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
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摘要
目的:本研究探讨单纯经胸超声心动图(TTE)引导下,行经皮卵圆孔未闭(PFO)封堵术的安全性及有效性。方法:回顾性分析2016年3月至2017年7月期间,在我院成功实施的单纯TTE引导下经皮PFO封堵术的患者35例,其中男性12例,女性23例。平均年龄(34.8±13.8)岁,平均体重(58.3±11.5)kg。术后即刻以超声心动图检查评价治疗效果,并于术后1个月、3个月进行门诊或电话随访。结果:所有患者均成功在TTE引导下行经皮PFO封堵术。5例患者因声窗不清晰,而加用食道超声辅助引导。患者的平均手术时间(穿刺至拔除鞘管)为(22.1±6.0)min。1例患者术后即刻存在微量残余分流,24 h后消失;1例术后发现少量心包积液,对症治疗后好转。35例患者的平均住院时间为(3.3±0.5)d,均康复出院,未出现外周血管损伤、心脏穿孔等并发症。术后1个月、3个月随访时,所有患者均未出现脑卒中、心包积液、封堵器脱落、残余分流等并发症。结论:单纯TTE引导下经皮PFO封堵术安全、有效,可以避免使用X线及对比剂,近期效果满意。
Objectives: Our study observed the safety and efficacy of percutaneous closure of Patent Foramen Ovale(PFO) guided solely by transthoracic echocardiography(TTE).Methods: Clinical data of 35 PFO patients(12 male) treated by percutaneous closure solely guided by TTE in our institute from 2016-03 to 2017-07 were retrospectively analyzed. The mean age of patients was(34.8 ± 13.8) years, mean body weight was(58.3 ± 11.5) kg. TTE was performed immediately after percutaneous closure, the clinical follow-up was conducted at 1 month and 3 months after the procedure.Results: Percutaneous closure was successful in all patients under the guidance of TTE. TTE and transesophageal echocardiography(TEE) guidance was required in 5 cases because the TTE images were not clear enough. The mean procedural time(from puncture to sheath removal) was(22.1 ± 6.0) minutes. There was 1 case of residual shunt immediately post procedure, which disappeared spontaneously at 24 hours post procedure, 1 patient developed a small amount of pericardial effusion, which also disappeared after conservative treatment. The mean hospital stay was(3.3±0.5) days. All patients discharged without complications such as peripheral vascular injury or cardiac perforation. No patients suffered from stroke, pericardial effusion, occluder malposition, or residual shunt during follow-up at 3 months post operation.Conclusions: TTE guided percutaneous closure of PFO is safe and effective, this technique avoids the radiation and use of contrast agent in selected patients and short-term results are satisfactory in this patient cohort.
Objectives: Our study observed the safety and efficacy of percutaneous closure of Patent Foramen Ovale(PFO) guided solely by transthoracic echocardiography(TTE).Methods: Clinical data of 35 PFO patients(12 male) treated by percutaneous closure solely guided by TTE in our institute from 2016-03 to 2017-07 were retrospectively analyzed. The mean age of patients was(34.8 ± 13.8) years, mean body weight was(58.3 ± 11.5) kg. TTE was performed immediately after percutaneous closure, the clinical follow-up was conducted at 1 month and 3 months after the procedure.Results: Percutaneous closure was successful in all patients under the guidance of TTE. TTE and transesophageal echocardiography(TEE) guidance was required in 5 cases because the TTE images were not clear enough. The mean procedural time(from puncture to sheath removal) was(22.1 ± 6.0) minutes. There was 1 case of residual shunt immediately post procedure, which disappeared spontaneously at 24 hours post procedure, 1 patient developed a small amount of pericardial effusion, which also disappeared after conservative treatment. The mean hospital stay was(3.3±0.5) days. All patients discharged without complications such as peripheral vascular injury or cardiac perforation. No patients suffered from stroke, pericardial effusion, occluder malposition, or residual shunt during follow-up at 3 months post operation.Conclusions: TTE guided percutaneous closure of PFO is safe and effective, this technique avoids the radiation and use of contrast agent in selected patients and short-term results are satisfactory in this patient cohort.
引文
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[14]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.DOI:10.3969/j.issn. 1000-3614.2015.08.014.
[2] Roguin A, Goldstein J, Bar O, et al. Brain and neck tumors among physicians performing interventional procedures[J]. Am J Cardiol,2013, 111(9):1368-1372. DOI:10. 1016/j. amjcard. 2012. 12. 060.
[3] Meinel FG, Nance JW, Harris BS, et al. Radiation risks from cardiovascular imaging tests[J]. Circulation, 2014, 130(5):442-445.DOI:10. 1161/CIRCULATIONAHA. 113. 005340.
[4] Maioli M, Toso A, Leoncini M, et al. Persistent renal damage after contrast-induced acute kidney injury:incidence, evolution, risk factors, and prognosis[J]. Circulation, 2012, 125(25):3099-3107.DOI:10. 1161/CIRCULATIONAHA. 111. 085290.
[5] Hara H, Virmani R, Ladich E, et al. Patent foramen ovale:current pathology, pathophysiology, and clinical status[J]. J Am Coll Cardiol,2005, 46(9):1768-1776. DOI:10. 1016/j. jacc. 2005. 08. 038.
[6] Wahl A, Juni P, Mono ML, et al. Long-term propensity scorematched comparison of percutaneous closure of patent foramen ovale with medical treatment after paradoxical embolism[J]. Circulation,2012, 125(6):803-812. DOI:10. 1161/CIRCULATIONAHA. 111.030494.
[7] Wessler BS, Kent DM. Prevention of recurrent stroke in patients with patent foramen ovale[J]. Neurol Clin, 2015, 33(2):491-500. DOI:10. 1016/j. ncl. 2015.01.002.
[8] Khan AR, Bin Abdulhak AA, Sheikh MA, et al. Device closure of patent foramen ovale versus medical therapy in cryptogenic stroke[J]. JACC Cardiovasc Interv, 2013, 6(12):1316-1323. DOI:10. 1016/j.jcin. 2013.08. 001.
[9] 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, 10(9):691-700. DOI:10. 1007/s00392-012-0445-1.
[10] Pan XB, Ouyang WB, Wang SZ, et al. Transthoracic echocardiography-guided percutaneous patent ductus arteriosus occlusion:a new strategy for interventional treatment[J].Echocardiography,2016, 33(7):1040-1045. DOI:10. 1111/echo.13207.
[11] Pan XB, Ouyang WB, Pang KJ, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children[J]. J Interv Cardiol,2015, 28(4):390-395. DOI:10. 1111/joic. 12214.
[12]李世军,岳庆雄,王苏平,等.卵圆孔未闭介入封堵治疗及近期随访研究[J].中国循环杂志,2014, 29(6):448-452. DOI:10. 3969/j.issn. 1000-3614.2014. 06.01.
[13]黄浩佳,胡海波,徐仲英,等.经导管封堵术治疗卵圆孔未闭合并隐匿性卒中或短暂性缺血发作的近中期疗效观察[J].中国循环杂志,2017, 32(4):377-379. DOI:10. 3969/j.issn. 1000-3614. 2017.04. 016.
[14]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.DOI:10.3969/j.issn. 1000-3614.2015.08.014.