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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (02) : 100 -103. doi: 10.11817/j.issn.1673-9248.2020.02.008

所属专题： 文献；

论著

单纯输送鞘通过法行经胸超声心动引导卵圆孔未闭封堵术的临床疗效分析
周文君1, 林进1, 姜新鹏1, 杨航1, 宫一宸1, 傅元豪1, 孙庆利1, 傅瑜1, 李小刚1, 冯杰莉1, 冯新恒1, 李晓明1,†(), 张喆1,†()   
  1. 1. 100191　北京大学第三医院心脏外科
  • 收稿日期:2020-02-19 出版日期:2020-04-01
  • 通信作者: 李晓明, 张喆
  • 基金资助:
    北京大学第三医院临床学科重点项目(Y75510-04)

Clinical efficacy of solo transcatheter closure of patent foramen ovale guided by transthoracic echocardiography

Wenjun Zhou1, Jin Lin1, Xinpeng Jiang1, Hang Yang1, Yichen Gong1, Yuanhao Fu1, Qingli Sun1, Yu Fu1, Xiaogang Li1, Jieli Feng1, Xinhang Feng1, Xiaoming Li1,†(), Zhe Zhang1,†()   

  1. 1. Department of Cardiosurgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-02-19 Published:2020-04-01
  • Corresponding author: Xiaoming Li, Zhe Zhang
  • About author:
    Corresponding author: Zhang Zhe, Email:
    Li xiaoming， Email:
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引用本文：

周文君, 林进, 姜新鹏, 杨航, 宫一宸, 傅元豪, 孙庆利, 傅瑜, 李小刚, 冯杰莉, 冯新恒, 李晓明, 张喆. 单纯输送鞘通过法行经胸超声心动引导卵圆孔未闭封堵术的临床疗效分析[J]. 中华脑血管病杂志(电子版), 2020, 14(02): 100-103.

Wenjun Zhou, Jin Lin, Xinpeng Jiang, Hang Yang, Yichen Gong, Yuanhao Fu, Qingli Sun, Yu Fu, Xiaogang Li, Jieli Feng, Xinhang Feng, Xiaoming Li, Zhe Zhang. Clinical efficacy of solo transcatheter closure of patent foramen ovale guided by transthoracic echocardiography[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(02): 100-103.

目的

分析使用单纯输送鞘通过法，在经胸超声心动（TTE）引导下完成卵圆孔未闭（PFO）封堵术的安全性和有效性。

方法

回顾性分析2018年12月至2019年12月在北京大学第三医院使用单纯输送鞘通过法完成的TTE引导PFO封堵术的25例患者资料，其中男性20例，女性5例，平均年龄（42.3±7.8）岁。术前合并脑梗死患者6例（RoPE评分＞6分），偏头痛患者19例。术前均经食道超声心动（TEE）证实PFO存在，孔径2~3 mm，隧道4~8 mm，对比增强经颅多普勒超声声学造影（cTCD）提示2~3级。术后即刻以TTE检查评价治疗效果，并于术后1、3、6个月进行随访。

结果

所有患者均使用单纯鞘管通过法，成功完成TTE引导下经皮PFO封堵术。患者的平均手术时间（穿刺至拔除鞘管）为（32.1±7.5）min，术中3例出现迷走神经反射表现，2例出现短暂室性心律失常，对症治疗后均好转。所有患者未发现心包积液、外周血管损伤、心脏穿孔等并发症，均于术后次日出院。术后随访无患者出现心包积液、封堵器脱落、残余分流、头痛与脑卒中复发。cTCD示PFO恢复正常。

结论

单纯输送鞘通过法对于TTE引导下PFO封堵术安全、有效，可以避免心脏损伤，近、中期效果满意。

关键词: 卵圆孔未闭, 经胸超声心动图, 介入治疗
Objective

To observe the safety and efficacy of solo transcatheter closure of Patent Foramen Ovale (PFO) guided solely by transthoracic echocardiography (TTE).

Methods

A total of 25 cases were retrospectively included who underwent the solo transcatheter closure of PFO guided by TTE in Peking University Third Hospital from December 2018 to December 2019. They were 20 females and 5 males with average age of (42.3±7.8) years. TTE was performed immediately after percutaneous closure. The follow-up interviews were conducted at 1 month, 3 months, and 6 months after the procedure, respectively. There were 6 patients with cryptogenic stroke (RoPE score＞6) and 19 patients with obstinate migraine. The presence of PFO was confirmed by preoperative transesophageal echocardiography (TEE). The diameter of PFO was 2-3 mm and the diameter of tunnel was 4-8 mm. The contrast-enhanced transcranial doppler (cTCD) was 2-3 grade.

Results

All patients were successfully treated with the solo transcatheter closure of PFO guided by TTE. The mean procedural time (from puncture to sheath removal) was (32.1±7.5) mins. During the operation, 3 cases presented vagal reflex and 2 cases developed transient ventricular arrhythmia, which disappeared after conservative treatment. All patients were discharged the next day after operation without complications, e.g. pericardial effusion, peripheral vascular injury, or cardiac perforation. During the follow-ups, no patients suffered from pericardial effusion, occluder malposition, residual shunt, recurrence of headache and stroke. The cTCD is normal.

Conclusion

The solo transcatheter closure of PFO guided by TTE is an effective procedure with high successful rate and low rate of complications.

Key words: Patent foramen ovale, Transthoracic echocardiography, Transcatheter closure
图1 单纯输送鞘通过法手术示意图
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