cTTE、cTEE分别联合cTCD在卵圆孔未闭诊断及介入封堵术中的应用比较

Comparison of cTTE and cTEE combined with cTCD in diagnosis and transcatheter closure of patent foramen ovale

目的分析经胸超声心动图声学造影(cTTE)、经食管超声心动图声学造影(cTEE)分别联合经颅多普勒超声声学造影(cTCD)在卵圆孔未闭诊断及介入封堵术中的应用效果。方法选择2017年1月—2019年12月河北医科大学第二医院收治的551例高度疑似卵圆孔未闭患者,所有患者均接受cTTE、cTEE、cTCD检查,以经食管超声心动图检查(TEE)为“金标准”,分析cTTE、cTEE分别联合cTCD对卵圆孔未闭的诊断效能。所有患者均接受介入封堵术治疗,术后随访1年,观察患者封堵有效率、症状缓解率及术后并发症发生情况。结果TEE检查卵圆孔未闭525例(95.28%),其余26例中,小房间隔缺损21例(80.77%),肺动静脉瘘5例(19.23%)。以TEE诊断结果为“金标准”,cTEE诊断的敏感性(98.67%)和准确性(98.00%)高于cTTE的敏感性(95.05%)和准确性(94.92%)(P<0.05);cTEE联合cTCD诊断的敏感性(99.24%)和准确性(98.91%)高于cTTE联合cTCD的敏感性(96.19%)和准确性(95.83%)(P<0.05)。术后随访1年,介入封堵术后6个月封堵有效率为81.30%;术后3个月出现心慌34例,胸闷40例,胸痛48例,总发生率为22.14%;术后6个月出现上述症状67例,总发生率为12.76%;术后1年仍有上述症状2例,总发生率为0.38%。结论cTTE、cTEE分别联合cTCD均可诊断卵圆孔未闭,但cTEE联合cTCD的诊断效能更高,有助于指导介入封堵术。

Objective TTo analyze the application effect of contrast transthoracic echocardiography(cTTE),contrast transesophageal echocardiography(cTEE)and contrast transcranial doppler(cTCD)in the diagnosis and interventional occlusion of patent oval foramen.Methods A total of 551 highly suspected patent oval foramen patients were admitted to the Second Hospital of Hebei Medical University from January 2017 to December 2019.All patients underwent cTTE or cTEE combined with cTCD to analyze the diagnostic efficacy using transesophageal echocardiography(TEE)as the"gold standard".All patients were treated with interventional occlusion and followed up for 1 year to check for patient occlusion efficiency,symptom remission rate,and occurrence of postoperative complications.Results There were 525 cases(95.28%)of patent oval foramen examined with TEE,and 21 cases(80.77%)of small atrial septal defect and 5 cases(19.23%)of pulmonary arteriovenous fistula in other 26 cases.When the TEE diagnosis was used as the"gold standard",the sensitivity of cTEE diagnosis(98.67%)and accuracy(98.00%)was higher than that for cTTE(95.05%and 94.92%)(P<0.05);diagnosis sensitivity(99.24%)and accuracy(98.91%)of cTEE combined with cTCD were higher than those of cTTE combined with cTCD(96.19%and 95.83%)(P<0.05).After 1 year follow-up,the effective rate of occlusion after 6 months was 81.30%;after 3 months,34 palpitation,40 chest tightness,and 48 chest pain had a total incidence of 22.14%;the incidence rate 67 cases of the above symptoms within 6 months was 12.76%;2 cases still had the above symptoms 1 year after surgery,with incidence rate of 0.38%.Conclusion Both cTTE and cTEE combined with cTCD can diagnose patent oval foramen respectively,but cTEE combined with cTCD has higher diagnostic efficacy and is helpful to guide surgical treatment.