cTTE与TEE诊断成人单纯PFO的对比分析

目的对比经胸超声心动图声学造影(cTTE)与经食管超声心动图(TEE)对卵圆孔未闭(PFO)的诊断价值。方法选取临床怀疑存在PFO的患者156例,均行经胸超声心动图(TTE)检查,TTE阴性者全部进一步行TEE及cTTE检查。对比分析两种方法的检出结果及超声特点。结果 (1)三项检查共检出单纯PFO 103例,包括TTE检出9例(5.8%)、TEE检出36例(24.5%,均为左向右分流)、cTTE检出94例(63.9%,均为右向左分流)。cTTE的PFO检出率明显高于TEE。(2)cTTE检出的94例PFO,静息状态下检出31例(21.1%),包括Ⅰ级13例、Ⅱ级15例、Ⅲ级3例;Valsalva动作(VM)后检出91例(61.9%),包括Ⅰ级16例、Ⅱ级28例、Ⅲ级47例。VM后PFO右向左分流(RLS)的检出率及量化分级均明显高于静息状态下。结论 (1)cTTE对单纯PFO检出率明显高于TEE。(2)cTTE可用于PFO定性及半定量诊断,应作为PFO-RLS的常规首选检查方法。     

经食管与经胸超声心动图造影诊断卵圆孔未闭及右向左分流

目的 对比经食管超声心动图造影（cTEE）与经胸超声心动图造影（cTTE）诊断卵圆孔未闭（PFO）及右向左分流（RLS）的价值。方法 回顾性分析117例因偏头痛或隐源性卒中就诊的患者,均依次接受TTE、cTTE、TEE及cTEE检查;比较cTTE与cTEE诊断PFO的敏感度、特异度及对RLS分级的差异,观察二者诊断价值。结果 TEE联合cTEE共检出89例（76.07%,89/117）PFO;TTE、cTTE、TEE及cTEE分别检出18例（20.22%,18/89）、80例（89.89%,80/89）、75例（84.27%,75/89）及88例（98.88%,88/89）。cTTE存在9例（10.11%,9/89）假阴性、7例（25.00%,7/28）假阳性;cTEE存在1例（1.12%,1/89）假阴性,无假阳性病例。cTEE诊断PFO的敏感度（98.88%）及特异度（100%）均高于cTTE（89.89%、75.00%;χ²=6.125、5.143,P=0.008、0.016）;cTEE的PFO-RLS分级结果总体低于cTTE（Z=-3.464,P=0.001）。结论 cTEE诊断PFO的敏感度及特异度均高于cTTE,而其PFO-RLS分级总体低于cTTE。     

右心声学造影联合经食管超声心动图在卵圆孔未闭诊断中的应用价值

目的探讨右心声学造影(cTTE)联合经食管超声(TEE)在卵圆孔未闭(PFO)诊断中的应用价值。方法选取不明原因脑卒中、偏头痛、胸闷患者200例,先进行cTTE检查,对cTTE检查阳性病例及不能配合行Valsalva动作的患者进行TEE检查。结果 cTTE检查PFO阳性89例,阳性率44.5%,其中Valsalva动作后右向左分流(RLS)少量9例,中量27例,大量53例,cTTE检查阳性病例均进行TEE检查,86例阳性,阳性病例中RLS少量者PFO内径(1.8±1.0)mm。RLS中量者PFO内径(3.2±1.5)mm,RLS大量者PFO内径(4.2±1.8)mm;3例阴性病例RLS为少量。7例不能配合行Valsalva动作且cTTE阴性病例进行了TEE检查,3例阳性,PFO内径0.8~1.6 mm,4例阴性。RLS分流量与PFO内径呈正相关(r=0.641,P0.05),与PFO长度无相关性(r=0)。结论 cTTE联合TEE在PFO的诊断中有着不可或缺的作用,对诊断PFO并指导下一步的治疗具有重要的价值。     

