经导管封堵卵圆孔未闭预防卒中复发的研究进展

经导管封堵卵圆孔未闭预防卒中复发的有效性和安全性备受争议.随着近几年随机对照试验结果的公布,卵圆孔未闭封堵治疗从争议变为统一.本综述就卵圆孔未闭封堵相关的几项随机对照试验一一讨论,并对卵圆孔未闭封堵治疗获益患者的特征、术后管理等内容进行探讨.     

经导管封堵卵圆孔未闭预防脑的矛盾栓塞

目的:经导管封堵卵圆孔未闭(PFO)预防脑的矛盾栓塞并评价其疗效。 方法:本组共32例,年龄15-68(50.2±8.1)岁,体重40-72(53.7±4.3)kg。均经临床及经胸超声心动图(TTE)或经食道超声心动图(TEE)检查证实为PFO合并右向左分流伴脑缺血事件、单纯PFO、PFO合并房间隔瘤或房间隔瘤合并多孔房间隔缺损(房缺)。32例术前均有不同程度的偏头痛,不明原因的晕厥22例,用力性晕厥3例,短暂性语言障碍3例,缺血性脑梗塞4例。20例声学造影显示微泡从右心房进入左心房。PFO合并房间隔瘤、房间隔瘤合并多孔房缺的患者在TTE或TEE下测量房间隔的伸展径,选用房缺封堵器进行介入治疗;对单纯PFO的患者选用PFO封堵器经9-12F的鞘管置入,进行介入治疗。 结果:本组技术成功率为100％。所有患者均能成功置放封堵器。术后24 h,1个月,3个月,6个月,12个月行TTE检查未见封堵器移位。术后1个月复发偏头痛患者1例,1例房间隔瘤患者术后3个月用力时发生头晕症状。 结论:经导管封堵PFO是一种较有效的非手术方法,可用于预防脑的矛盾栓塞。     

经导管卵圆孔未闭介入封堵术预防卒中的研究进展

目前临床研究证实卵圆孔未闭（PFO）与隐源性卒中密切相关。迄今为止国际上已开展了多个大规模临床研究评估经皮卵圆孔介入封堵在预防卒中方面是否有效,与卵圆孔未闭相关隐源性卒中的诊治策略也有了长足进展,但依旧有一些问题亟待解决。本文将回顾近年来国内外经导管卵圆孔未闭介入封堵预防卒中再发的研究历程,以加强临床医生对PFO的认识。     

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。     

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。     

缺血性卒中相关性卵圆孔未闭的介入治疗

卵圆孔未闭是缺血性卒中的一个新的危险因素，但其具体机制仍不明，许多相关问题尚需进一步探讨。通过对相关文献进行比较，进一步肯定了卵圆孔未闭与缺血性或不明原因的卒中之间有很强的联系。房间隔瘤伴发卵圆孔未闭是脑梗死的危险因素。经皮导管卵圆孔未闭封堵术的应用前景看好，但还需要进行进一步的前瞻性研究。     

国产封堵器经导管封堵治疗小儿动脉导管未闭33例

目的评估小儿动脉导管未闭的介入治疗的临床效果。方法33例患儿术前经心超等检查证实为PDA,方法是将封堵器经股静脉途径沿输送鞘管送至降主动脉,再回撤将封堵器腰部卡在PDA最窄处。33例均采用国产封堵器。结果33例介入治疗成功。27例术后无分流,6例术后存在极少量分流。随访1～12个月所有患儿无PDA再通、装置移位或肺动脉狭窄。结论在熟练操作技巧的条件下,PDA封堵术安全、创伤小、成功率高、疗效可靠、价格适中,是目前我国导管治疗PDA的较为理想方法。     

卵圆孔未闭介入封堵术中右心房造影临床评价

目的:探讨右心房造影在卵圆孔未闭（PFO）介入封堵术中的临床应用价值。方法:选择2021年1月—2021年9月于我院行介入封堵术的PFO患者185例。经右股静脉送6F猪尾巴导管至右心房行高压造影（投照体位LAO45⁰+CRA10-15⁰,对比剂量25 mL,压力500 PSI,注射速率18 mL/s）,初步显示PFO的位置、形态及有无并发房间隔缺损等,测量其直径;使用多功能端侧孔导管从右心房顺利通过PFO至左心房,通过手推对比剂（8～10 mL）行选择性造影,显示PFO的直径、形态,并再次测量。选择合适的封堵器,建立静脉输送轨道并送入封堵器输送系统,释放封堵器前再次行右心房造影明确是否存在房间隔残余分流。术后3 d、1个月和3个月复查心脏彩超,并于术后6个月复查发泡试验。结果:右心房造影可清晰显示PFO,其中隧道型106例（57.30%）,火山口型56例（30.27%）,裂隙型23例（12.43%）。此外,术中发现8例合并小的继发房间隔缺损;右心房造影与选择性造影测量PFO直径无统计学差异[（3.12±0.98） mm∶（3.06±0.65）...     

