卵圆孔未闭封堵治疗在卵圆孔未闭合并偏头痛患者中的中长期随访分析

目的 分析偏头痛患者中卵圆孔未闭（PFO）封堵术的中长期疗效。方法 收集2013年1月至2017年12月于西安交通大学第一附属医院结构性心脏病科诊断为PFO合并偏头痛,同时行PFO封堵术的患者,随访2年,比较术前及术后3个月、6个月、1年、2年的偏头痛发作频率、持续时间、头痛影响测验-6(HIT-6)评分、偏头痛残疾程度评价量表（MIDAS）评分及头痛视觉模拟量表（VAS）评分,评价PFO封堵治疗对PFO合并偏头痛患者的中长期获益,并探索影响偏头痛缓解的危险因素。结果 共193例患者入组本研究,随访术后各时间段偏头痛发作频率、持续时间、HIT-6评分、MIDAS评分及VAS评分均较术前明显改善,差异均有统计学意义（均P<0.001）。术后2年偏头痛完全缓解率为62.7%,有效率为92.2%。多因素Logistic回归分析显示术前存在静息状态下持续性右向左分流与术后长期偏头痛缓解率的降低相关（OR 0.462,95%CI 0.231～0.923,P=0.029）。结论 PFO封堵治疗可能显著改善偏头痛患者症状,使偏头痛患者可以从中获益。对术前存在静息状态下持续性右向左分流的患者应多...     

经皮封堵术治疗复杂型卵圆孔未闭的疗效分析

目的：分析长隧道型或合并房间隔膨出瘤（atrial septal aneurysm,ASA）的卵圆孔未闭（patent foramen oval,PFO）经皮封堵术后的临床疗效及相关影响因素。方法：选取2021年3月至2022年8月期间,于郑州市第七人民医院行PFO封堵术的24例长隧道型或合并ASA的PFO患者。在术前、术后3个月、术后6个月对患者进行随访观察,记录患者偏头痛、头晕等临床症状的程度及持续时间,以头痛影响测定评分-6(headache impact test-6,HIT-6)和头晕视觉模拟量表（visual analogue scale,VAS）表示。结果：术后随访,此类PFO患者术后3个月临床症状缓解有效的18例（75.0%）,术后6个月临床症状缓解有效的20例（83.3%）,封堵术前术后HIT-6评分及头晕VAS评分均显著降低（P<0.01）。6例术前有脑血管事件发生的患者,术后6个月均无再发脑血管事件。结论：长隧道型或合并ASA的PFO患者,行PFO封堵术可以有效缓解相关临床症状,改善生命质量,同时手术安全性较高,具有一定临床指导意义。     

介入封堵术在偏头痛合并卵圆孔未闭患者中的临床疗效和安全性

目的探讨介入封堵术在偏头痛合并卵圆孔未闭(patent foramen ovale,PFO)患者中的临床疗效和安全性。方法前瞻性纳入武汉亚洲心脏病医院2018年11月至2020年1月确诊为偏头痛合并PFO并行封堵术的患者50例。于术前及术后1个月、3个月、6个月评估头痛影响测验-6(headache impact test-6,HIT-6)评分、视觉模拟疼痛评分(visual analogue scale,VAS)、头痛发作频率、头痛持续时间,用于评估PFO封堵术对偏头痛的疗效。其次,选取在同一时间段就诊于本院的偏头痛合并PFO且没有行封堵术的患者,根据年龄、性别、经颅多普勒超声(transcranial doppler,TCD)发泡试验分流量分级相匹配的50例患者作为非封堵组,以经食道超声心动图确诊PFO当天作为入组时间,随访6个月,并与封堵组患者术后6个月比较HIT-6评分、头痛发作频率、头痛持续时间。结果封堵组患者均成功置入封堵器,术后未发现手术并发症;术后1个月、3个月、6个月HIT-6评分[(48.42±10.02)分、(43.38±8.03)分、(40.38±5.24)分]、VAS评分[(2.82±0.14)分、(1.54±0.61)分、(0.88±0.04)分]、头痛发作频率[(2.62±0.13)次/个月、(1.44±0.62)次/个月、(0.82±0.18)次/个月]、头痛持续时间[(1.39±1.27)h/次、(0.85±1.02)h/次、(0.56±0.14)h/次]与术前比较,差异有统计学意义(P0.05)。6个月随访时,封堵组患者偏头痛发作指标[HIT-6评分(40.38±5.24)分、头痛发作频率(0.82±0.18)次/个月、头痛持续时间(0.56±0.14)h/次]较非封堵组患者[HIT-6评分(53.80±5.36)分、头痛发作频率(4.88±1.91)次/个月、头痛持续时间(2.19±1.19)h/次]明显好转,差异有统计学意义(P0.05)。结论介入封堵术在偏头痛合并PFO治疗中有效、安全。     

