杜亚娟, 张玉顺, 成革胜, 王星烨, 何 璐, 杨 蒙. TTE结合cTTE在卵圆孔未闭介入治疗中的应用[J]. 心脏杂志, 2015, 27(4): 397-400.
    引用本文: 杜亚娟, 张玉顺, 成革胜, 王星烨, 何 璐, 杨 蒙. TTE结合cTTE在卵圆孔未闭介入治疗中的应用[J]. 心脏杂志, 2015, 27(4): 397-400.
    shu
    Application of combined transthoracic echocardiography and contrast transthoracic echocardiography for percutaneous intervention of patent foramen ovale[J]. Chinese Heart Journal, 2015, 27(4): 397-400.
    Citation: Application of combined transthoracic echocardiography and contrast transthoracic echocardiography for percutaneous intervention of patent foramen ovale[J]. Chinese Heart Journal, 2015, 27(4): 397-400.
    shu

    TTE结合cTTE在卵圆孔未闭介入治疗中的应用

    Application of combined transthoracic echocardiography and contrast transthoracic echocardiography for percutaneous intervention of patent foramen ovale

      摘要
    • 摘要: 目的 探讨经胸超声心动图（TTE）结合经胸超声心动图右心声学造影（cTTE）在卵圆孔未闭（PFO）介入治疗中的应用价值。方法 入选我院90例行介入封堵治疗的PFO患者，年龄（40±15）岁。用TTE、cTTE及食管超声心动图（TEE）评估、检测及随访。结果 90例PFO患者，TTE或TEE检查符合简单型PFO 52例（58%）、复杂型PFO 38例（42%）。术前cTTE检查，38例（42%）于静息状态下检出右向左分流（RLS），其中少量24例(27%)、中量11例(12%)和大量3例(3%)，Valsalva动作除8例（9%）为中量RLS外，余均为大量RLS。Valsalva动作后大量RLS检出率明显高于静息状态（P<0.01）。52例简单型PFO患者均用PFO封堵器，其中18/25 mm、30/30 mm和25/35 mm封堵器各用38例（73%）、6例（12%）和8例（15%），18/25 mm封堵器使用率明显高于30/30 mm和25/35 mm封堵器（P<0.01）。38例复杂型PFO患者，37例用单封堵器，其中30/30 mm和25/35 mmPFO封堵器分别为16例（42%）和17例（45%）、房间隔缺损（ASD）封堵器4例（11%）。1例PFO并发ASD的患者，孔间距为20 mm，应用18/18 mm和25/35 mm双封堵器。术后cTTE随访：3个月、半年、1年完全堵闭率（无RLS）分别为40%、67%和74%。术后1年残余RLS为23例，其中22例(96%)微泡出现时间超过5个心动周期。结论 TTE结合cTTE在PFO封堵术前病例筛查、术中指导封堵器选择及术后疗效评价中均有着不可或缺的作用，对保证PFO封堵治疗成功具有重要价值。

       

      Abstract: AIM To evaluate the application value of transthoracic echocardiography (TTE) combined with contrast transthoracic echocardiography (cTTE) for percutaneous intervention of patent foramen ovale (PFO). METHODS Ninety PFO patients, who aged from 14 to 61 years (mean age, 40±15) and underwent percutaneous PFO closure, were assessed, monitored and followed up by TTE, cTTE and transoesopheageal echocardiography (TEE). RESULTS TTE or TEE showed that 52 patients had simple PFO (57.8%) and 38 patients had complicated PFO (42.2%). The right to left shunt (RLS) at rest was detected by the preoperative cTTE in 38 patients (42%), of whom were 24 cases (27%) with a small amount of RLS, 11 cases (12%) with moderate RLS and 3 cases (3%) with a large number of RLS. After Valsalva maneuver, 8 patients had moderate RLS and the rest patients had a large amount of RLS. The detectable rate of a large amount of RLS after Valsalva maneuver was significantly higher than that at rest (P<0.01). The 52 patients with simple type PFO were treated with PFO occluders, including 38(73%) 18/25 mm-occluders, 6(12%) 30/30 mm- occluders and 8(15%) 25/35 mm-occluders. Our data indicated the utilization ratio of 18/25 mm-occluder was significantly higher than that of 30/30 mm-occluder and 25/35 mm-occluder (P<0.01). Thirty-seven of the 38 complicated PFO patients were treated with single occluders, including 16(42%) 18/25 mm-PFO occluders, 17(45%) 25/35 mm- PFO occluders and 4 atrial septal defect (ASD)-occluders (11%). One complicated PFO patient coexisting with small ASD had 20 mm hole spacing and was treated with 18/18mm and 25/35 mm- PFO occluders. Complete closure rates (no RLS) by cTTE at the follow-up time of 3 months, 6 months and 1 year were respectively 40%, 67% and 74%. Residual RLF was found in 23 patients at 1 year after operation. The time of microbubbles appeared over 5 cardiac cycle in 22 of the 23(96%) patients. CONCLUSION The combination of TTE with cTTE is indispensable for preoperative screening, choice of occluder and treatment evaluation and is thus of important value for ensuring successful percutaneous intervention of PFO.

       

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