经颅多普勒超声检查对卵圆孔未闭所致脑栓塞的筛查意义

Screening significance of transcranial Doppler for patients with patent foramen ovale induced cerebral embolism

目的探讨经颅多普勒超声检查（1、CD）对卵圆孔未闭所致脑栓塞的筛查意义，有利于进一步针对患者病因进行治疗。方法选择年龄小于60岁不明原因脑栓塞及短暂性脑缺血发作患者36例，所有患者在常规检查基础上行24h动态心电图、经胸超声心动图、颈部血管多普勒超声、常规TCD、TCD发泡试验、经食管超声心动图（TEE）、头颈CT血管造影（CTA）及双下肢静脉超声检查。结果所有患者均无心房颤动，经胸超声心动图未提示结构性心脏病及心腔内占位病变，颈部血管多普勒超声、常规TCD及头颈CTA检查无颅内外动脉狭窄，双下肢静脉超声未见深静脉血栓。TCD发泡试验发现14例提示心脏存在右向左分流，其中10例10s内出现微气泡信号，4例Valsalva动作后出现微气泡信号，此14例患者中12例TEE证实存在卵圆孔未闭。结论卵圆孔未闭是导致心源性脑栓塞的病因之一，TCD对卵圆孔未闭的筛查准确可靠。

Objective To investigate the screening significance of transcranial Doppler （TCD） for patients with patent foramen ovale （PFO） induced cerebral embolism and to improve the treatment aiming at the causes. Methods Thirty-six patients of less than 60 years old with unknown-cause cerebral embolism and transient ischemic attack were enrolled. Besides conventional examination, the 24 h Hoher, transthoracic echocardiography,carotid artery Doppler ultrasonography （CAU）,routine TCD,TCD foaming test, transesophageal echocardiography （TEE）, CT angiography （CTA） of head and neck, uhrasonography of vein in bilateral lower limbs were examined in all patients. Results All the patients showed no atrial fibrillation. No structural heart disease and intracardiac occupying lesion were shown in transthoracic echocardiography. No carotid stenosis was shown in carotid artery Doppler ultrasonography. Routine TCD showed no intracranial artery stenosis. No thrombus was found in ultrasonography of deep veins in bilateral lower limbs. CTA of head and neck showed everything was normal. Fourteen patients were observed with right-W-left shunt in heart by TCD foaming test, including 10 cases with microbubble signals（MBS） in 10 s, and 4 cases with MBS after Valsalva maneuver. Among 14 patients, 12 patients were proved PFO by TEE. Conclusions PFO is one of the causes of cardiogenic cerebral embolism. TCD is accurate and reliable for the screening of PFO.