卵圆孔未闭封堵治疗单中心经验

Single center experience in occlusive treatment of patent foramen ovale

目的评价卵圆孔未闭(PFO)封堵治疗的有效性、安全性及预后转归。方法连续纳入2018年7月至2022年9月在襄阳市中心医院心内科行介入封堵治疗的783例PFO患者。在术前完善经胸超声心动图(TTE)、经胸右心声学造影(cTTErr)、经食管超声心动图(TEE)及经颅多普勒(c-TCD)检查,在术后1、3、6、12个月行TTE检查,必要时复查c-TCD。偏头痛患者在术前及术后1、3、6、12个月时记录患者头痛症状和头痛影响测试问卷6(HIT-6)评分。结果783例PFO患者,年龄为(55.5±21.3)岁,其中男占30.0%(235/783)。720(92.0%,720/783)例封堵成功,其中608(77.7%,608/783)例用常规方法通过PFO,112(14.3%,112/783)例经由SWARTZ鞘通过卵圆孔。8(1.0%,8/783)例术中发生心脏穿孔,其中2例行急性心包穿刺引流,6例为少量心包积液未处理。术后3例咯血,其中1例咯血量较多,另2例少量咯血,均在2 d后好转。术后随访(33.8±3.6)个月,633(77.7%,633/783)例达到治愈标准,14(1.8%,14/783)例明显缓解,32(4.1%,32/783)例无效,总有效率为89.9%(647/783)。其中18(4.1%,18/439)例偏头痛患者治疗无效,4(4.8%,4/83)例晕厥患者治疗无效,10(9.4%,10/106)例非特异性症状患者治疗无效。围手术期及最长5年随访过程中未出现封堵器脱落、严重心律失常、股动静脉瘘等并发症。其中48例半年后原有症状不缓解或部分缓解者复查cTTErr仍有右向左分流,追溯患者术前TTE或TEE,均提示患者卵圆孔周边边缘菲薄(剑突下双房切面卵圆孔周边不显影)或合并房间隔膨胀瘤。结论PFO患者行封堵治疗严重并发症少,手术成功率高;术前规范评估最为重要,可提高患者症状改善程度,减少并发症;需要研发新型卵圆孔封堵器,以提高封堵效果。

Objective To evaluate the efficacy,safety,and prognostic regression of occlusion therapy for patent foramen ovale(PFO).Methods PFO patients who underwent interventional closure treatment in the Department of Cardiology,Xiangyang Central Hospital from July 2018 to September 2022 were included.Preoperative evaluations included transthoracic echocardiography(TTE),contrast transthoracic echocaidiography of right heart(cTTErr),transesophageal echocardiography(TEE),and transcranial Doppler ultrasound bubble test(c-TCD).Follow-up evaluations were conducted at 1,3,6,and 12 months postoperatively using TTE,with additional c-TCD if necessary.Migraine patients recorded headache symptoms and the Headache Impact Test-6 scores before surgery and at 1,3,6,and 12 months after surgery.Results A total of 783 PFO patients with age of(55.5±21.3)years,and 30.0%(235/783)male were involved.Seven hundred and twenty patients were successfully occluded with a success rate of 92.0%(720/783).Of these,608(77.7%,608/783)patients were passed through the PFO using the conventional approach,and 112(14.3%,112/783)using the SWARTZ sheath.Intraoperative cardiac perforation occurred in 8(1.0%,8/783)patients,acute pericardiocentesis in 2 patients,and a small amount of pericardial effusion was left untreated in 6 patients.Postoperatively,3 patients coughed up blood,including 1 case with a large amount of blood and the other 2 patients with a small amount of blood,all of which improved after 2 days.Postoperative follow-up was(33.8±3.6)months.During the follow-up,633(77.7%,633/783)patients were found to have reached the cure standard,14(1.8%,14/783)significantly relieved,and 32(4.1%,32/783)ineffective,with an overall effective rate of 89.9%(647/783).Among them,18(4.1%,18/439)patients with migraine were ineffective,4(4.8%,4/83)with syncope were ineffective,and 10(9.4%,10/106)with nonspecific symptoms were ineffective.There were no complications such as blocker dislodgement,severe arrhythmia,femoral arteriovenous fistula,etc.during the perioperative period and up to 5-year follow-up.Forty eight patients had no relief or partial relief of their original symptoms after 6 months of follow-up.Their cTTErr was reviewed,and they still had residual right to left shunt.Tracing the patients'preoperative TTE or TEE suggested that the patients had thin peripheral margins of the foramen ovale(peripheral periphery of the foramen ovale was not visualized in the subxiphoid biatrial view)or combined with atrial septal aneurysm.Conclusion Patients with PFO undergoing occlusion therapy have fewer serious complications and a high rate of surgical success.Standardized preoperative evaluation is of utmost importance to improve the degree of symptomatic improvement and reduce complications in patients.There is a need to develop new types of patent foramen ovale occluders to improve the effectiveness of occlusion.