经食管超声心动图联合右心声学造影评估偏头痛和隐源性脑卒中患者右向左分流类型

目的 应用经食管超声心动图（TEE）联合右心声学造影（c-TEE）评估偏头痛和隐源性脑卒中（CS）患者右向左分流（RLS）类型。方法 选取我院收治的疑诊RLS相关的偏头痛患者146例（偏头痛组）和CS患者167例（CS组）,入选患者均完成TEE、c-TEE检查,比较两组TEE及c-TEE所测RLS阳性结果,以及c-TEE获取的左房内微泡来源、分流程度等特征。结果 TEE检查显示,CS组与偏头痛组发生PFO者分别为82例、32例,两组均未发现肺静脉异常;c-TEE检查显示,偏头痛组与CS组发生肺相关右向左分流（P-RLS）分别为66例、71例,PFO相关右向左分流（PFO-RLS）分别为80例、96例,c-TEE对偏头痛组中PFO的检出率高于TEE(25.6%vs. 10.2%),差异有统计学意义（P<0.05）。c-TEE检查显示两组不同类型RLS占比比较差异无统计学意义,但偏头痛组1级RLS占比高于CS组（51.2%vs. 24.8%,P<0.05）,其中偏头痛组P-RLS和PFO-RLS占比均高于CS组（50.0%vs. 31.0%,52.5%vs. 19.5%）,差异...     

经颅多普勒联合经胸心脏声学造影在军事人员卵圆孔未闭中的诊断价值

目的 探讨经颅超声联合经胸心脏声学造影(cTCCD+cTTE)技术在军事人员卵圆孔未闭(PFO)中的诊断价值。方法 以怀疑存在PFO的军事人员作为研究对象，包括16例军事飞行人员和8例一般军事人员，分析cTCCD+cTTE判断PFO有无、静息状态及Valsalva动作下右向左分流(RLS)的情况，并对发现存在RLS的病例进一步行经食管超声心动图(TEE)检查。结果 5例临床怀疑PFO的军事飞行人员cTCCD+cTTE检查为阴性；余19例(包括11例军事飞行人员及8例一般军事人员)cTCCD+cTTE法可见PFO-RLS,包括8例常规经胸超声心动图(TTE)检查判定为PFO和11例常规TTE检查未检出PFO的人员。未检出的11例PFO人员中，TEE在8例中可见过隔血流，检出率为72.7%。与cTTE、cTCCD比较，cTCCD+cTTE法在平静状态下检出率较两者均提高15.8%,Valsalva动作下检出率分别提高了5.3%和10.5%,而且固有型比例及中大量分流检出率均有所提高。结论 TTE检查在PFO-RLS中灵敏度低，cTCCD+cTTE能够显著提高PFO-RLS的检出率；有效地执...     

超声心动图在卵圆孔未闭封堵中的应用及卵圆孔未闭分流方向的探讨

目的探讨超声心动图在卵圆孔未闭(PFO)治疗中的应用价值.方法 7例封堵治疗PFO患者,术前经胸(TTE)或经食管超声心动图(TEE)明确PFO诊断,术中TTE和X线引导监护,术后TTE随访;并对157例PFO分流方向进行统计分析.结果 7例PFO封堵患者右向左分流的确诊方法:TTE 1例,TEE 4例,TTE或TEE 右心声学造影各1例.术后TTE随访PFO分流消失.157例TTE诊断的PFO以左向右分流表现为主,少数右向左分流和双向分流者多伴其他心脏结构和功能改变.结论超声心动图在PFO封堵术中具有多方面重要作用.TEE及声学造影诊断PFO右向左分流的敏感性高于单纯TTE.常规TTE检查PFO多表现为左向右分流,而非理论定义的右向左分流.     

偏头痛和隐源性脑卒中患者经食管超声心动图右心声学造影特征分析

目的：分析偏头痛和隐源性脑卒中患者经食管超声心动图右心声学造影(c-TEE)特征,探讨 c-TEE在不同疾病右向左分流类型评估中的作用。方法：选取2018年1月至2018年10月我院收治的疑诊右向左分流相关的偏头痛患者146例,隐源性脑卒中患者167例作为研究对象进行回顾性分析。所有入选患者均完成TEE、c-TEE检查,分析患者一般情况,并比较两组间TEE及c-TEE右向左分流阳性结果及c-TEE左房内微气泡来源、分流程度等特征。结果：偏头痛组女性居多,且年龄小于隐源性脑卒中患者(P均＜0.05)。TEE观察到隐源性脑卒中组PFO 患者82例,偏头痛组32例,均未发现肺静脉异常;c-TEE检查中偏头痛组肺相关右向左分流(P-RLS)66例,PFO相关右向左分流(PFO-RLS)80例;隐源性脑卒中组P-RLS 71例,PFO-RLS 96例,c-TEE在偏头痛组的PFO检出率明显高于TEE(P＜0.05),隐源性脑卒中组无明显统计学差异(P>0.05)。两组间c-TEE检查不同类型右向左分流比例无统计学差异(P>0.05),但偏头痛组1级RLS(65/127,51%)显著高于隐源性卒中组(38/153,25%,P＜0.05),其中偏头痛患者的P-RLS和PFO-RLS均显著高于隐源性脑卒中患者( P均＜0.05);隐源性卒中组3级RLS比例 (51/153,33%)显著高于偏头痛组 (22/127,18%)(P＜0.05),其中隐源性脑卒中组PFO-RLS显著高于偏头痛组(P＜0.05)。结论： c-TEE可明确偏头痛和隐源性脑卒中患者右向左分流来源并进行半定量分析,为病因学诊断提供可靠的影像学依据。     

