经食管与经胸超声心动图造影检出卵圆孔未闭右向左分流效果比较

目的比较经食管超声心动图（TEE）造影和经胸超声心动图（TTE）造影对卵圆孔未闭（PFO）右向左分流（I也s）的检出效果。方法随机选取不明原因脑卒中或偏头痛伴PFO患者29例。所有患者均先、后进行了TEE和TTE造影，TTE造影探头频率为二次谐波1．7MHz／3．4MHz。TEE造影探头频率为7MHz。通过肘前静脉快速注入手振0．9％氯化钠溶液10ml进行造影，观察记录右心房充分显影后前3个心动周期内有无微泡进入左心房，根据进入左心房的微泡数量将PFO—RLS划分为4个等级：1级为无RLS，即未见微泡进入左心房；2级为少量RLS，即左心房内可见1～10个微泡／帧；3级为中量RLS，即左心房内可见11～30个微泡／帧；4级为大量RLS，即左心房内可见〉30个／帧，或左心房充满微泡。结果TTE造影和TEE造影对PFO．RLS的检出率分别为86．2％（25／29）、55．2％（16／29）。对2种方法的检出率进一步作配对，检验，结果表明差异有统计学意义（x^2=5．711，P=0．017）。TTE造影半定量分级；1级（无RLS）4例；2级（少量RLS）1例；3级（中量RLS）5例：4级（大量RLS）19例。TEE造影半定量分级：1级（无RLS）13例；2级（少量RLS）3例；3级（中量RLS）6例；4级（大量RLS）7例。对PFO—RLS半定量分级的Wllcoxon检验显示，2种技术所得结果的差异有统计学意义（Z=-3．789，P4）．000）。结论]r]匝造影对PFO—RLS的检出效率优于TEE造影。以前者替代后者不但便于相关工作的开展，还可能减少和（或）避免经食管超声检查带来的不适和并发症。

Comparison of transthoracic contrast echocardiography and transesophageal contrast echocardiography for detecting right to left shunt in patients with petent foramen ovale

Objective To compare the effect of transthoracic contrast echocardiography （cTTE） with transesophageal contrast echocardiography （cTEE） for detecting right to left shunt （RLS） in patients with patent foramen ovale （PFO）. Methods The prospective study was conducted in 29 consecutive patients with PFO who suffered from cryptogenic stroke and/or migraine. Contrast echocardiography was performed in all 29 patients. The cTTE was performed using transducer with second harmonic imaging modality （transmitting frequency 1.7 MHz, receiving frequency 3.4 MHz）. The cTEE was performed using transducer with frequency 7 MHz. Ten milliliter saline solution of contrast were rapidly administrated through an antecubital vein. According to whether microbubble （MB） appearing in left atrium after complete opacification of right atrium within the first 3 circles, the results were classified by a four-level semi-quantitative categorization： Level 1 （no PFO-RSL）, no MB in left atrium; Level 2 （small PFO-RSL） 1-10 MBs; Level 3 （medium PFO-RSL） 10-30 MBs; Level 4 （large PFO-RSL） 〉 30 MBs. Results The total detection rate of PFO-RSL was significant different between cTTE and cTEE （86.2% vs 55.2%, X2=5.711, P=0.017）. In cTTE there were 4 cases at level 1, 1 case at level 2, 5 cases at level 3 and 19 cases at level 4. In cTEE there were 13 cases at leverl 1, 2 cases at level 2, 6 cases at level 3 and 7 cases at level 4. The comparison of semi-quantitative grading derived from cTTE and cTEE was also significant different （Wilcoxon signed ranks test showed Z=-3.789, P=0.000）. Conclusions The efficiency in detection of PFO-RLS with cTTE was better than with cTEE. Compared with cTEE, cTTE was easier in practice and brought less discomfort and complications to patients.