经房间隔穿刺途径行卵圆孔未闭封堵术患者的临床疗效及预后观察

目的 探讨经房间隔（AS）穿刺途径行介入封堵术治疗卵圆孔未闭（PFO）患者的安全性、有效性及预后。 方法 选取2016年8月—2017年12月衡水市人民医院心外科和武汉大学人民医院心内科经卵圆孔途径行介入封堵 失败后改经AS穿刺途径完成PFO封堵的21例患者为AS穿刺组，取同期经卵圆孔途径行介入封堵术的30例PFO患 者为对照组。观察PFO封堵术的有效封堵率、并发症、心脑血管事件的发生及预后情况。结果 经导管PFO封堵术 的成功率为100%。AS穿刺组的平均手术时间较对照组延长（78.0 min±13.4 min vs. 49.2 min±11.9 min）。2组患者术 中及术后3 d的手术并发症发生率差异无统计学意义。术后随访1~18个月，AS穿刺组存在1例严重残余分流，有效 封堵率为95.2%，与对照组间比较差异无统计学意义；2组间主要研究终点事件（卒中、周围血栓栓塞、死亡）和次要研 究终点事件（新发房颤、心肌梗死、PFO相关的再次住院、出血）比较差异无统计学意义；Kaplan-Meier分析结果显示 随访期间内2组间无缺血事件生存率差异无统计学意义。结论 经房间隔穿刺和卵圆孔常规途径行PFO封堵术的 临床疗效、并发症和无缺血事件的生存率比较无明显差异，可作为常规途径失败后较为安全的一种技术补充。

Clinical observation and prognosis of patients with patent foramen ovale closure via transseptal approach

Objective To investigate the safety, efficacy and prognosis of transcatheter closure of patent foramen ovale in patients with patent foramen ovale (PFO) by transatrial septum (AS) puncture. Methods From August 2016 to December 2017, 21 patients underwent transcatheter closure of PFO through foramen ovale in the Department of Cardiology of Hengshui People’s Hospital and the Department of Cardiology of Renmin Hospital of Wuhan University were selected as AS puncture group, and 30 patients with PFO who underwent interventional occlusion through foramen ovale in the same period were selected as control group. The effective occlusion rate, complications, occurrence and prognosis of cardiovascular and cerebrovascular events in PFO occlusion were observed. Results The success rate of transcatheter PFO occlusion was 100%. The average operation time was longer in the AS puncture group than that in the control group (78.0 min±13.4 min vs. 49.2 min±11.9 min). There were no significant differences in the incidences of operative complications during operation and 3 days after operation between the two groups. During the follow-up from 1 to 18 months after operation, there was 1 case of severe residual shunt in the AS puncture group, and the effective occlusion rate was 95.2%. There was no significant difference in the effective occlusion rate between the two groups. There were no significant differences in the main end point events (stroke, peripheral thromboembolism and death) and secondary study end events (new atrial fibrillation, myocardial infarction, PFO related rehospitalization and bleeding) between the two groups. The results of Kaplan-Meier (Log-Rank test) showed that there was no significant difference in the survival rate of ischemic events between the two groups during the follow-up period. Conclusion There are no significant differences in clinical efficacy, complications and ischemic eventsfree survival rate between PFO occlusion via transatrial septum puncture and conventional approach to foramen ovale, and it can be used as a safe technical supplement after the failure of conventional approach.