卵圆孔解剖特征对经皮卵圆孔未闭介入封堵术的影响  

The influence of characteristics of patent foramen ovale on percutaneous interventional occlusion

作　　者：李炜杰 蒋威[2] 温健恒 许兆延[1] 杨希立[1] 胡晖[1] LI Weijie;JIANG Wei;WEN Jianheng;XU Zhaoyan;YANG Xili;HU Hui(Department of Cardiology,The First People's Hospital of Foshan Foshan,Guangdong,528000,China;Department of Pediatrics,The First People's Hospital of Foshan Foshan,Guangdong,528000,China)

机构地区：[1]佛山市第一人民医院心血管内科,广东佛山528000 [2]佛山市第一人民医院儿科

出　　处：《临床心血管病杂志》2024年第5期421-425,共5页Journal of Clinical Cardiology

基　　金：佛山市卫生健康局医学科研课题(No:20220365)。

摘　　要：目的:探讨经皮卵圆孔未闭(patent foramen ovale,PFO)介入封堵术中影响通过PFO的相关因素。方法:纳入在我院确诊PFO并行经皮介入封堵术患者183例,收集患者的基本特征、经食管心脏超声心动图、经胸右心声学造影(transthroracic contrast echocardiography,cTTE)、术中血流动力学等参数。以导管通过PFO时间60s为截点,将患者分成容易通过组和非容易通过组,比较两组患者临床资料。使用logistic回归分析确定影响通过PFO的独立危险因素。结果:容易通过组的左心房面开口[(1.4±0.8)mmvs(0.8±0.6)mm]和右心房面开口[(1.9±1.6)mmvs(0.9±0.6)mm]均显著大于非容易通过组(均P<0.05)。静息状态和VALSAVA状态下两组患者右向左分流(righttoleftshunt,RLS)等级构成均差异有统计学意义(均P<0.05)。两组患者的隧道长度、术中心率、血压、肺动脉压力等参数均差异无统计学意义。多因素logistic回归分析显示,VALSAVA状态RLS≥2级是经皮介入封堵术中影响PFO通过的独立危险因素(OR=31.59,95%CI:7.61~131.17,P<0.01)。结论:cTTE评估的RLS等级作为独立影响因子预测介入封堵术中通过PFO的难易程度具有一定价值。Objective:To investigate factors that affecting passage through the patent foramen ovale(PFO)during percutaneous interventional occlusion.Methods:A total of 183 patients who were diagnosed with PFO and underwent percutaneous interventional occlusion in our hospital were included.Basic characteristics,parameters of transesophageal echocardiography,transthoracic contrast echocardiography(cTTE),and intraoperative hemodynamics were collected.Patients were divided into easy passage and non-easy passage groups based on catheter pas sage through the PFO(within 60 seconds).Clinical data between the two groups were compared.Results:In the easy passage group,the opening size of left atrium and right atrium was(1.4±0.8)mm and(1.9±1.6)mm,respectively,which were significantly larger than those[left atrium(0.8±0.6)mm,right atrium(0.9±0.6)mm] in the non-easy passage group(both P<o.05).There were significant differences in the composition of right to left shunt(RLS)grades in the resting and VALSAVA states between the two groups(both P<0.05).However,there was no statistical difference in the parameters of tunnel length,heart rate,blood pressure,and pulmonary artery pressure.Multivariate logistic regression analysis showed that RLS grade(VALSAVA status)≥2 was an independent risk factor on the passage time of PFO in the percutaneous occlusion surgery(OR=31.59,95%CI:7.61-131.17,P<0.01).Conclusion:RLS evaluated by cTTE as an independent influencing factor has predictive value for the difficulty of PFO passage during interventional occlusion.

关 键 词：卵圆孔未闭 经皮介入封堵术 经胸右心声学造影 

分 类 号：R541.1[医药卫生—心血管疾病]