| 经颅多普勒增强实验结合经食管超声鉴别肺动静脉瘘与卵圆孔未闭所致隐源性卒中的研究 |
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| 引用本文： | 董培,潘华. 经颅多普勒增强实验结合经食管超声鉴别肺动静脉瘘与卵圆孔未闭所致隐源性卒中的研究[J]. 中国卒中杂志, 2016, 11(9): 752-757. DOI: 10.3969/j.issn.1673-5765.2016.09.008 |
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| 作者姓名： | 董培 潘华 |
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| 作者单位： | 100050 北京首都医科大学附属北京天坛医院临床神经生理科 |
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| 摘 要： | 目的 探讨经颅多普勒增强实验（contrast transcranial Doppler，cTCD）结合经食管超声（transesophagealechocardiography，TEE）对于鉴别肺动静脉瘘（pulmonary arteriovenous fistula，PAVF）与卵圆孔未闭（patent foramen ovale，PFO）所致隐源性卒中的意义。方法 收集4例隐源性卒中患者（PAVF组2例，PFO组2例）的临床资料，行cTCD、TEE检查，比较两组的检查结果差异。结果 PAVF组cTCD结果显示患者平静呼吸时即见雨帘样栓子信号，Valsalva动作（Valsalva maneuver，VM）后栓子数量变化不明显；TEE彩色多普勒（color Doppler flow image，CDFI）未见异常，右心声学造影VM后5个心动周期左房内肺静脉开口处见大量微泡。PFO组cTCD结果显示，一例平静呼吸时可见4个栓子，VM后雨帘样栓子信号，VM作用消失后第40个心动周期有2个栓子信号。一例平静呼吸时无栓子信号，VM后可见>50个栓子信号，VM作用消失后无栓子信号。TEECDFI示原发隔继发隔间裂隙左向右过隔血流，右心声学造影VM后2～3个心动周期卵圆孔附近的左心房内见数个微气泡。结论 cTCD结合TEE鉴别诊断PFO和PAVF敏感性高，易于操作。二者主要鉴别点在于cTCD平静呼吸时是否出现大量栓子及是否受VM影响。
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| 关 键 词： | 肺动静脉瘘 卵圆孔未闭 隐源性卒中 经颅多普勒 |
| 收稿时间： | 2016-03-09 |
The Significance of Contrast Transcranial Doppler Combined with Transesophageal Echocardiography in the Differential Diagnosis of Cryptogenic Stroke with Pulmonary Arteriovenous Fistula and Patent Foramen Ovale |
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| DONG Pei,PAN Hua. The Significance of Contrast Transcranial Doppler Combined with Transesophageal Echocardiography in the Differential Diagnosis of Cryptogenic Stroke with Pulmonary Arteriovenous Fistula and Patent Foramen Ovale[J]. Chinese Journal of Stroke, 2016, 11(9): 752-757. DOI: 10.3969/j.issn.1673-5765.2016.09.008 |
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| Authors: | DONG Pei PAN Hua |
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| Abstract: | Objective To explore the significance of contrast transcranial Doppler (cTCD) combined with transesophageal echocardiography (TEE) in the differential diagnosis of cryptogenic stroke with pulmonary arteriovenous ifstula and patent foramen ovale. Methods Detailed clinical information were collected. TEE and cTCD were performed in 4 patients with cryptogenic stroke (2 patients with pulmonary arteriovenous fistula [PAVF] and 2 patients with patent foramen ovale [PFO]) to compare the difference in test results. Results cTCD in 2 patients with PAVF showed the following characteristics: detection of massive microembolic signals (curtain pattern) during regular breathing, and not influenced by Valsalva maneuver (VM). TEE showed large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM. cTCD in 2 patients with PFO showed: detection of none or 4 signals during regular breathing, and curtain pattern of signals after VM. TEE with color Doppler imaging showed left-to right shunt and several microbubbles appeared in the left atrium at 2nd-3rd cardiac cycle after VM. Conclusion cTCD combined with TEE is useful for differential diagnosis of PFO and PAVF due to high sensitivity and easy operation. The main identiifcation points is that whether there are lots of massive microembolic signals and whether it will be inlfuenced by VM at cTCD during regular breathing. |
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| Keywords: | Pulmonary arteriovenous fistula Patent foramen ovale Cryptogenic stroke Transcranial Doppler |
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