封堵术对卵圆孔未闭伴偏头痛的作用

目的探讨卵圆孔未闭(PFO)伴偏头痛的影响因素,以及卵圆孔封堵后对PFO伴偏头痛的疗效。方法选取2014年1月至2019年12月于郑州市第七人民医院心内科诊断PFO患者70例,其中合并偏头痛者42例(PFO组)。另选取同期我院非PFO者95例,其中合并偏头痛者30例(非PFO组)。对比两组偏头痛的发生数,同时比较PFO右向左分流(RLS)不同分级对偏头痛的发生以及严重程度的影响。对比其中PFO组中38例患者成功行卵圆孔封堵术前后头痛严重程度以及头痛对生活质量影响评分。结果 PFO组偏头痛发病人数较非PFO组明显偏高,差异有统计学意义(χ~2=14.28,P0.05);RLS分级与偏头痛的发生及头痛程度呈正相关,差异有统计学意义(χ~2=6.308,24.86,P0.05,γ=0.600)。对比封堵1年后头痛评分以及头痛影响生活质量因子-6评分均较术前明显降低,差异有统计学意义(t=31.49,5.98,P0.05)。患者术后1年随访时均未发现心内膜炎、原位血栓形成、封堵器脱落等并发症。结论 PFO患者右向左分流量越大其偏头痛发生率以及头痛程度越高。对PFO合并顽固性偏头痛患者,行封堵术治疗能有效减轻其头痛程度,改善其生活质量,且安全可靠。     

经导管封堵卵圆孔未闭治疗偏头痛的安全性与有效性分析

目的探讨经导管封堵卵圆孔未闭(PFO)在偏头痛治疗中的临床疗效。方法选取2016年7月至2017年8月于北部战区总医院住院并接受经导管封堵PFO的46例偏头痛患者,术后常规复查超声心动图及心电图,并于术前及术后6个月、12个月进行头痛发作频率问卷、头痛影响测验-6(HIT-6)、偏头痛残疾程度评估问卷(MIDAS)、视觉模拟疼痛评分(VAS)。结果 46例患者中男18例(39.1%),年龄42.5(24.0,60.0)岁,偏头痛病程为10(2,40)年,先兆性偏头痛8例(17.4%),无先兆性偏头痛38例(82.6%);发作频率为(8.2±4.4)次/月,术前右心声学造影示10例(43.5%)为中量右向左分流(RLS),36例(56.5%)为大量RLS。与基线水平比较,术后6个月及12个月头痛发作频率、HIT-6评分、MIDAS评分、VAS评分均明显改善(均P0.05)。术后6个月复查右心声学造影仅3例有少量RLS。术后12个月20例(43.5%)患者头痛完全缓解,17例(37.0%)显著缓解,5例(10.9%)缓解,4例(8.7%)无效,而先兆性偏头痛(87.5%)与无先兆偏头痛(92.1%)缓解率比较,差异无统计学意义(P=0.879)。围术期及术后12个月随访期间所有患者均未见血栓/空气栓塞、股动静脉瘘、心脏压塞、封堵器移位及脱落、严重心律失常等并发症发生。结论经导管封堵PFO安全性高,能有效缓解伴大量RLS的PFO患者偏头痛症状。     

伴有偏头痛的卵圆孔未闭封堵患者的疗效研究

目的:探讨经皮卵圆孔未闭(PFO)封堵的可行性,为开展此项工作提供理论基础。方法:采用自身对照,收集患者术前术后的HIT-6头痛评分量表得分、手术前后的超声心动图、TCD发泡实验结果、血常规中血小板含量。采集患者术前1h内行Valsalva动作或咳嗽后的股动脉及股静脉血样,术后1d股动静脉血样。并对术后患者规范随访至少1年。结果:动脉血中五羟色胺(5-HT)含量术后较术前明显降低(t=4.877,P0.05),而静脉血中5-HT含量术后与术前比较无明显差异(t=0.063,P0.1)。患者HIT-6得分术后与术前对比,术后偏头痛对生活的影响程度明显降低(t=10.511,P0.05)。TCD发泡实验结果与HIT-6评分资料分级进行Spearman秩相关分析结果显示:一致性分析结果:χ~2=44.69,P=0.020.05,相关系数r=0.74,P=0.000.05,表明栓子信号数量越多,患者头痛越严重。结论:对于存在PFO的严重偏头痛患者而言,行经皮PFO封堵手术治疗能减轻偏头痛的影响。     

