充分Valsalva动作在超声心动图声学造影诊断单纯卵圆孔未闭中的作用  

Effect of Contrast Transthoracic Echocardiography with Adequately Performing Valsalva Maneuver to Detect Patent Foramen Ovale

作　　者：杨燕 晋群 梁春香 孙梦语 孙玉坤 YANG Yan;JIN Qun;LIANG Chunxiang;SUN Mengyu;SUN Yukun(Department of Cardiology,the 960th Hospital of the PLA Joint Logistics Support Force,Jinan 250031,China)

机构地区：[1]联勤保障部队第九六〇医院心内科,济南250031

出　　处：《岭南心血管病杂志》2023年第6期649-653,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的 对比分析经胸超声心动图声学造影(contrast transthoracic echocardiography, c TTE)辅以标准Valsalva动作(Valsalva maneuver, VM)与cTTE辅以充分的VM对卵圆孔未闭(patent foramen ovale, PFO)患者的诊断价值。方法 拟对2019年9月至2021年9月联勤保障部队第九六〇医院137例临床怀疑存在PFO、经胸超声心动图检查阴性的患者行cTTE检查。患者行静息状态下cTTE后,再先后辅以标准VM与辅以充分的VM,对比分析这两种方法对PFO右向左分流(right to left shunt, RLS)的检出结果及超声特点。结果 137例患者中,排除静息状态下c TTE左心微气泡大量(Ⅲ级)3例、肺循环RLS 2例,最终132例纳入研究对象。标准VM后c TTE检出PFO-RLS 67例(67/132,50.7%)、充分的VM后cTTE检出PFO-RLS 87例(87/132,65.9%),20例患者仅在辅以充分的VM后检出。充分的VM组检出率(65.9%)明显高于标准VM组(50.7%),且差异具有统计学意义(P<0.001)。标准VM后检出的67例PFO-RLS患者,包括Ⅰ级13例、Ⅱ级20例、Ⅲ级34例;充分的VM后检出的87例PFO-RLS患者,包括Ⅰ级14例、Ⅱ级25例、Ⅲ级48例。cTTE辅以标准VM和充分的VM半定量分级诊断PFO-RLS的一致性一般(Kappa值=0.054,P=0.0046),充分的VM组PFO-RLS半定量分级高于标准VM组(Z=-2.512,P=0.012)。20例标准VM后未检出的假阴性患者,行充分的VM张力期右心房直径、面积、容积均明显小于标准VM张力期,差异有明显统计学意义(t=8.823、10.168、10.759,P均<0.001)。结论 充分的VM明显提高c TTE对PFORLS的检出率,建议行标准VM的同时辅以指导患者腹肌收缩,使VM达到充分有效,以避免出现假阴性结果。Objectives To compare the effect of contrast transthoracic echocardiography(cTTE)with standard Valsalva maneuver(VM)and cTTE with adequately performed VM for detecting right to left shunt(RLS)in adult patients with patent foramen ovale(PFO).Methods Totally 137 consecutive patients who were highly suspected to have PFO and with negative transthoracic echocardiography results were enrolled from September 2019 to September 2021 in the 960th Hospital of the PLA Joint Logistics Support Force.All the patients underwent cTTE at resting state,then standard VM and adequately performing VM were performed to provoke PFO-RLS,respectively.The detection rate of PFO by the two provocative maneuvers and ultranonic characteristics were compared.Results Three patients with levelⅢat resting state and 2 patients considered with pulmonary RLS were excluded from this study.A total of 132 patients were selected as the research objects.Sixty-seven patients with PFO-RLS(67/132,50.7%)were detected after standard VM and 87 patients with PFO(87/132.65.9%)were detected after adequately performing VM.The detection rate of PFO-RLS by cTTE after adequately performing VM was significantly better than that of cTTE after standard VM(65.9%vs.50.7%,P<0.001).Twenty patients with PFO were derected by cTTE only after adequately performing VM.The semi-quantification grading of PFO-RLS in patients detected by cTTE:there were 13 cases in levelⅠ,20 cases in levelⅡand 34 cases in levelⅢafter standard VM and 14 cases in levelⅠ,25 cases in levelⅡand 48 cases in levelⅢafter adequately performing VM.The semi-quantitative evaluation of left chamber opacifification showed that only moderate agreement between standard VM and adequately performing VM(K=0.054,P=0.0046).The comparison of semi-quantitative grading derived from adequately performing VM was significantly higher than that of standard VM(Z=-2.512,P=0.012).In 20 patients with false-negative results,the right artial diameter,area and volume during the strain phase of adequately performing VM w

关 键 词：卵圆孔未闭 超声心动图声学造影 VALSALVA动作 

分 类 号：R541.1[医药卫生—心血管疾病]