不同类型卵圆孔未闭合并不明原因偏头痛经导管封堵治疗效果与近期随访观察

【摘要】目的研究不同类型卵圆孔未闭合并不明原因偏头痛经导管封堵治疗效果并进行近期随访观察。方法回顾性分析2016年12月至2019年12月来我院进行偏头痛治疗的127例伴随卵圆孔未闭患者,依据最终卵圆孔未闭合并不明原因偏头痛经导管封堵的类型分为简单型组（79例）与复杂型组（48例）,比较两组患者一般生理指标和头痛特征,随访一年观察各时间段两组患者的头痛缓解情况。结果简单型组与复杂型组在治疗1个月后的HIT-6评分与治疗前相较均无显著性差异（t=4.846, P=0.065; t=3.457, P=0.090）;简单型组与复杂型组在治疗1个月后的头痛发作频次与治疗前相较均无显著性差异（t=5.235, P=0.060; t=5.883, P=0.054）。在进行治疗3个月后比较复杂型组与简单型组治疗前后HIT-6评分以及头痛发生频次,发现在本研究中,简单型组治疗后的HIT-6评分显著性低于治疗前、复杂型组治疗后（t=21.832, P=0.015; t=15.324, P=0.021）,简单型组治疗后的头痛发作频次显著性低于治疗前、复杂型组治疗后（t=19.736, P=0.016; t=15.992, P=0.020）;在进行治疗6个月后比较复杂型组与简单型组治疗前后HIT-6评分与头痛发生频次,发现在本研究中,简单型组治疗后的HIT-6评分显著性低于治疗前、复杂型组治疗后（t=24.587, P=0.013; t=14.234, P=0.022）。结论不同类型卵圆孔未闭合并偏头痛患者在进行经导管封堵治疗后,复杂型卵圆孔未闭与简单型卵圆孔未闭均表现出良好的治疗效果,但是复杂型卵圆孔未闭,解剖结构较为复杂,封堵器偏大,完全内皮化所需时间较长,导致改善效果迟显。     

Percutaneous transcatheter closure of patent foramen ovale

In presence of a patent foramen ovale (PFO) with cryptogenic cerebral embolism, traditional therapy consists of oral anticoagulation or antiplatelet therapy. Surgery was considered only in case of recurrence. Transcatheter closure of PFO is currently performed. The availability of new user friendly devices and the increasing knowledge of pathophysiology, epidemiology, and follow-up of these patients has broadened the indications and marked reduced morbidity related to interventional PFO closure. This review presents the current knowledge and our own data concerning transcatheter closure of PFO.     

经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭

目的 探讨经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭的安全性和疗效.方法 在X线透视和超声心动图引导下经股静脉,通过10～12 F长鞘,采用左盘外包膜卵圆孔封堵器对有指征的卵圆孔未闭患者行介入治疗.术后口服阿司匹林(100 mg/d)6个月.术后24 h、1个月、3个月、6个月和1年分别行临床和超声心动图随访,以后每年随访1次.结果 共有25例卵圆孔未闭患者行卵圆孔封堵术,成功率为96%.没有发生院内不良事件和封堵器血栓形成、感染、心肌梗死等并发症.7例患者在术中出现频发性房性早搏或阵发性房性心动过速,术后很快终止.随访6～42(25±12)个月,封堵器位置正常,无房水平残余分流,未出现新发的心律失常和脑血管事件.结论 经皮导管左盘外包膜卵圆孔封堵器治疗卵圆孔未闭安全、有效.     

Eustachian valve interfering with transcatheter closure of patent foramen ovale

A prominent Eustachian valve (EV) is a common finding in patientswith a patent foramen ovale (PFO). Its presence might compromisetranscatheter closure of the PFO.     

Transient transcatheter balloon closure of patent foramen ovale following surgical repair of critical pulmonary stenosis

Severe cyanosis resulting from postoperative atrial right-to-left shunt is a life-threatening complication. We present a technique of transient transcatheter balloon closure of a patent foramen ovale in a newborn operated on for critical pulmonary stenosis, where the foramen ovale had been left open intraoperatively. Cardiac catheterization was performed under echocardiographic control in the intensive care unit and the foramen ovale was occluded with a water-filled balloon-catheter. Significant improvement of arterial oxygen tension allowed delayed definitive surgical closure in a second step. Unfortunately, the child developed right-sided pneumothorax postoperatively and died of cardiopulmonary failure. Nevertheless, this procedure seems a suitable way to relieve atrial right-to-left shunt temporarily until definitive surgical closure can be performed.     

Indication and techniques of transcatheter closure of patent foramen ovale

A potential causal relationship of a patent foramen ovale (PFO) and a stroke was first suggested by Cohnheim in 1877.1 Today, this correlation is generally accepted. However, there is still no "gold standard" for the treatment of patients with presumed paradoxical embolism. This article reviews the epidemiology of and the diagnostic methods for PFO, the clinical relationship between PFO and cerebral ischemia, as well as indications and techniques for transcatheter closure of PFO. In the author's opinion, transcatheter PFO closure represents an elegant management for selected patients at risk.     