卵圆孔未闭合并偏头痛的相关性分析及介入封堵术疗效评价

目的 探讨卵圆孔未闭（PFO）患者偏头痛的发生率及相关危险因素,评估介入封堵术对PFO合并偏头痛患者的疗效。方法 入选2019年5月至2021年7月就诊于兰州大学第二医院的PFO患者288例,依据有无偏头痛分为偏头痛组（n=93）和无偏头痛组（n=195）。分析两组患者的一般临床资料、实验室及影像学指标,探讨PFO患者偏头痛发生的危险因素;同时对PFO合并偏头痛患者术前及术后半年的头痛发作频率、持续时间、头痛程度及测试问卷-6(HIT-6)评分进行比较,评估介入封堵术对PFO合并偏头痛患者的疗效。结果 288例PFO患者中93例（32.3%）存在不同程度的偏头痛。相比于无偏头痛组,偏头痛组患者年龄更小,女性和中PFO比例更高,且具有更高的血小板和同型半胱氨酸（Hcy）水平,差异有统计学意义（P<0.05）;而在脑卒中、冠状动脉粥样硬化性心脏病（冠心病）、糖尿病比例及体质指数、收缩压、舒张压、脉压、平均动脉压、血肌酐、空腹血糖、尿酸、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、血红蛋白、红细胞、D-二聚体、右向左分流（RLS）水平方面,两组患者无明显差异（P>0.05）。多...     

经导管封堵术治疗卵圆孔未闭偏头痛的疗效分析

目的 研究经导管封堵术治疗卵圆孔未闭（Patent Foramen Ovale,PFO）偏头痛的疗效。方法 选取2021年8月至2022年8月在我院进行治疗的78例卵圆孔未闭偏头痛患者作为研究对象,采用随机数字表法分为观察组和对照组,各39例,对照组采用常规药物治疗,观察组采用经导管PFO封堵术治疗,比较两组患者治疗后3、6个月的偏头痛发作频率、持续时间、疼痛程度[视觉模拟量表（visual analogue scale,VAS）];头痛缓解程度;偏头痛严重程度[偏头痛残疾评估问卷（TheMigraineDisabilityAssessmentquestionnaire,MIDAS）]。结果 （1）治疗3、6个月后,观察组患者偏头痛发作频率、持续时间、VAS评分均低于对照组（P<0.05）;(2)治疗后,观察组患者头痛缓解程度高于对照组（P<0.05）;(3)治疗后,观察组患者偏头痛严重程度低于对照组（P<0.05）。结论 采用经导管PFO封堵术治疗PFO偏头痛患者疗效显著,能明显减少其发作频率,缩短持续时间,同时减轻患者疼痛,降低偏头痛严重程度。     

偏头痛合并卵圆孔未闭病人介入封堵术前后头痛发作与5-羟色胺的相关性分析

目的研究卵圆孔未闭(PFO)合并偏头痛病人介入封堵术前后偏头痛发作情况和动静脉5-羟色胺(5-HT)含量变化及相关性分析。方法纳入2013年1月—2015年1月在大连市中心医院诊治的偏头痛病人60例(分组:研究组1共30例,均合并PFO;研究组2共30例,均不合并PFO)及正常者30名(对照组)。对研究组1病人进行经颅多普勒发泡试验(c-TCD)及经食道超声心动图(TEE)检查证实合并PFO,对病人行PFO介入封堵术,并对其进行随访。分别于封堵术前及封堵术后3 d、1个月、3个月、6个月及12个月,抽取动脉血及静脉血测定5-HT,并行c-TCD、经胸超声心动图(TTE)声学造影检查术后是否残存心房水平右向左分流,同时行头痛影响测试问卷(HIT-6)评分,观察偏头痛症状是否改善。研究组2每例偏头痛病人及对照组每名健康人均经c-TCD证实不存在PFO,分别抽取动脉血及静脉血测定5-HT。结果研究组1病人封堵治疗后偏头痛症状较术前明显改善(P0.000 1),术后6个月及12个月与术后3 d比较,偏头痛症状改善程度差异无统计学意义(P0.05);封堵术后动脉血5-HT含量比术前明显减少(P0.05);PFO封堵术前后静脉血5-HT含量差异无统计学意义(P0.05)。研究组2病人静脉血中5-HT含量明显高于对照组(P0.05)。研究组1静脉血中5-HT含量与对照组接近(P0.05)。结论偏头痛合并PFO病人卵圆孔封堵术后,症状明显改善。动脉血中5-HT含量与偏头痛程度具有相关性。     