经胸右心声学造影不同右心房增压方式评估卵圆孔未闭隐匿性右向左分流的价值

目的探讨不同右心房增压方式应用于经胸右心声学造影（C-TTE）评估卵圆孔未闭（PFO）隐匿性右向左分流（RLS）的价值。 方法回顾性选取2019年6月至2020年6月在四川省人民医院行C-TTE检查的患者70例。所有患者均经手术或经食管超声心动图（TEE）确诊为PFO。所有患者静息状态下C-TTE均为阴性,然后依次完成了用力咳嗽（CH）、有效Valsalva动作（SVM）、有效Valsalva动作放松即刻用力咳嗽（SVM-CH）3种右心房增压方式,且至少有1种增压方式激发出RLS。比较不同增压方式对PFO隐匿性RLS的检出率,并与TEE进行对比分析。 结果CH、SVM、SVM-CH 3种增压方式和CH+SVM、SVM+SVM-CH 2种增压方式联合应用,C-TTE对PFO隐匿性RLS的检出率分别为71.43%、95.71%、81.43%、97.14%、100%,对大量RLS的检出率分别为10.00%、54.28％、35.71％、55.72％、71.43％。CH、SVM、SVM-CH、CH+SVM、SVM+SVM-CH对无、少量、中量、大量RLS检出率的比较,总体差异有统计学意义（χ²=37.771,P＜0.001）。70例中有34例进行了TEE检查,SVM+SVM-CH联合增压方式下C-TTE对PFO隐匿性RLS的检出率（100%,34/34）高于TEE的检出率（82.35%,28/34）。34例中SVM-CH检出而SVM未检出RLS者3例,此3例TEE均显示为长裂隙样PFO。 结论SVM和SVM-CH两种增压模式联合应用有助于提高C-TTE对PFO隐匿性RLS的检出率,且C-TTE配合右心房增压方式的合理选择对于PFO隐匿性RLS的检出率优于TEE。     

应用经胸超声心动图诊断小儿卵圆孔未闭及其分流方向的探讨

目的：应用经胸超声心动图（TTE）探讨小儿卵圆孔未闭（PFO）发生情况、声像特点及分流方向。方法：426例小儿分为婴幼儿组（0～3岁）243例和儿童组（4～7岁）183例,再按是否合并先天性心脏病分婴幼儿先心组（A组）93例,婴幼儿正常组（B组）150例,儿童先心组（C组）60例,儿童正常组（D组）123例。TTE观察卵圆孔闭合及分流情况,必要时行右心声学造影。结果：426例小儿共检出PFO 86例,TTE显示卵圆孔瓣与继发隔之间回声分离1.5～5.7mm及细小的斜行分流束,多普勒频谱多呈正向、低速、持续性。婴幼儿组、儿童组PFO大小无明显差别[（2.9±0.7）mm vs （2.6±1.0）mm,P>0.05]。73例PFO为左向右分流,7例为右向左分流,4例为双向分流,2例为潜在分流,右向左及双向分流者均有先心病或肺动脉高压。婴幼儿组、儿童组PFO检出率分别为26.7%及11.5%。A、B、C、D组PFO检出率分别为33.3%,22.7%,18.3%及8.1%。检出率比较：A组高于C组,B组高于D组,C组高于D组（P<0.01或P<0.05）。结论：PFO在婴幼儿期较常见,至儿童期明显减少,部分先心病可能延缓卵圆孔闭合;除外某些先心病及肺动脉高压者,小儿PFO多为左向右分流;TTE对小儿PFO有较高诊断价值,声学造影有助检出PFO潜在分流。     

