卵圆孔未闭隧道特点对介入封堵术的影响因素分析

Analysis of the influence of tunnel characteristics of patent foramen ovale on interventional closure

目的通过经食管超声心动图(transesophageal echocardiography,TEE)观察卵圆孔未闭(patent foramen ovale,PFO)隧道特点,并探讨其对介入封堵术的影响。方法选取2020年8月至2022年4月在中山大学附属第五医院行PFO介入封堵术的患者124例,术前均行TEE检查,评估PFO的隧道特点;根据手术时间及J型导丝过房间隔难度分为简单手术组(92例)和复杂手术组(32例),术中记录并比较术中手术操作时间、J型导丝过隔成功率及X线暴露时间;通过Logistic回归分析筛选介入封堵术的独立影响因素,并分析不同PFO隧道特点对手术的影响。结果124例PFO隧道特点表现为4种类型:无脂肪粘连管道型55例(44.35%)、脂肪粘连管道型21例(16.94%)、右漏斗型23例(18.55%)及左漏斗型25例(20.16%)。二元Logistic回归分析显示PFO右房侧内径(OR=0.078,95%CI:0.018~0.339)、继发隔厚度(OR=3.070,95%CI:1.591~5.925)和隧道内脂肪粘连(OR=12.081,95%CI:1.312~111.206)是介入封堵术的独立影响因素(P<0.05)。脂肪粘连管道型PFO手术操作时间及X线暴露时间最长(P<0.05),J型导丝过隔成功率最低(P<0.05);与无脂肪粘连管道型及右漏斗型PFO相比,左漏斗型PFO手术操作时间及X线暴露时间较长(P<0.05),J型导丝过隔成功率较低(P<0.05)。结论PFO隧道特点具有多样性,术前TEE明确分型有助于指导临床制定更合理的封堵方案及选择适宜型号的封堵器,缩短手术时间,减少相关并发症,提高封堵成功率。

Objective To investigate the influence of tunnel characteristics of patent foramen ovale(PFO)by transesophageal echocardiography(TEE)on interventional closure.Methods 124 patients with PFO closure in the Fifth Affiliated Hospital of Sun Yat-sen University from August 2020 to April 2022 were selected.Preprocedural TEE was performed to evaluate the tunnel characteristics of PFO.All patients were divided into simple operation group with 92 cases and complex operation group with 32 cases according to the operation time and the difficulty of the J-shaped guidewire crossing the interatrial septum.The operation time,the success rate of the J-shaped guidewire crossing the interatrial septum and the X-ray exposure time were recorded during the operation and compared.The independent influencing factors of interventional closure were screened by Logistic regression analysis,and the influence of different PFO tunnel characteristics on the operation was analyzed.Results The PFO tunnel characteristics of 124 cases were described as four types:the channel type without fatty adhesion in the tunnel(55/124,44.35%),the channel type with fatty adhesion in the tunnel(21/124,16.94%),the right funnel type(23/124,18.55%)and the left funnel type(25/124,20.16%).The right atrial diameter of PFO(OR=0.078,95%CI:0.018-0.339),the secondary septum thickness(OR=3.070,95%CI:1.591~5.925)and fatty adhesion in the tunnel(OR=12.081,95%CI:1.312~111.206)were the independent influencing factors of interventional closure by binary Logistic regression analysis.The channel type with fatty adhesion in the tunnel PFO could lead to longest operation time and X-ray exposure time(P<0.05),and the success rate of the J-shaped guidewire crossing the interatrial septum was lowest(P<0.05).Compared with the channel type without fatty adhesion in the tunnel and the right funnel type PFO,the left funnel type PFO had longer operation time and X-ray exposure time(P<0.05),and a lower success rate of the J-shaped guidewire crossing the interatrial septum(P<0.05).Conclusion The characteristics of PFO tunnel are diverse.The definite classification of PFO by TEE before surgery is helpful to formulate a more reasonable occlusion plan,select an appropriate type of occluder,shorten the operation time,reduce the related complications,and improve the success rate of occlusion.