神经系统症状为主的房间隔缺损患者的特征及疗效分析

目的探讨以右向左分流致神经系统症状为临床表现的房间隔缺损患者的临床特征及封堵疗效。 方法纳入2019年1月至2021年10月在南京医科大学第一附属医院神经内科就诊主诉为偏头痛或卒中相关症状的房间隔缺损患者,且由经颅多普勒超声发泡试验（c-TCD）证实存在右向左分流,收集其基本信息、c-TCD、经胸超声心动图（TTE）、经食管超声心动图（TEE）、右心导管检查结果,分析患者临床特征。术后随访0.5～1.5年,偏头痛患者完善头痛影响测定量表（HIT-6）评分及偏头痛失能程度评估问卷（MIDAS评分）,评估封堵疗效。 结果研究共纳入14例患者,年龄（55.8±12.4）岁,其中女9例（57.1％,9/14）。偏头痛6例,脑卒中8例,TTE及右心导管检查提示无右心代偿性增大,肺血管阻力<3 Wood,评估不存在右心容量超负荷。14例患者均行经皮房间隔缺损封堵术。与术前相比,6例偏头痛患者术后HIT-6及MIDAS评分均明显降低（P=0.024;P=0.027）。8例缺血性卒中患者均无脑卒中复发。 结论成人房间隔缺损而无右心容量负荷升高者首发症状可以表现为神经系统症状,且c-TCD检查可为阳性。介入封堵治疗可有效缓解症状。     

Patent Foramen Ovale: Comparison among Diagnostic Strategies in Cryptogenic Stroke and Migraine

Objective: The aim of this study was to compare transthoracic echocardiography (TTE) and transcranial Doppler ultrasonography (TCD) with transesophageal echocardiography (TEE) in order to define the best clinical approach to patent foramen ovale (PFO) detection. Methods: In total, 72 consecutive patients (33 men) with a mean age of 49 ± 13 years were prospectively enrolled. The TEE indication was cryptogenic stroke (36 patients) or migraine (36 patients, 22 with aura). All patients underwent standard TTE, TCD, and TEE examination. For any study, a contrast test was carried on using an agitated saline solution mixed with urea-linked gelatine (Haemaccel), injected as a rapid bolus via a right antecubital vein. A prolonged Valsalva maneuver was performed to improve test sensitivity. Results: TEE identified a PFO in 65% of the whole population: 56.5% in the migraine cohort and 43.5% in the cryptogenic stroke cohort. TTE was able to detect a PFO in 55% of patients positive at TEE (54% negative predictive value, 100% positive predictive value, 55% sensitivity, and 100% specificity). TCD was able to identify a PFO in 97% of patients positive at TEE (89% negative predictive value, 98% positive predictive value, 94% sensitivity, and 96% specificity). Conclusions: In patients with cryptogenic stroke and migraine, there is a fair concordance (k = 0.89) between TCD and TEE in PFO recognition. Accordingly, TCD should be recommended as a simple, noninvasive, and reliable technique, whereas TEE indication should be restricted to selected patients. TTE is a very specific technique, whose major advantage is the ability to detect a large right-to-left shunt, particularly if associated with an atrial septal aneurysm.     

Transcatheter Closure of Patent Foramen Ovale: A New Migraine Treatment?

