左室辅助装置植入前超声心动图诊断卵圆孔未闭的经验  

Experience of Echocardiography for the Diagnosis of Patent Foramen Ovale during the Left Ventricular Assist Device Implantation

作　　者：牛丽莉[1] 朱振辉 施怡声 王浩[1] 石佳 胡盛寿[3] NIU Li-li;ZHU Zhen-hui;SHI Yi-sheng;WANG Hao;SHI Jia;HU Sheng-shou(Ultrasound Imaging Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Anesthesia Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Adult Surgery Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心中国医学科学院,北京协和医学院阜外医院超声影像中心,北京市100037 [2]国家心血管病中心中国医学科学院,北京协和医学院阜外医院麻醉中心,北京市100037 [3]国家心血管病中心中国医学科学院,北京协和医学院阜外医院成人外科中心,北京市100037

出　　处：《中国分子心脏病学杂志》2021年第2期3813-3815,共3页Molecular Cardiology of China

摘　　要：目的卵圆孔未闭(PFO)的存在可致左室辅助装置(LVAD)植入后出现低氧血症及矛盾栓塞。超声是术前PFO检出的重要手段,本文对LVAD植入前超声心动图检查PFO的评估价值进行总结。方法回顾分析2018年1月至2020年1月行永仁心LVAD植入术的12例患者资料,LVAD植入前通过经胸超声心动图(TTE)、经食管超声心动图(TEE)、经食管超声心动图声学造影(cTEE)3种方法联合评估是否存在PFO,并将结果与植入前外科探查、植入后TEE、血液及经皮氧饱和度结果进行比较。结果12例患者均在植入前行TTE、TEE,结合cTEE,共检出PFO 3例:1例TTE和TEE彩色多普勒均(+),未行cTEE;1例TEE彩色多普勒(+),而TTE彩色多普勒及cTEE(-);1例cTEE(+),TTE、TEE彩色多普勒均(-)。外科探查证实PFO诊断并行修补术。9例TTE、TEE、cTEE均未见PFO。12例LVAD植入后即刻、入ICU后复查TEE均未见PFO。住院及随访期间均未出现低氧血症及LVAD泵堵塞事件。结论LVAD植入前TTE、TEE结合cTEE可以有效诊断PFO。但由于终末期心衰特殊的血流动力学状态,LVAD植入前PFO的超声诊断仍需更多经验的积累。Objective The presence of a patent foramen ovale(PFO)can lead to hypoxemia and paradoxical embolization after Left ventricular assist device(LVAD)implantation.The preoperation echocardiography is an important method for diagnosis of PFO.Therefore,we summarized the experiences in diagnosis of PFO by echocardiography before LVAD implantation.Methods The data of 12 patients who received EVAHEART LVAD implantation in our hospital from January 2018 to January 2020 were analyzed retrospectively.The presence of PFO was detected at transthoracic echocardiography(TTE),transesophageal echocardiography(TEE)and contrast-transesophageal echocardiography(cTEE)before LVAD implantation which was compared with the result of intraoperative surgical exploration,TEE,blood and percutaneous oxygen saturation after implantation.Results All 12 patients received TTE and TEE,and combined with cTEE,3 PFOs were revealed at TTE,TEE,and cTEE before implantation:1 case of TTE and TEE color suggested PFO,with no cTEE;1 case of TEE color(+),TTE color and cTEE(-);1 case of cTEE(+),TTE and TEE color(-).Surgical exploration confirmed 3 PFOs above,which were repaired simultaneously.There was no evidence of PFO in the other 9 cases at TTE,TEE,and cTEE before implantation.All 12 patients were revealed no PFO at immediate TEE in theatre and intensive care unit(ICU).There were no hypoxemia or pump embolization occurred in hospital and during follow-up.Conclusion TTE,TEE combined with cTEE before LVAD implantation are effective methods for the diagnosis of PFO.Because of the special hemodynamic state of patients with end-stage heart failure,the ultrasonic diagnosis of PFO before LVAD implantation still needs more experiences.

关 键 词：超声心动图 左室辅助装置 卵圆孔未闭 

分 类 号：R540.45[医药卫生—心血管疾病] R541.6[医药卫生—内科学] R541.1[医药卫生—临床医学]