肺动静脉瘘所致隐源性卒中病例分析及初筛方法研究

Case Analysis and Study on Screening Method of the Cryptogenic Stroke Caused by Pulmonary Arteriovenous Fistula

目的分析肺动静脉瘘(pulmonary arteriovenous fistula,PAVF)致隐源性卒中患者临床表现,比较各种诊断方法特点,寻找筛查方法。方法 2例PAVF所致隐源性卒中患者详细临床资料,并行经食管超声(transesophageal echocardiography,TEE)、经颅多普勒增强试验(contrast transcranial Doppler,cT CD)。结果 2例患者cT CD结果显示栓子信号具备出现晚、数量多、时间久、持续性(即不受Valsalva动作影响)的特点。TEE结果显示CDFI未见异常,右心声学造影Valsalva动作(valsalva maneuver,VM)后5个心动周期左房内肺静脉开口处见大量微泡。结论缺血性卒中是PAVF最常见的肺外表现,发生与PAVF与供血动脉直径及数量有关。cT CD敏感易操作,结合动脉血气分析可用于该病的初筛,而且适于疗效评价及随访。

Objective To analyze the clinical features of the patients with cryptogenic stroke caused by pulmonary arteriovenous fistula（PAVF）, and compare the characteristics of different diagnostic methods to find preliminary screening method.Methods Detailed clinical data of 2 patients with cryptogenic stroke were collected. Transesophageal echocardiography（TEE） and contrast transcranial Doppler（cTCD） were performed.Results cTCD in 2 patients showed the following characteristics of microemboli signals： late appearance, large number, long duration, and the number was not influenced by Valsalva maneuver（VM）. TEE showed that there were no abnormal CDFI and large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM.Conclusion Ischemic stroke is the most common extra-pulmonary manifestation of PAVF, influenced by the diameter of feeding artery and quantity of PAVF. cTCD combined with arterial blood gas analysis is useful for preliminary screening, efficacy evaluation and follow-up for PAVM.