下腔静脉加压法与Valsalva动作在提高卵圆孔未闭检出率中的对比研究

目的 探讨下腔静脉加压法与Valsalva动作在经食道超声心动图(Transesophageal echocardiography,TEE)对卵圆孔未闭(Patent foramen ovale,PFO)检出率中的差异。方法 回顾性分析手术证实的PFO患者114例,包括对比增强经颅多普勒超声(Contrast-enhanced transcranial Doppler ultrasonography,c-TCD)少量右向左分流(Right-to-left shunt,RLS)(n=51)组、中量RLS(n=37)组、大量RLS(n=26)组,记录常规TEE超声、Valsalva动作配合下TEE检查、PFO封堵术前无痛TEE下下腔静脉加压检测,分析3组房间隔右向左一过性分流信号发生率的不同和其它临床因素在3组间的差异。结果 3组身体质量指数(Body mass index,BMI)、高血压病、高脂血症及冠心病的比例无明显差异(P>0.05); 大量RLS组患者年龄明显小于少量RLS及中量RLS组(P<0.05)。少量RLS及中量RLS组患者Valsalva动作和下腔静脉加压后较常规TEE下PFO的显示率均有提高(P<0.01); 大量RLS组患者Valsalva动作和下腔静脉加压后PFO显示率改变不明显(P>0.05)。结论 大量RLS患者较少量及中量RLS患者的年龄小,更容易早期出现临床症状; 下腔静脉加压法可以替代Valsalva动作提高TEE超声对PFO的检出率。

Comparative study of inferior vena cava compression and Valsalva maneuver in improving the detection rate of PFO

Objective To investigate the difference between inferior vena cava compression and Valsalva maneuverin improving detection rate of patent foramen ovale(PFO)by transesophageal echocardiography(TEE).Methods 114 patients with PFO were reviewed, including small Right-to-left shunt(RLS)(n=51), medium RLS(n=37), large RLS(n=26)detected by Contrast-enhanced transcranial Doppler ultrasonography(cTCD). Conventional TEE, TEE with Valsalva maneuver and TEE with painless compression oninferior vena cava before PFO occlusion were recorded. The detection rate of right to left transient shunt at atrial septum in these three groups was detectedand the difference of other clinical factors among the three groups were analyzed.Results There was no significant difference in body mass index(BMI), hypertension, hyperlipidemia and coronary heart disease among the three groups(P>0.05). Age of patients in large RLS group was significantly younger than that in small and medium RLS groups(P<0.05). The detection rate of PFO by TEE with Valsalva maneuver and inferior vena cava compressionwas higher than by conventional TEE in small and medium RLS groups(P<0.01). There was no significant difference in PFO detection rate by TEE with Valsalvamaneuver and inferior vena cava compression, compared with conventional TEE, in the large RLS group(P>0.05).Conclusion Thepatients with large RLS,who were more prone to early clinical symptoms,were younger than patients with small and medium RLS. TEE withinferior vena cava compression could replace Valsalva maneuver for increasingdetection rate of PFO.