联合声学造影对卵圆孔未闭右向左分流的诊断价值

目的 探讨经颅多普勒超声声学造影(cTCD)联合经胸超声心动图声学造影(cTTE)在卵圆孔未闭(PFO)诊断和介入治疗中的应用价值。方法 本研究纳入南京医科大学第一附属医院收治的112例高度疑似PFO的患者,所有患者均行cTCD、cTTE和经食道超声心动图(TEE)检查,评估PFO右向左分流(RLS)分级情况。以经导管PFO探查封堵术结果为金标准,比较cTCD联合cTTE和cTCD联合TEE对PFO的诊断效能的差异。结果 cTCD联合cTEE的诊断敏感度、准确度分别为98.1%、93.8%,略高于cTCD联合TEE的96.2%、91.1%,但差异无统计学意义(P>0.05)。112例高度疑似PFO患者中,行封堵术106例(94.6%),术后随访6～12个月,患者无明显手术相关并发症,无卒中复发,83.1%有不同程度偏头痛的患者得到缓解。结论 cTCD联合cTTE可以准确判断RLS来源及严重程度,敏感度和准确度较高,可以用于临床PFO的筛查。     

超声心动图联合右心声学造影在卵圆孔未闭诊断中的价值探讨

目的:探讨经食道超声心动图(transesophageal echocardiography,TEE)、右心声学造影(contrast transthoracic echocardiography,cTTE)在卵圆孔未闭(patent foramen ovale,PFO)诊断中的应用价值.方法:本研究选取2019年8月...     

Transthoracic contrast echocardiography using vitamin B6 and sodium bicarbonate as contrast agents for the diagnosis of patent foramen ovale

To evaluate the utility of transthoracic contrast echocardiography (cTTE) using vitamin B6 and sodium bicarbonate as contrast agents for diagnosing right-to-left shunt (RLS) caused by patent foramen ovale (PFO) compared to that of transesophageal echocardiography (TEE). We investigated 125 patients admitted to our neurology department with unexplained cerebral infarction and migraine. All patients underwent cTTE using vitamin B6 and sodium bicarbonate as contrast agents, after which they underwent transthoracic echocardiography. The Doppler signal was recorded during the Valsalva maneuver, and TEE examinations were performed. The feasibility, diagnostic sensitivity, and safety of cTTE and TEE for PFO recognition were compared. Evidence of PFO was found in 49 (39.20%) patients with cTTE, more than were detected with TEE (39, 31.20%) (χ²=5.0625, P=0.0244). cTTE had a sensitivity of 92.31% and a specificity of 84.88% for diagnosing PFO, showing high concordance with TEE for PFO recognition (κ=0.72). Further, results of a semi-quantitative evaluation of PFO-RLS by cTTE were better than those with TEE (Z=?2.011, P=0.044). No significant adverse reaction was discovered during cTTE examination. cTTE using vitamin B6 and sodium bicarbonate as contrast agents has relatively good sensitivity and specificity for diagnosing RLS caused by PFO when compared with those for TEE. Using vitamin B6 and sodium bicarbonate as contrast agents to perform cTTE is recommended for detecting and diagnosing the PFO due to its simplicity, non-invasive character, low cost, and high feasibility.     

Contrast Transthoracic Echocardiography Using 50% Glucose as a Contrast Agent for Screening of a Patent Foramen Ovale

A patent foramen ovale (PFO) is considered a risk factor for neurologic events. The goal of the study described here was to assess the feasibility, advantages, diagnostic sensitivity and accuracy of contrast transthoracic echocardiography examination (cTTE) using 50% glucose as a contrast agent in comparison with the use of agitated saline as contrast to screen for PFO. In our study, we found that the peak time, effective duration and duration of microbubbles produced by 50% glucose were all longer than those produced by the physiologic saline. The sensitivities for detection of PFO with cTTE using physiologic saline and 50% glucose as contrast were 83% (20/24) and 100% (24/24), respectively. TEE suggested a PFO in 24 patients in two groups. Use of 50% glucose as a contrast agent in cTTE examination enables ultrasound technicians to easily observe the right-to-left shunt across the PFO. However, the sensitivities for detection of PFO with cTTE using 50% glucose did not statistically significantly differ from those for physiologic saline.     

