卵圆孔未闭伴心房颤动患者行左心耳联合卵圆孔未闭封堵安全性与有效性初探

目的:初步评估成年卵圆孔未闭（PFO）伴心房颤动（房颤）患者左心耳联合PFO封堵的安全性和有效性。方法:本研究为回顾性、横断面研究。入选2017年6月至2020年10月在上海健康医学院附属周浦医院经食道超声心动图（TEE）确诊的7例房颤合并PFO患者,收集年龄、性别、病史等基本资料。根据未闭卵圆孔大小、左心耳口宽度和深...     

心房颤动左心耳联合卵圆孔未闭封堵：过犹不及？

心房颤动（房颤）患病率高,左心耳封堵预防缺血性卒中近年来有较大进展。成年人卵圆孔未闭（PFO）的发生率较高,PFO与偏头痛及不明原因卒中可能相关,目前指南/专家共识指出,血栓栓塞性脑梗死伴PFO患者,未发现其他卒中发病机制,结合PFO的解剖和分流情况,可考虑PFO封堵术,但对于老年患者并不积极地建议PFO封堵术。对于房...     

房间隔联合左心耳封堵治疗房间隔缺损伴心房颤动老年患者1例

<正>1对象和方法患者,男性,70岁,陕西省神木市人。主因"阵发性心慌、气短10年,加重2周"入院。患者于10年前无明显诱因感心慌、气短,活动后为著,经休息可好转,无胸痛,未经过特殊治疗。半年前患者因一过性晕厥、跌倒至当地医院行心电图检查提示"心房颤动(房颤)",头颅CT提示"脑梗死",心脏彩超提示"房间隔缺损"。当地医院     

左心耳封堵联合房间隔缺损封堵“一站式”治疗对房间隔缺损合并房颤患者的安全性及疗效观察

目的 探讨对先天性房间隔缺损合并房颤的患者,同期进行经皮左心耳联合房间隔缺损封堵术的可行性、安全性及疗效。 方法 回顾性分析珠海市人民医院及四川省人民医院2016年1月-2018年6月收治的13例先天性房间隔缺损合并房颤的患者的临床资料,术后即刻评价封堵疗效,并于术后45天,90天随访观察左心耳和房间隔封堵器的位置、血栓形成以及残余分流情况及患者临床表现。结果 13例患者均成功植入WATCHMAN左心耳封堵器及双盘式房间隔缺损封堵器。术后即刻封堵效果满意,房缺封堵器封堵器位置满意,固定,无残余分流,WATCHMAN封堵器符合PASS原则,术中无器械表面血栓,无心包填塞及血管并发症。随访结果显示,13例患者无新发脑卒中者;未发现心功能恶化者;未发现封堵器移位;未发现左心耳封堵器残余分流加重及器械表面血栓。其中1例患者自行转为窦性心律。结论 对先天性房间隔缺损合并房颤患者,同期实施左心耳联合房间隔缺损封堵术具有操作安全简便的特点,近、中期的随访效果良好。     

卵圆孔未闭封堵器在儿童多孔型房间隔缺损封堵治疗中的研究

目的:总结卵圆孔未闭(PFO)封堵器介入治疗儿童多孔型房间隔缺损(ASD)的疗效和经验。方法:对2017年1月至2018年11月,我院采用PFO封堵器进行介入封堵治疗儿童多孔型ASD的患儿共40例进行总结,术前经临床及经胸超声心动图诊断,术中心导管结合经胸超声心动图及术后随访,观察术后右心房前后径,左右径,右心室内径变化,观察封堵器位置,有无残余分流情况及并发症。结果:所有患儿均成功置入PFO封堵器,所有患儿术后未发现明显心律失常。术后封堵器位置良好,未出现移位,未出现心脏穿孔、封堵器脱落以及栓塞等不良反应。术后1、3、6个月行经胸超声心动图检查测量患儿右心房前后径,左右径,右心室内径,较术前均明显缩小,差异有统计学意义(P0.05)。术后即刻封堵行经胸超声心动图显示39例完全闭合,1例术后6个月仍有少量残余分流,但对血流动力学无影响。结论:PFO封堵器对于封堵儿童多孔型ASD,具有封堵器效率较高,短期疗效可靠的特点,在把握适应证的前提下具有较好的封堵效果。     

有偏头痛的卵圆孔未闭患者行封堵治疗的临床研究现状

流行病学资料显示超过18%女性和6%男性患有偏头痛(MA)[1].越来越多的研究表明,MA和卵圆孔未闭(PFO)密切相关,而近几年采用导管封堵PFO以缓解或终止MA发作,但临床疗效仍有争议[2].现回顾综述PFO封堵治疗的临床研究资料,以提高对有MA的PFO患者行封堵治疗的认识.     

