经胸右心声学造影联合对比增强经颅多普勒对卵圆孔未闭右向左分流的诊断价值

Diagnostic value of contrast-transthoracic echocardiography plus contrast-enhanced transcranial Doppler for patent foramen ovale-right to left shunt

目的 探讨经胸右心声学造影(contrast-transthoracic echocardiography, c-TTE)联合对比增强经颅多普勒(contrast-enhanced transcranial Doppler, c-TCD)对卵圆孔未闭(patent foramen ovale, PFO)右向左分流(right to left shunt, RLS)的诊断价值。方法 回顾性选取218例PFO患者为研究对象,在平静状态及Valsalva状态下分别行经食管超声心动图(transesophageal echocardiography, TEE)及c-TTE联合c-TCD检查,探讨c-TTE联合c-TCD检查对PFO-RLS的诊断价值。结果 Valsalva动作后PFO-RLS检出率高于平静呼吸状态时(P<0.05);无论平静呼吸状态还是Valsalva动作后,联合检查的PFO-RLS检出率均高于单独c-TTE检查或c-TCD检查(P<0.05);诊断分级为Ⅰ级时,c-TCD的检出率高于c-TTE(P<0.05),而在Ⅱ级及Ⅲ级中两种检查方法的检出率无明显差异(P>0.05);在分级为Ⅰ级和Ⅱ级的范围中,联合检查的PFO-RLS检出率均高于单独c-TTE检查或c-TCD检查(P<0.05),而在Ⅲ级中单独c-TTE检查或c-TCD检查或联合检查的PFO-RLS检出率无明显差异(P>0.05)。结论 Valsalva作为可提高右心房压力的辅助动作可提高PFO-RLS检出率。与常规单独c-TTE检查或单独c-TCD检查相比,联合检查对PFO-RLS具有较高的诊断价值。

Objective To investigate the diagnostic value of contrast transthoracic echocardiography(c-TTE)plus contrast-enhanced transcranial Doppler(c-TCD)for patent foramen ovale right to left shunt(PFO-RLS).Methods The data of 218 PFO patients were examined with transesophageal echocardiography(TEE),and c-TTE plus C-TCD in the resting state and Valsalva state,to assess its diagnostic value for PFO-RLS.Results The detection rate of PFO-RLS was significantly higher in Valsalva state than in resting state(P<0.05).In both state,the c-TTE plus c-TCD examination showed a higher detection rate than c-TTE(P<0.05)or c-TCD alone(P<0.05).When patients had grade I disease,c-TCD had a higher detection rate than c-TTE(P<0.05),but there was no significant difference in the detection rate when the disease was Grade II or Grade III(P>0.05).In grade I and II cases,c-TTE plus c-TCD showed a higher detection rate than c-TTE(P<0.05)or c-TCD alone(P<0.05),but there was no significant difference in the detection rate between c-TTE or c-TCD alone,or combined examination in grade III cases(P>0.05).Conclusion The Valsalva maneuver which increases the right atrial pressure can significantly improve the detection rate of PFO-RLS.The sensitivity and accuracy of c-TTE plus C-TCD are significantly improved in the diagnosis of PFO-RLS compared with those of c-TTE and C-TCD alone(P<0.05).