卵圆孔未闭并发小房间隔缺损的介入治疗

目的 评价卵圆孔未闭（PFO）并发小房间隔缺损（ASD）介入治疗的有效性和安全性。方法 PFO并发小ASD患者18（男7，女11）例，其中不明原因卒中6例，偏头痛12例, 年龄21~58（36±13）岁，均行介入治疗。结果18例PFO并发小ASD患者，PFO直径2~4（2.7±0.8）mm，ASD直径3~5（4.0±0.9）mm，10例两孔间距离<7 mm，5例8~12 mm，3例>12 mm。15例患者置入单封堵器，3例置入双封堵器。术前经胸超声心动图声学造影（cTTE）静息状态均有右向左分流（RLS），Valsalva动作（VM）后大量RLS。术后18例患者静息状态下均无RLS,15例置入单封堵器者术后:1个月VM后均为大量RLS，3个月11例为少~中量RLS及4例为大量RLS，6个月4例为大量RLS，其余11例无RLS。3例置入双封堵器者术后1个月VM后为大量RLS、3个月为中量RLS，而6个月均无RLS。6例不明原因脑卒中患者复查头颅MRI无新发梗死病灶。12例偏头痛患者，封堵术后6个月1例无明显改善，11例患者症状消失或明显减轻。HIT-6评分较术前明显减少〔(66±10)分 vs.(42±10)分，P<0.01〕。结论介入治疗PFO并发小ASD是一种安全有效的方法，但短期内仍有部分患者存在RLS，尤其是置入单封堵器者。

Transcatheter closure in patients with patent foramen ovale accompanied with a small atrial septal defect

AIM To evaluate the efficacy and safety of transcatheter closure in patients with patent foramen ovale (PFO) accompanied with a small atrial septal defect (ASD). METHODSE ighteen PFO patients accompanied with a small ASD (7 males, 11 females; age 21-58 years (36±13) years, including 6 with cryptogenic stroke and 12 with migraine underwent interventional treatments. RESULTS In the 18 patients, the diameter of PFO was 2-4(2.7±0.8) mm and the diameter of ASD was 3-5(4.0±0.7) mm. The distance between two holes was <7 mm in 10 patients, 8-12 mm in 5 patients and >12 mm in 3 patients. Fifteen patients were implanted with single occluder and 3 patients with double occluders. Contrast transthoracic echocardiography (cTTE) showed that all the patients had right-to-left shunt (RLS) pre-operation at rest and that after Valsalva maneuver (VM), a large amount of RLS was indicated. Eighteen patients showed no RLS at rest post-operation. Patients implanted with single occluder showed that after operation and after Valsalva maneuver (VM), a large amount of RLS was indicated in all the patients at 1 month, a small to moderate amount of RLS was found in 11 patients and a large amount of RLS in 4 patients at 3 months, a large amount of RLS in 4 patients and no RLS in the other 11 patients at 6 months. In the 3 patients implanted with double occluders, after VM a large amount of RLS was found at 1 month, a moderate amount of RLS at 3 months and no RLS at 6 months. No fresh infarction lesions were found by brain MRI in the follow-ups for the 6 patients with cryptogenic stroke. Among the 12 patients with migraine, 11 showed significantly improved migraine symptoms at 6 months after the closure procedure. HIT-6 score significantly decreased compare with that pre-operation (66.5±10.4 vs. 42.3±9.5, P<0.01). CONCLUSIONT ranscatheter closure of PFO accompanied with a small ASD is safe and effective, even though RLS still occurs in some patients, especially those implanted with single occluder.