“经皮冠状动脉介入治疗+左心耳封堵术+卵圆孔未闭封堵术”一站式治疗冠心病合并卒中高风险的心房颤动1例

对于冠心病合并卒中高风险的心房颤动治疗,难点在于无法权衡抗凝和抗血小板联合应用所带来的出血风险。本文报道1例冠心病合并卒中高风险的心房颤动患者的治疗,以期为临床提供经验。     

房间隔缺损或卵圆孔未闭患者封堵术后封堵器血栓形成的发生率和临床过程[英]／Krumsdorf U…／／J Am Coll Cardiol．

自开展经导管房间隔缺损(ASD)及卵圆孔未闭(PFO)封堵术以来，先后有多种类型的封堵器应用于临床。封堵器的血栓形成及其临床过程的有关研究尚不多。该研究观察并分析了1000例ASD或PFO封堵术后封堵器血栓形成的发生率、形态学、可能的预测指标及血栓形成的临床处理。     

心耳结扎不完全、房间隔缺损封堵后左心耳封堵1例

<正>1临床资料患者,女性,45岁,主因“间断心慌、胸闷、气短18年,加重1个月”于2019年11月收入空军军医大学第一附属医院心脏内科。患者于18年前出现心慌、胸闷、气短,就诊于本院,行“房间隔缺损（房缺）封堵术”。2017年患者再次出现心慌、胸闷、气短,伴恶心,短暂意识丧失,持续约数秒,就诊于“首都医科大学附属北京安贞医院”,诊断“二、三尖瓣关闭不全、心房颤动（房颤）、房缺封堵术后、短暂脑缺血发作”,行“二尖瓣、三尖瓣成形术、左心耳结扎术、     

Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure

Objectives: To compare pre‐ and post‐procedure electrocardiograms (ECGs) in a large cohort of patients after percutaneous closure of atrial septal defect (ASD) and patent foramen ovale (PFO). Background: Percutaneous device closure of ASD or PFO is commonplace. Conduction and rhythm anomalies associated with percutaneous device placement have been reported. Methods: We reviewed records for all patients who underwent percutaneous device closure of ASD or PFO at our institution from 1999 to 2008. Pre‐procedure ECG and Holter studies were compared to available short term (<2 months after placement) and intermediate follow‐up (>2 months) ECG or Holter. Results: Pre‐ and post‐procedural ECGs were available in 610 patients (305 females, average age 50 ± 18.1 years, range 1–91 years, 384 PFO, 184 ASD, 42 with multiple defects, mean device size 16 mm, range 5–38 mm). We report an incidence of 5.2% (32/610) of arrhythmias in the 4 months following device placement, including 29 patients with atrial tachyarrhythmias (ATs, 22 fibrillation, 7 flutter), 1 with junctional tachycardia, and 2 with heart block. Among other findings, the average P‐wave duration was increased on intermediate follow‐up as compared to early follow‐up (P < 0.001). Development of new‐onset 1st degree AV Block after the procedure was associated with an increased risk of ATs post‐procedure (P < 0.0001). Conclusion: We report a low risk of clinically significant post‐procedure arrhythmias after device placement. Clinically significant heart block occurred in only two patients (0.3%). Changes in several markers of atrial conduction were found, suggesting an effect of device closure on intra‐atrial conduction. © 2011 Wiley‐Liss, Inc.     

Transseptal puncture for catheter ablation of atrial fibrillation after device closure of patent foramen ovale

The technique of transseptal puncture for catheter ablation of atrial fibrillation after percutaneous closure of a foramen ovale with the Amplatzer Occluder is demonstrated based on 2 representative cases. © 2008 Wiley‐Liss, Inc.     