Transcranial Doppler (TCD) is a very sensitive tool for detecting microembolic signals (MES) in the brain vessels after injection of air-mixed saline in case of right-to-left shunt (RLS). Patent foramen ovale (PFO) can be found in nearly one-half of migraineurs with aura, and, reciprocally, the prevalence of migraine in patients with stroke with PFO is exceedingly high. We aimed to monitor the passage of MES in the brain vessels during transcatheter closure of PFO and to subsequently follow-up patients for both the efficacy of the procedure and the severity of migraine. Seventeen patients suffering from migraine with aura (MA+, n = 8) or without aura (MA-, n = 9) scheduled to undergo transcatheter closure of PFO with Amplatzer PFO occluder devices for paradoxical cerebral embolism were monitored with contrast TCD (DWL, Germany) before, during, and after the procedure to estimate the magnitude of the shunt. Spontaneous embolization to the brain was also recorded. The patients were thereafter followed-up at 1, 3, and 6 months. A composite score of migraine severity, which included frequency, duration, and intensity of the attacks in the previous 3 months (range 0-10), was obtained at the time of the procedure and at the follow-up visits. Complete occlusion of PFO was achieved in all patients after 1 month in most cases. Preoperatively, the migraine score was 6.75 in MA+ and was 6 in MA--patients. After closure, the score dropped to 2.5 in MA+ and to 4.2 in MA--patients at the 6-month follow-up visit, the difference being statistically highly significant in both groups. Overall, 5 of 17 patients no longer complained of migraine, 10 of 17 were substantially improved, and two of 17 were unchanged at 6 months. Migraine aura disappeared in six of eight patients. Closure rate was very satisfactory, from a preoperative average bubble count of 42 to an average of 4 bubbles in the four patients in whom a small residual shunt was still detectable at the 6-month follow-up visit. TCD monitoring provides the most accurate assessment of RLS at the brain level. Closure of PFO with transcatheter devices results in the substantial relief of migraine in patients with stroke with large RLS.     

卵圆孔未闭结构特征对介入治疗封堵器选择的影响

目的 探讨卵圆孔未闭（PFO）结构特征对介入治疗封堵器选择的影响。方法 回顾性分析98例拟进行PFO封堵治疗患者临床资料,按经胸超声心动图(TTE)和（或）经食管超声心动图(TEE)检查结果分为简单PFO组和复杂PFO组,比较两组患者封堵器的选择及疗效。结果 PFO患者98（男41,女57）例,年龄8~74(41±14)岁。92例封堵成功,6例未成功,其中导丝无法到达左房4例,肺动静脉瘘1例,并发肺动脉高压患者1例。手术总成功率为94%。简单PFO组42例,复杂PFO组56例,简单PFO以18/25 mm PFO封堵器为主,复杂PFO以30/30 mm和25/35 mm PFO封堵器为主,两组间封堵器的选择有显著差异（P<0.01）。术后半年复查经胸超声心动图声学造影（cTTE）,完全堵闭65例（71%）,Valsalva动作后有右向左分流（RLS）27例（29%）,其中少量20例(22%),中量4例(4%),大量3例(3%)。大量RLS均发生在复杂PFO组应用30/30 mm和25/35 mmPFO封堵器的患者。复杂PFO组有1例新发阵发性心房纤颤。结论 封堵器选择与PFO特征有关,简单PFO以18/25 mm PFO封堵器为主,复杂PFO以30/30 mm和25/35 mm PFO封堵器为主。     

Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts.

AIMS: To assess transthoracic echocardiography (TTE) using second harmonic imaging with Valsalva manoeuvre compared to transesophageal echocardiography (TEE) for the diagnosis of right to left cardiac and pulmonary shunts. METHODS AND RESULTS: One hundred and ten patients referred for TEE underwent TTE with bubble contrast. Bubbles in the left atrium within three cardiac cycles were considered diagnostic for a patent foramen ovale (PFO) and later as a pulmonary shunt. Greater than 20 bubbles in the left atrium was considered a large shunt and less than 20 a small shunt. TEE was performed immediately afterwards and read blinded to the TTE results. Pick-up rates were similar with 19 TEE positive (13 PFO) and 18 TTE positive (14 PFO) patients. There were five TEE positive/TTE negative cases who had significantly poorer TTE image quality score (2.7 +/- 0.8 vs 1.9 +/- 0.6, p < 0.05). There were six TEE negative/TTE positive cases, two cases requiring Valsalva manoeuvre to become positive. The Valsalva manoeuvre significantly increased the number of bubbles shunting (10 +/- 11 vs 20 +/- 19, p < 0.005). CONCLUSION: TTE with Valsalva manoeuvre is as good as TEE in diagnosing shunts. Valsalva manoeuvre increases the size of shunt. Both techniques produce false negative results.     