Saline contrast and colour Doppler transoesophageal echocardiography in detecting a patent foramen ovale and right-to-left shunts in stroke patients

Summary. A paradoxical embolism due to right-to-left shunt through a patent foramen ovale (PFO) can be responsible for stroke and other ischaemic cerebral events. We studied the usefulness of saline contrast transoesophageal echocardiography after the Valsalva manoeuvre in detecting PFO and right-to-left shunts in 28 adult patients without known reason for a recent stroke. The results were compared with conventional transthoracic colour Doppler and with transoesophageal colour Doppler techniques. A PFO was found in 24 patients (86%) of our selected study population, whereas in four patients no PFO was found. A PFO with left-to-right shunt could be diagnosed by transthoracic colour Doppler echocardiography in only one case. A PFO with left-to-right shunt was found by transoesophageal colour Doppler echocardiography in 17 patients (61%), but in only three of them was a right-to-left shunt detected, even after the Valsalva manoeuvre. In contrast, a PFO with right-to-left shunt could be detected in 21 patients (75%) by using saline contrast transoesophageal echocardiography with the Valsalva manoeuvre. However, the method was unable to detect three cases of PFO with only left-to-right shunt, which were detected by colour Doppler transoesophageal echocardiography. In conclusion, our results show that saline contrast transoesophageal echocardiography with the Valsalva manoeuvre greatly improves the echocardiographic detection of PFO with right-to-left shunts in stroke patients.     

右心声学造影与经颅多普勒发泡试验诊断隐源性卒中患者卵圆孔未闭的对比研究

目的：探讨右心声学造影(c-TTE)及经颅多普勒发泡试验(c-TCD)对隐源性卒中患者并卵圆孔未闭(PFO)的诊断价值。方法：选取2020年1月～2022年12月在我院诊治的隐源性卒中患者102例,均行c-TCD及c-TTE检查,以经食管超声心动图(TEE)作为诊断金标准,比较c-TTE、c-TCD检查对隐源性卒中患者PFO的诊断价值。结果：TEE检查证实102例隐匿性卒中患者有44例PFO,c-TCD检查结果显示,真阳性36例,假阳性10例,假阴性8例,真阴性48例；c-TTE检查结果显示,真阳性42例,假阳性3例,假阴性2例,真阴性55例。受试者工作特征(ROC)曲线分析显示,c-TCD检查、c-TTE诊断隐匿性卒中患者PFO的AUC分别为0.823,0.951,c-TCD检查诊断隐源性卒中患者PFO的敏感度、特异度、准确率分别为81.82%、82.76%、82.35%,明显低于c-TTE检查的95.45%、94.83%、95.10%(P<0.05)。c-TCD检查对右向左分流半定量分级低于c-TTE(P<0.05),c-TCD检查对右向左分流的检出率为30.39%,明显低于c-TTE的58.82%(P<0.05)。结论：与c-TCD检查相比较,c-TTE对隐源性卒中患者PFO具有更高的诊断价值,且对隐源性卒中PFO患者的右向左分流半定量分级程度更高、检出率更高。     

健康志愿者右心声学造影结果的初步分析

目的了解健康人卵圆孔未闭（PFO）右向左分流（RLS）和（或）来源于肺部的RLS（P—RLS）的检出率。方法随机选取健康成年志愿者42名,进行经食管超声心动图（TEE）和经胸超声心动图（TTE）常规检查。另外,分别在静息状态和Valsalva动作过程中上肢静脉快速注入手振0．9％氯化钠溶液10ml,进行经胸超声心动图右心造影（cTTE）,根据右心显影后左心房微泡出现的时间区分来PFO—RLS与P-RLS;根据进入左心房的微泡数量将RLS半定量划分为3个等级：1级为少量微泡进入左心房（1～10个微泡／帧图像）：2级为中量微泡进入左心房（11～30个微泡／帧图像）;3级为大量微泡进入左心房（〉30个微泡／帧图像）。对以下几个方面进行观测和统计分析：（1）健康成年人PFO的发生率、大小及RLS检出率;（2）健康成年人是否存在P-RLS及其检出率：（3）RLS与Valsalva动作的关系;（4）不同起源RLS的半定量分级比较。结果42名健康志愿者中,TEE诊断PFO13名（13／42,30％）,PFO宽（1．46±0．18）mm（1-3mm）,长（7．23±1．09）mm（4-14mm）。cTTE检出RLS共30名（30／42,71％）,其中4名同时存在PFO．RLS和P-RSL,PFO-RLS为12名（12／42,29％）,P—RLS为22名（22／42,52％）。除1名受检者外,PFO．RLS的检出均与Valsalva动作有关,PFO-RLS多出现在Valsalva动作结束的瞬间;而P-RLS多出现在静息状态下（14名）,部分出现在Valsalva动作后（8名）。不同来源RLS检出率的差异有统计学意义（χ2=4．941,P=0．026）。TEE诊断PFO与cTTE检出PFO-RLS一致者共11名。有2名TEE诊断PFO,但cTTE未检出PFO-RLS;有1名cTTE检出PFO-RLS,但TEE未诊断PFO。PFO-RLS与P-RLS半定量分级的差异有统计学意义（Z=-3．901,P=0．000）。在12名PFO-RLS中,2级和3级各有6名;在22名P-RLS中,1级11名,2级10名,3级仅1名。结论PFO及其伴随的暂短微量RLS在健康成年人群中检出率约为1／4,PFO-RLS的检出必须辅以Valsalva动作。在健康人群中存在着半定量分级相对PFO．RLS较低的P-RLS,其检出率、影响因素及其临床意义尚待更多研究。     