Live three-dimensional transthoracic echocardiographic assessment of transcatheter closure of atrial septal defect and patent foramen ovale

We report the usefulness of live three-dimensional transthoracic echocardiography in the accurate assessment of the morphology and efficacy of Amplatzer transcatheter devices used for closure of atrial septal defect and patent foramen ovale.     

Impact of a patent foramen ovale on paroxysmal atrial fibrillation ablation

Introduction: A patent foramen ovale (PFO) is located at the anterior and superior part of the anatomical interatrial septum, the area that is targeted during transseptal puncture. This study sought to investigate the impact of accessing the left atrium via a PFO on paroxysmal AF ablation. Methods: From March 2004, 203 patients (55 ± 11 years) underwent catheter ablation for paroxysmal AF (80 ± 71 months), with the endpoint being electrical isolation of all pulmonary veins (PV) and AF noninducibility. The presence of a PFO was determined by both transesophageal echocardiography and catheter probing. Procedural difficulty was evaluated by radiofrequency (RF), procedural, and fluoroscopic durations. Clinical follow‐up was also investigated. Results: A PFO was detected in 27 patients (13%) by transesophageal echocardiography and in 22 additional patients (total 49 patients, 24%), by catheter probing (P < 0.001). A PFO was associated with longer total RF applications (57 ± 19 vs 51 ± 18 min, P = 0.04) and RF applications to isolate the PVs (42 ± 16 vs 35 ± 12 min, P = 0.001). Procedural and fluoroscopic times were unaffected. Seventy‐three patients (36%) required a second procedure; there was no difference in the number of PV reconnections (1.3 vs 1.8 veins, P = NS). After a mean follow‐up of 19 ± 9 months, 194/203 patients (96%) were free of AF, with no difference in patients in whom a PFO had been used. Conclusion: Although isolation of PVs is longer, overall procedural duration and success is not affected when using a PFO compared with a transseptal puncture. The presence of a PFO is underestimated by transesophageal echocardiography with brachial injection when compared with catheter probing.     

Transcatheter closure of patent foramen ovale in older adults.

OBJECTIVES: Comparing results of patent foramen ovale (PFO) closure in older and younger patient cohorts. BACKGROUND: The literature pertaining to stroke and PFO has focused on patients <55 years of age. METHODS: Between March 2000 and December 2003, 456 consecutive stroke/transient ischemic attack (TIA) patients (14.2-91.1 years, mean 51.4 +/- 15.5) underwent successful closure of PFO with a CardioSEAL Septal Occluder by one operator at five hospitals. Of the 456 patients, 184 (40.4%) were >55 years of age at the time of the procedure (mean 66.9 +/- 8.3 years) and comprise the subject group (OLDER). The remaining 272 patients (mean 41.1 +/- 7.7) comprise the control group (YOUNGER). Data were collected prospectively in a registry type format. RESULTS: Minor procedural complications were comparable: 7/184 (3.8%) OLDER vs. 12/272 (4.4%) YOUNGER (P = NS). In the follow-up period (1-45 months, mean = 17.8 +/- 11.1), there was no significant difference in the rate of recurrent stroke/TIA, headaches, or late unrelated death. Forty OLDER patients and 47 YOUNGER developed new onset atrial arrhythmia (P = NS). The incidence of new onset atrial fibrillation (AF), however, was significantly higher in OLDER (14/40 OLDER and only 2/47 YOUNGER, P < 0.025). All patients who were in normal sinus rhythm (NSR) before the procedure are in NSR at last follow-up. CONCLUSIONS: Older patients should not be excluded from PFO closure. The procedure seems as safe and effective in preventing recurrent stroke in the older, as in the younger population. Older patients seem more prone to developing AF.     

Transhepatic closure of patent foramen ovale

Transhepatic right heart catheterization is an uncommon procedure for adult interventional cardiologists. We report its successful use for closure of a patent foramen ovale in an elderly patient without femoral vein access. Also described is a novel method of using a vascular plug to achieve hemostasis of the hepatic venous access site. © 2009 Wiley‐Liss, Inc.