Effect of Residual Interatrial Shunt on Migraine Burden After Transcatheter Closure of Patent Foramen Ovale

ObjectivesThis study sought to evaluate the long-term effect of transcatheter patent foramen ovale (PFO) closure on migraineurs with and without aura and examine the effect of residual right-to-left shunt.BackgroundMany studies reported improvement in migraine symptoms after PFO closure, yet randomized trials failed to reach its clinical endpoints.MethodsThe study retrospectively analyzed data from 474 patients who underwent transcatheter PFO closure at Massachusetts General Hospital. Patients completed a migraine burden questionnaire at baseline and at follow-up. Migraine severity is reported as migraine frequency (days/month), average duration (min), and migraine burden (days × min/month). Improvement following closure was defined as complete abolishment of symptoms or >50% reduction in migraine burden.ResultsA total of 110 migraineurs who underwent PFO closure were included; 77.0% had aura and 23.0% were without aura, and 91.0% had a cryptogenic stroke. During long-term median follow-up of 3.2 (interquartile range: 2.1 to 4.9) years, there was a significant improvement in migraine symptoms in migraineurs with or without aura. Migraine burden was reduced by >50% in 87.0% of patients, and symptoms were completely abolished in 48%. Presence of aura was associated with abolishment of migraine (odds ratio: 4.30; 95% confidence interval: 1.50 to 12.30; p = 0.006). At 6 months after PFO closure, residual right-to-left shunt was present in 26% of patients. Absence of right-to-left shunt was associated with improvement in migraine burden by >50% (odds ratio: 4.60; 95% confidence interval: 1.30 to 16.10; p = 0.017).ConclusionsLong-term follow-up after transcatheter PFO closure was associated with significant improvement in migraine burden. Aura was a predictor of abolishing symptoms. Absence of residual right-to-left shunt was a predictor of significant reduction in migraine burden.     

Prevalence and grade of RLS in migraine: A prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

Background:Right-to left shunt (RLS) is regarded as a risk factor resulting in migraine, but the relevance between the RLS and migraine remains controversial. This paper aims at investigating the prevalence and RLS grade of patent foramen ovale (PFO) in cases of migraine (including migraine with and without aura) and evaluate the relationship between PFO and migraine.Methods:Synchronous test of contrast transthoracic echocardiography and contrast transcranial Doppler ultrasonography was performed in 251 cases of migraine, which contains 62 cases of migraine with aura (MA) and 189 cases without aura (MO) and 275 healthy adults. Among these cases, 25 cases with migraine and 14 healthy adults were evaluated through transesophageal echocardiography.Results:(1). The prevalence of permanent RLS, total RLS, and large RLS in migraine was 11.16%, 39.04%, and 17.13%, respectively, which was significantly higher than that of the controls (P = .042, <.001, and.001, respectively). (2). Permanent RLS was detected as 7.93% of the cases in MO, 20.96% in MA, and 6.18% in controls. Total RLS was detected as 35.98% of the cases in MO, 48.38% in MA, and 23.64% in controls. Large RLS was detected as 13.76% of the cases in MO, 27.41% in MA, and 7.27% in controls. Compared with controls, the positive rate of total RLS and large RLS in MO increased (P = .004 and.022, respectively), the that of permanent RLS, total RLS, and large RLS in MA also increased (P < .001 for each of the comparisons). The positive rate of permanent RLS and large RLS in MA was remarkably higher than that in MO (P = .005 and.013, respectively). (3) The presence of large-size PFO (≥2.0 mm) of migraine showed higher than that of the controls (P = .048).Conclusions:PFO is associated with the migraine (especially with aura), when it is permanent RLS, large RLS, and large-size PFO (≥2.0 mm).     

Frequency of migraine headache relief following patent foramen ovale "closure" despite residual right-to-left shunt

