58例卵圆孔未闭的封堵治疗

Closure treatment of 58 cases of patent foramen ovale

目的:探讨卵圆孔未闭(PFO)的治疗方法,总结食道超声(TEE)引导下经皮PFO封堵治疗经验。方法:收集2018年1月至2020年6月共58例PFO患者,所有患者行食道超声引导下经皮PFO封堵治疗,记录患者TEE二维表现及术中TEE动态监测变化,手术后3个月及1年随访。结果:58例PFO患者,在TEE引导下,全部完成经皮封堵治疗,其中2例使用房间隔穿刺针(卵圆孔直径<0.5 mm)。术中患者TEE二维图像清晰,动态显示鞘过卵圆孔过程及释放封堵伞后连续性观察封堵伞,伞位置牢靠,伞形满意,房室瓣功能正常。术后3个月及1年随访检查均未发现心包积液封堵伞脱落残余分流等并发症。结论:经TEE引导下经皮PFO封堵治疗安全有效,动态监测治疗避免盲目穿刺损伤心脏结构,避免使用大型放射设备的局限性,值得推广和应用。

Objective:Explore the treatment of patent foramen ovale,Summarize the experience of percutaneous patent foramen ovale occlusion under the guidance of esophageal ultrasound(TEE).Methods:A total of 58 patients with patent foramen ovale were collected from January 2018 to June 2020,All patients were treated with percutaneous patent foramen ovale occlusion under the guidance of esophageal ultrasound,Record the two-dimensional TEE performance of patients and the dynamic monitoring changes of TEE during operation,Follow-up 3 months and 1 year after surgery.Results:58 cases of patent foramen ovale,Under the guidance of TEE,all percutaneous occlusion treatments are completed,Two cases used atrial septal puncture needle(foramen ovale diameter less than 1 mm).The two-dimensional image of the patient’s TEE is clear during the operation,and the process of the sheath passing through the foramen ovale is dynamically displayed and the blocking umbrella is continuously observed after releasing the blocking umbrella.Umbrella position is firm,umbrella shape is satisfactory,atrioventricular valve function is normal.No complications such as pericardial effusion,shedding of occlusion,residual shunt,etc.were found in follow-up examinations at 3 months and 1 year after operation.Conclusions:Transesophageal ultrasound guided percutaneous patent foramen ovale occlusion is safe,effective and dynamic monitoring therapy to avoid blind puncture damage to the heart structure,Avoid the limitations of using large-scale radiological equipment,which is worthy of promotion and application.