超声心动图在卵圆孔未闭封堵中的应用及卵圆孔未闭分流方向的探讨

Echocardiographic value in transcatheter closure and discussion of shunt direction of patent foramen ovale

目的 探讨超声心动图在卵圆孔未闭 (PFO)治疗中的应用价值。方法 7例封堵治疗PFO患者 ,术前经胸(TTE)或经食管超声心动图 (TEE)明确PFO诊断 ,术中TTE和X线引导监护 ,术后TTE随访 ;并对 15 7例PFO分流方向进行统计分析。结果 7例PFO封堵患者右向左分流的确诊方法 :TTE 1例 ,TEE 4例 ,TTE或TEE +右心声学造影各 1例。术后TTE随访PFO分流消失。 15 7例TTE诊断的PFO以左向右分流表现为主 ,少数右向左分流和双向分流者多伴其他心脏结构和功能改变。结论 超声心动图在PFO封堵术中具有多方面重要作用。TEE及声学造影诊断PFO右向左分流的敏感性高于单纯TTE。常规TTE检查PFO多表现为左向右分流 。

Objective To study the value of echocardiography in transcatheter closure treatment of patent foramen ovale (PFO). Methods The study included 7 cases of PFO treated by transcatheter closure. Before operation transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) examination were performed. The standard for the closure treatment was cryptogenic stroke and PFO accompanied with right to left shunt. During operation, TTE was used for guiding and monitoring the whole process. After operation TTE was used for follow up. In addition, 157 PFO cases diagnosed by TTE were analysed. Results The right to left shunt in 7 PFO cases were diagnosed by echocardiography (1 by TTE, 4 by TEE, 1 by TTE + contrast echocardiography and 1 by TEE + contrast echocardiography). During operation TTE could guide and monitor the procedure satisfactorily. The transcatheter closures were successful in all 7 cases. After 6-18 month follow-up, no residual shunt or complications was found by TTE. In the 157 PFO were diagnosed by TTE, there were 76 cases younger than 1 year old, 81 cases more than 1 year old. In 157 PFO cases, 88 cases had no other cardiac abnomality except PFO, 69 cases accompanied with other cardiac structure or function abnormality,while 132 cases showed left to right shunt,11 cases showed right to left shunt, 18 cases showed bidirection shunt. PFO with right to left or bidirection shunt more often be found in the cases accompanied other cardiac structure or function abnormality. Conclusion Echocardiography plays an important role in selecting cases before the operation, guiding and monitoring during the operation and following up after the operation. In the diagnosis of right to left shunt of PFO, the sensitivity of TEE with contrast is higher than that of TTE. Most PFO showes left to right shunt and not right to left as described in old definition during common TTE examination.