TEE、cTTE联合诊断在卵圆孔未闭封堵术治疗偏头痛患者中的应用价值

Application Value of Combined Diagnosis of TEE and cTTE in the Treatment of Migraine Patients with Patent Foramen Ovale Closure

目的:探讨偏头痛患者采用卵圆孔未闭(PFO)封堵术治疗前应用经食道超声心动图(TEE)+经胸超声心动图声学造影(cTTE)联合诊断的意义。方法:选取我院于2022年10月—2023年10月收治的初步诊断PFO并偏头痛患者100例,均计划行PFO封堵,手术前双盲法下予以TEE、cTTE检查,并于术中完成确诊。比较TEE、cTTE单独与联合诊断PFO的确诊符合率,并将联合检测符合确诊者进行分组,分析右向左分流(RLS)不同等级病例的PFO长度、孔径、原发隔活动度。结果:cTTE、TEE联合确诊符合率为100.00%,高于cTTE、TEE(P<0.05)。Ⅲ级RLS者PFO长度、孔径、原发隔活动度均高于Ⅱ级与Ⅰ级(P<0.05)。结论:对于PFO封堵术治疗偏头痛的患者,术前实施TEE+cTTE诊断能提高检出率,明确PFO结构与RLS分级情况,为临床医生拟定个性化治疗方案提供依据。

Objective:To investigate the significance of combined diagnosis of transesophageal echocardiography(TEE)and contrast transthoracicechocardiography(cTTE)in patients with migraine before transcatheter closure of patent foramen ovale(PFO).Methods:From October 2022 to October 2023,100 patients with PFO and migraine who were initially diagnosed in our hospital were selected.All patients planned to undergo PFO occlusion.TEE and cTTE were performed under double-blind method before operation,and the diagnosis was completed during the operation.The coincidence rates of TEE and cTTE alone and combined diagnosis of PFO were compared,and the patients who were confirmed by combined detection were grouped to analyze the PFO length,aperture and primary septum activity of different grades of right-to-left shunt(RLS).Results:The coincidence rate of combined diagnosis of cTTE and TEE was 100.00%,which was higher than that of cTTE and TEE(P<0.05).The PFO length,aperture and primary septum activity of RLS patients with grade Ⅲ were higher than those of grade Ⅱ and grade Ⅰ(P<0.05).Conclusion:For patients with migraine treated with PFO closure,preoperative TEE+cTTE diagnosis can improve the detection rate,clarify the structure of PFO and RLS classification,and provide a basis for clinicians to formulate personalized treatment plans.