Patent foramen ovale: anatomy versus pathophysiology--which determines stroke risk?

This study investigated anatomic and pathophysiologic variables that may determine which patent foramen ovale (PFO) are associated with cerebrovascular accidents (CVAs). Anatomic features of a PFO have been identified as risk factors that predispose certain people to cryptogenic strokes (strokes of unknown cause). However, potential pathophysiologic variables that can determine the pressure gradient between left and right atria, which could influence the right-to-left shunt through a PFO, have not been examined. A retrospective study included 78 consecutive patients in whom PFOs were detected during routine transesophageal echocardiography examination. Group I included 36 patients with CVAs of unknown cause (cryptogenic stroke). Group II included 42 patients without CVAs whose PFOs were incidental findings. Anatomic features measured included separation and overlap between septum primum and septum secundum, interatrial septal motion, and the relative size of the right-to-left shunt with peripheral saline solution contrast injections. Pathophysiologic variables considered were those that could cause elevated left atrial pressure, thereby minimizing the right-to-left shunt.Patients with a clinical neurologic event (group I) had a larger right-to-left shunt volume of contrast bubbles than did patients with asymptomatic PFO (group II; P =.004). The size of the overlap between septum primum and septum secundum was less in patients from group I as compared with patients from group II (7.5 +/- 3.4 mm versus 9.9 +/- 6.0 mm; P =.026). However, other anatomic features of PFO that are determinants of the "opening" were not significantly different between the 2 groups. No statistically significant difference was found in the distance of the separation between septum primum and septum secundum (2.5 +/- 2.0 mm versus 1.9 +/- 1.6 mm; P = not significant). The prevalence of interatrial septal aneurysm was also similar between the 2 groups (28% versus 21%; P = not significant). However, the prevalence of variables that could potentially raise left atrial pressure was greater in patients without CVA as compared with those with a CVA (48% versus 14%; P =.01). In our study, anatomic features alone did not determine interatrial shunt size and pathophysiologic variables that could raise left atrial pressures did differentiate between patients with a PFO with a CVA/transient ischemic attack and those without it. Thus, both anatomic and pathophysiologic mechanisms should be considered in determination of the potential clinical significance of a PFO.     

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。     

卵圆孔未闭介入封堵预防隐源性脑卒中复发

目的 探究卵圆孔未闭(PFO)封堵治疗的安全性、有效性,进一步讨论介入封堵治疗PFO的临床意义。方法 选取2019年1-7月我院行PFO介入封堵术的PFO患者90例,术前所有患者均行经胸超声心动图右心声学造影（cTTE）及经食道超声心动图（TEE）证实为卵圆孔未闭并存在右向左分流。封堵成功即刻予床旁经胸超声心动图（TTE）,观察封堵器及分流情况。术后3个月,行cTTE及颅脑CT。结果 所有患者均成功置入封堵器,即刻经胸超声心动图证实封堵器位置正常,二、三尖瓣功能正常,未见残余分流,均未出现术中、术后并发症。术后随访3个月,58.9%患者头痛症状完全消失,34.4%患者头痛症状明显改善,发作频率较前明显减少,总的有效率为93.3%。术前27例一侧肢体麻木乏力患者中19例术后肢体麻木乏力症状完全消失,8例肢体麻木乏力症状虽未完全消失但较前不同程度缓解;术前8例恶心呕吐患者,术后症状完全消失。术后3个月复查经胸壁超声心动图右心声学造影示阳性率为5.6%（5/90）。术后3个月复查颅脑CT,提示本研究中90例患者均未发现新发梗死灶,再发脑卒中发生率为0%。结论 介入封堵治疗PFO可明显缓解患者临床症状,解除患者痛苦,减少分流量,降低脑卒中的再发风险,是一种安全、有效的治疗方法,对PFO的治疗具有指导意义。