经胸超声右心声学造影联合经食道超声在卵圆孔右向左分流诊断与治疗中的应用

Clinical application of the transthoracic echocardiography combined with transesophageal echocardiography in diagnosis and treatment of the right-to-left shunt of patent foramen ovale

目的探讨经胸超声右心声学造影联合经食道超声心动图评价卵圆孔未闭(PFD)右向左分流诊断与治疗中的应用。方法选择因头晕、偏头痛、TIA和不明原因脑卒中住院的患者127例,经胸超声右心声学造影观察静息状态下和Valsalva动作后左房内微泡的数量;经食管超声心动图观察卵圆孔的形态学特征,记录卵圆孔右房侧、左房侧的直径、卵圆瓣长度以及TTE引导下介入封堵开始至完成的时间。结果静息状态下cTTE检出PFO为99例(77.9%),Valsalva动作后检出119例(93.7%);cTTE联合TEE检出PFO为123例(96.8%)。TEE检查PFO右房侧的平均直径为(2.21±1.32)mm,左房侧的平均直径为(1.55±0.64)mm,卵圆瓣长度的平均值为(6.74±2.47)mm。PFO右房侧直径大小与TTE引导下介入封堵术的时间具有相关性(P<0.05)。结论 cTTE可以作为筛查PFO的有效方法,在实施介入封堵治疗时,有针对性地采用TEE对PFO的形态学特征进行观察对指导介入治疗和缩短手术时间具有重要作用。

Objective To evaluated the transthoracic echocardiography(cTTE) combined with transesophageal echocardiography(TEE) in diagonosis and treatment of the right-to-left shunt(RLS) in patient with patent foramen ovale(PFO).Methods 127 patients with dizziness,migraine,transient ischemic attack and unexplained stroke were selected. cTTE and TEE were applied to observe the number of contrast agents in the left atrium during resting state and after Valsalva action,the morphological characteristics of the foramen ovale was observed,respectively. The diameters of the right atrial side and the left atrial side of the foramen ovale,the length of the foramina ovale valve and the time from the beginning to the end of interventional closure of PFO guided by cTTE was recorded.Results 99(77.9%) cases of PFO were detected by cTTE in resting state,and 119(93.7%) cases were detected after Valsalva action. 123(96.8%) cases of PFO were detected by cTTE combined with TEE. The mean diameters of the right atrial side and the left atrial side of the foramen ovale examined by TEE were(2.21±1.32)mm and(1.55±0.64)mm,respectively. The mean length of the foramina ovale valve was(6.74±2.47)mm. The right atrial diameter of PFO was associated with the time of interventional closure of PFO guided by TTE(P<0.05). Conclusion cTTE can be used as an effective method for screening PFO. In the interventional occlusion of PFO,observing the morphological characteristics of PFO by TEE plays an important role in guiding the therapy and shortening the operation time.