切换至 "中华医学电子期刊资源库"

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:
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/OL]. 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/OL]. 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。

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.

图1 单纯输送鞘通过法手术示意图
1
Mas JL, Derumeaux G, Guillon B, et al. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke [J]. N Engl J Med, 2017, 377(11): 1011-1021.
2
Søndergaard L, Kasner SE, Rhodes JF, et al. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke [J]. N Engl J Med, 2017, 377(11): 1033-1042.
3
Saver JL, Carroll JD, Thaler DE, et al. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke [J]. N Engl J Med, 2017, 377(11): 1022-1032.
4
张玉顺, 朱鲜阳, 孔祥清, 等. 卵圆孔未闭预防性封堵术中国专家共识 [J]. 中国循环杂志, 2017, 32(3): 209-214.
5
Hoffman JIE, Kaplan S. The incidence of congenital heart disease [J]. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
6
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts [J]. Mayo Clinic proceedings, 1984, 59(1): 17-20.
7
Schubert S, Kainz S, Peters B, et al. Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients [J]. Clin Res Cardiol, 2012, 101(9): 691-700.
8
Bartakian S, El-Said HG, Printz B, et al. Prospective randomized trial of transthoracic echocardiography versus transesophageal echocardiography for assessment and guidance of transcatheter closure of atrial septal defects in children using the Amplatzer septal occluder [J]. JACC Cardiovasc Interv, 2013, 6(9): 974-980.
9
Erdem A, Sarıtas T, Zeybek C, et al. Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults [J]. Int J Cardiovasc Imaging, 2013, 29(1): 53-61.
10
杨滔, 欧阳文斌, 赵广智, 等. 单纯经胸超声心动图引导下行经皮卵圆孔未闭封堵术的临床研究 [J]. 中国循环杂志, 2019, 34(1): 77-80.
11
潘湘斌, 逄坤静, 欧阳文斌, 等. 单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究 [J]. 中国循环杂志, 2015, 30(8): 774-776.
[1] 陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 959-965.
[2] 王益佳, 周青, 曹省, 袁芳洁, 周妍, 张梅. 中国经胸超声心动图检查存图及报告质控现状分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(07): 657-663.
[3] 王岚, 徐斌胜, 谢乐. 肥厚型心肌病的经胸超声心动图诊断与心电图表现特征[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 593-596.
[4] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[5] 孔莹, 惠品晶, 丁亚芳, 周炳元. 基于对比增强经颅多普勒的多模式超声评估卵圆孔未闭相关右向左分流的临床意义[J/OL]. 中华医学超声杂志(电子版), 2024, 21(04): 345-351.
[6] 邢颖, 程石. 巨脾外科治疗现状与介入治疗序贯手术策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 253-258.
[7] 唐必英, 李钢. 治疗时机对动脉瘤性蛛网膜下腔出血患者预后的影响[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(04): 213-219.
[8] 杨金朔, 吴桥伟, 王春雷, 史怀璋. 脑血管内支架成形术后再狭窄的研究进展[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(03): 174-179.
[9] 牟超鹏, 宗斌, 刘奕, 史美英, 徐杜娟, 冯春光. 经远端桡动脉与经常规桡动脉行急诊冠脉介入诊疗后穿刺部位血肿的对比[J/OL]. 中华临床医师杂志(电子版), 2024, 18(03): 275-282.
[10] 陈芳, 王建英, 曹建用, 刘丽, 罗晓琴. 基于分析-设计-开发-实施-评价模式的叙事护理培训在产科预防性介入治疗中的应用[J/OL]. 中华介入放射学电子杂志, 2024, 12(04): 392-396.
[11] 李超迪, 刘娟芳, 闫肃, 秦胜东, 张镐哲, 常琼方, 韩新巍, 张建好. 血管性介入治疗在宫颈癌大出血患者中的临床疗效[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 217-220.
[12] 周宝林, 刘曦, 谌浩, 王金, 马雪琴. 温敏水凝胶在血管内栓塞治疗中的研究进展[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 244-249.
[13] 陈晓波. 使用抓捕器辅助经导管卵圆孔未闭封堵一例[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 287-288.
[14] 郭方明, 赵明俐, 颜凡辉, 刘萌萌, 王阳, 赵英杰, 刘远航, 张艳芬, 詹景冬. 光学相干断层成像在急性心肌梗死冠状动脉分层斑块病变中的应用[J/OL]. 中华诊断学电子杂志, 2024, 12(02): 73-79.
[15] 周洪千, 张煜坤, 顾天舒, 胡苏涛, 姜超, 张雪, 张昊, 陶华岳, 刘行, 刘彤, 陈康寅. 既往出血性脑卒中患者行经皮冠脉介入治疗后不良事件的危险因素分析[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 323-329.
阅读次数
全文


摘要