Migraine headache relief after transcatheter closure of patent foramen ovale

OBJECTIVES: The purpose of this study was to determine the effects of transcatheter patent foramen ovale (PFO) closure on migraine frequency in patients with paradoxical cerebral embolism. BACKGROUND: The prevalence of migraine headache is higher in cryptogenic stroke patients with PFO than in the general population. Previous studies have suggested that closure of the PFO may reduce migrainous symptoms. METHODS: Between April 2001 and December 2003, 162 consecutive patients with paradoxical cerebral embolism underwent transcatheter PFO closure for prevention of recurrent cryptogenic stroke or transient ischemic attack. A one-year retrospective analysis of migraine symptoms before and after PFO closure was performed. RESULTS: Active migraine was present in 35% (57 of 162) of patients, and 68% (39 of 57) experienced migrainous aura; 50 patients were available for analysis at one year. Complete resolution of migraine symptoms occurred in 56% (28 of 50) of patients, and 14% (7 of 50) of patients reported a significant (>or=50%) reduction in migraine frequency. Patients reported an 80% reduction in the mean number of migraine episodes per month after PFO closure (6.8 +/- 9.6 before closure vs. 1.4 +/- 3.4 after closure, p < 0.001). Results were independent of completeness of PFO closure at one year. CONCLUSIONS: In patients with paradoxical cerebral embolism, migraine headaches are more frequent than in the general population, and transcatheter closure of the PFO results in complete resolution or marked reduction in frequency of migraine headache.     

Early systemic device embolization after transcatheter patent foramen ovale closure

Serious complications after percutaneous atrial septal abnormality closure are uncommon. We present a case of patent foramen ovale closure with early mobilization of the device and asymptomatic embolization into the descending aorta without sequels. Percutaneous retrieval of the device was successful down to the femoral artery from where it was extracted surgically.     

卵圆孔未闭并发不明原因脑卒中患者封堵治疗的疗效和安全性

目的:探讨封堵治疗卵圆孔未闭(patent foramen ovale,PFO)并发不明原因缺血性脑卒中患者的临床疗效及安全性。方法:26例缺血性脑卒中患者,均经头颅CT或磁共振成像(MRI)证实有脑梗死病灶,排除其他脑梗死原因,如主动脉和脑血管病变,及左心系统疾病等。经颅多普勒超声(TCD)声学造影判断有右向左分流,经胸超声心动图(TTE)和(或)经食管超声心动图(TEE)证实为PFO或PFO并发房间隔瘤。所有患者均行PFO封堵治疗。结果:26例患者,静息超声测量PFO大小为1.0~4.6(2.8±1.2)mm,其中5例PFO并发房间隔瘤。TCD声学造影分流量Ⅰ级6例,Ⅱ级9例,Ⅲ级以上11例。24例封堵成功,技术成功率为92%,所用封堵器18 mm 6个、25 mm7个、30 mm 8个及35 mm 3个。未成功病例2例,主要原因为导丝无法到达左房。术后随访6个月~1年,TTE检查未见封堵器移位及心房水平残余分流,TCD声学造影检查均无右向左分流,所有患者无再发缺血性脑梗死。结论:经导管封堵PFO是一种安全有效的治疗方法,可有效减少缺血性脑卒中的再发生。     

Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale

BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) in patients with a history of cryptogenic stroke is performed with increasing frequency. However, the long-term effects of these closure devices on atrial tachyarrhythmias (ATs) are not known. METHODS AND RESULTS: The study population included 71 patients [31 (44%) men, aged 54 +/- 14 years] with PFO, diagnosed by transesophageal echocardiography (TEE), and greater than or equal to 1 cryptogenic stroke (n = 70) or orthodoxia (n = 1). Patients underwent transcatheter closure of PFO using a 28 mm (n = 53) or a 33 mm (n = 18) CardioSEAL closure device (n = 67) or an Amplatzer occluder (n = 4). Five (7%) patients presented with newly diagnosed (n = 4) or recurrent (n = 1) episodes of AT (3 atrial fibrillation and 2 typical atrial flutter) within 1 to 480 days following the procedure, with an average time to onset of 175 +/- 221 days. ATs were more frequent in those who received a 33 mm device than those who received a 28 mm device [4/18 (22%) vs. 1/53 (2%); p < 0.05]. Patients with ATs showed a trend toward a larger left atrium only on apical view (6.5 +/- 1.4 cm vs. 5.1 +/- 0.9 cm; p = 0.05). However, the difference in left atrial size on parasternal view and right atrial size between the 2 groups was not statistically significant (4.5 +/- 1.1 cm vs. 3.7 +/- 0.8 cm and 5.9 +/- 2.4 cm vs. 4.6 +/- 0.7 cm). Conclusion. Compared to the age-matched population, sustained ATs appear to be relatively common following transcatheter closure of PFO. In our series, they seemed to occur more frequently in patients who received larger devices.