显示,当c-TCD检查分流量为Ⅰ级时,其通过PFO困难风险是分流量为Ⅲ级时的8.462倍(95%CI 1.470~48.710,P=0.017)。结论PFO介入封堵术前应完善c-TCD检查,评估术中通过PFO的难易程度。当c-TCD分流量为Ⅰ级时,术中通过PFO难度增加,需要使用房间隔穿刺鞘管辅助才能完成手术。Objective To explore the correlation between the contrast enhanced transcranial doppler(c-TCD)and interventional treatment of patent foramen ovale(PFO).Methods A total of 192 patients undergoing PFO interventional treatment in Wuhan Asia Heart Hospital from January 2017 to December 2019 were retrospectively analyzed.Based on the results of c-TCD,contrast transthoracic echocardiography(c-TTE)and transesophageal echocardiography(TEE),logistic regression analysis was used to analyze the relationship between interventional treatment and those results.Results The mean PFO length was(11.90±4.56)mm and width was(1.90±0.62)mm.The rate of GradeⅠ,Ⅱ,andⅢshunts of c-TCD was 18.8%,20.3%,and 60.9%,respectively;the rate of GradeⅠ,Ⅱ,andⅢshunts of c-TTE was 4.2%,16.1%,and 79.7%,respectively.During the interventional therapy,15 cases of PFO were diffi cult to pass routinely and were assisted by puncture sheath.Logistic regression showed that when the c-TCD shunt grade wasⅠ,the diffi culty of routine passage of the PFO channel increased 8.462(95%CI 1.470–48.710,P=0.017)times than that when the shunt grade wasⅢ.Conclusions The examination of c-TCD should be completed before PFO interventional therapy.When the c-TCD shunt grade wasⅠ,it is more diffi cult to pass the PFO channel during operation.

关 键 词：卵圆孔未闭 介入封堵 对比增强经颅多普勒超声声学造影 

分 类 号：R541.1[医药卫生—心血管疾病]