Retrospective studies have shown improvement in migraines after patent foramen ovale (PFO) closure. To date, no study has evaluated whether the completeness of closure affects headache status; therefore, the objective of this study was to evaluate the impact of residual right-to-left shunt (RLS) on migraine symptoms after transcatheter PFO closure in migraineurs with and without aura. This was a small-series, single-center, retrospective analysis of late follow-up data on 77 patients with presumed paradoxical embolism and migraine who underwent PFO closure for secondary stroke prevention. Power M-mode transcranial Doppler was used to assess RLS at baseline and 6 and 12 months after closure. A standardized migraine questionnaire was administered at baseline and 6, 12, and 24 months after closure. Fifty-five (71%) patients had migraine with aura. Final closure and migraine status were available for 67 patients; 23 (34%) had incomplete PFO closure, defined as 30 embolic tracks detected at final power M-mode transcranial Doppler examination (median 366 days, 95% confidence interval 332 to 474). Migraine relief (> or = 50% reduction in frequency) was independent of closure status (77% complete closure vs 83% incomplete closure, p = 0.76) at late follow-up (540 days, 95% confidence interval 537 to 711). Migraineurs with aura were 4.5 times more likely to experience migraine relief than migraineurs without aura. In conclusion, migraine relief may occur despite residual RLS after transcatheter PFO closure, which may suggest a reduction in RLS burden below a neuronal threshold that triggers migraine; however, this warrants further investigation. Migraine with aura may be an independent predictor of relief after PFO closure.     

超声心动图检查继发孔型房间隔缺损封堵术后并发症的诊断价值

目的:研究超声心动图检查继发孔型房间隔缺损封堵术后并发症的应用价值。方法:选取我院2009年7月至2018年7月确诊继发孔型房间隔缺损并行经导管或经胸封堵术的患者3910例,所有患者术前经胸超声心动图(TTE)或经食管超声心动图(TEE)诊断筛选适应证,术中经经胸超声心动图或经食管超声心动图监测,术后复查经胸超声心动图,观察评价封堵器形态位置,评估相关并发症。结果:3910例行房间隔封堵术的患者中,封堵器脱落8例(0.20%),均急诊转外科修补治疗。心脏穿孔/磨蚀事件共8例,其中主动脉窦-右心房瘘1例(0.03%),经皮封堵治疗成功;二尖瓣前叶穿孔2例(0.05%),予随诊观察7年未特殊处理;心脏穿孔或心房壁损伤5例(0.13%),其中1例死亡(0.03%),4例行心包穿刺引流后好转(0.10%)。术后心包积液102例(2.61%),其中8例为少中量-中量心包积液,术后随访无明显变化或有所增多,患者血流动力学稳定,予随诊观察;94例为微量-少量心包积液,随诊观察积液量未见增加。术后残余分流167例(4.27%),其中多发房间隔缺损共102例;另外残余分流束宽度大于等于5 mm共17例,残余分流束小于5 mm或少量分流共150例,复查后分流均减少或消失。结论:房间隔缺损封堵术相关严重并发症包括封堵器脱落、心脏穿孔/磨蚀,发生率极低但危害大,常见并发症包括心包积液和残余分流,发生率低且预后好,超声心动图在及时诊断并发症和随访观察方面起到了不可替代的作用。     

TTE结合cTTE在卵圆孔未闭介入治疗中的应用

目的 探讨经胸超声心动图（TTE）结合经胸超声心动图右心声学造影（cTTE）在卵圆孔未闭（PFO）介入治疗中的应用价值。方法 入选我院90例行介入封堵治疗的PFO患者,年龄（40±15）岁。用TTE、cTTE及食管超声心动图（TEE）评估、检测及随访。结果 90例PFO患者,TTE或TEE检查符合简单型PFO 52例（58%）、复杂型PFO 38例（42%）。术前cTTE检查,38例（42%）于静息状态下检出右向左分流（RLS）,其中少量24例(27%)、中量11例(12%)和大量3例(3%),Valsalva动作除8例（9%）为中量RLS外,余均为大量RLS。Valsalva动作后大量RLS检出率明显高于静息状态（P<0.01）。52例简单型PFO患者均用PFO封堵器,其中18/25 mm、30/30 mm和25/35 mm封堵器各用38例（73%）、6例（12%）和8例（15%）,18/25 mm封堵器使用率明显高于30/30 mm和25/35 mm封堵器（P<0.01）。38例复杂型PFO患者,37例用单封堵器,其中30/30 mm和25/35 mmPFO封堵器分别为16例（42%）和17例（45%）、房间隔缺损（ASD）封堵器4例（11%）。1例PFO并发ASD的患者,孔间距为20 mm,应用18/18 mm和25/35 mm双封堵器。术后cTTE随访:3个月、半年、1年完全堵闭率（无RLS）分别为40%、67%和74%。术后1年残余RLS为23例,其中22例(96%)微泡出现时间超过5个心动周期。结论 TTE结合cTTE在PFO封堵术前病例筛查、术中指导封堵器选择及术后疗效评价中均有着不可或缺的作用,对保证PFO封堵治疗成功具有重要价值。