隐源性缺血性脑卒中患者的食管超声心动图解析

Analysis of Esophageal Echocardiography in Patients with Cryptogenic Ischemic Stroke

目的探讨食管超声心动图(TEE)诊断隐源性缺血性脑卒中(CS)患者房间隔异常的特点。方法收集我院CS患者181例,根据年龄分为<30岁组、31～50岁组、>51岁组。所有患者均行TEE检查,观察房间隔情况。结果所有患者中,PFO患者63例,占34.81%,房间隔膨出瘤患者6例,占3.31%,房间隔膨出瘤并缺损患者19例,占10.50%,房间隔组织稀疏并分流患者24例,占13.26%;小于30岁组房间隔组织稀疏并分流患者4例,占44.44%;31～50岁组房间隔结构异常者以PFO居多,占33.33%;大于51岁组PFO最多,占37.36%。CS患者中房间隔异常的TEE超声特点:(1)卵圆孔未闭类型:卵圆瓣较长,与房间隔组织贴合欠佳,有明显裂隙,形似"隧道"样;卵圆瓣较短,与房间隔组织贴合处有间隙。(2)房间隔膨出瘤或合并房间隔缺损,即房间隔组织菲薄,随心脏舒缩活动膨向右房、左房或摆动于左右房之间,部分患者可合并房间隔小缺损。(3)房间隔组织薄弱、稀疏,形同"筛子"样,可合并心房水平多股细小分流信号。结论 PFO是CS的重要致病原因之一,TEE作为目前诊断PFO和房间隔病变的首选方法,可精准描述房间隔结构和准确判断心房水平的分流情况,为临床尽早识别和预防脑血管卒中提供客观依据。

Objective To investigate the characteristics of esophageal echocardiography （TEE） in the diagnosis of atrial septal abnormalities in patients with cryptogenic ischemic stroke （CS）. Methods A total of 181 patients with CS in our hospital were enrolled. According to age, they were divided into groups of less than 30 years old, 31-50 years old, and older than 51 years old. All patients underwent a TEE examination to observe the interatrial septum. Results Among all patients, 63 patients with PFO, accounting for 34.81%, 6 patients with atrial fibrillation, accounting for 3.31%, 19 patients with atrial fibrillation and defect, accounting for 10.50%, There were 24 cases of sparse and shunted patients in the room, accounting for 13.26%; 4 cases of atrial septal tissue sparse and shunted in less than 30 years old, accounting for 44.44%; those with abnormal atrial septal structure in the 31-50 years old group were mostly PFO, accounting for 33.33%; More than 51 years old group PFO most, accounting for 37.36%. Characteristics of TEE ultrasound in patients with abnormal septal septal in CS： ~Type of patent foramen ovale： the oval valve is long, and the atrial septal tissue is poorly fitted, with obvious fissures, resembling a ＂tunnel＂; the oval valve is shorter, and there is a gap between the atrial septal tissue and the atrial septal tissue. GRoom septal bulging tumor or combined atrial septal defect, that is, the atrial septal tissue is thin, with the expansion of the heart to the right atrium, left atrium or swing between the left and right rooms, some patients may have a small interatrial septal defect. ~The compartments are weak and sparse, and they are similar to the ＂sieve＂. They can be combined with multiple small shunt signals at the atrial level.Conclusion PFO is one of the most important causes of CS. TEE, as the first choice in the diagnosis of PFO and atrial septal disease, can accurately describe the atrial septal structure and accurately.judge the atrial shunt. To provide objective basis for clinical early identification and prevention of cerebrovascular apoplexy.