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...     

卵圆孔未闭患者经胸超声心动图右心声学造影中护理工作要点分析

为探讨卵圆孔未闭(PFO)患者行经胸超声右心声学造影(cTTE)时的临床护理工作要点与意义,本研究选择临床疑为PFO并在我科进行cTTE检查的331例患者为对象,检查前进行心理疏导,指导Valsalva动作或连续剧烈咳嗽训练;检查中及检查后密切观察患者有无不适反应。结果显示,331例中无一例因紧张、恐惧而放弃检查;325例顺利完成平静呼吸及Valsalva动作或连续剧烈咳嗽时cTTE检查,6例因无法完成符合检查要求的连续咳嗽动作而仅行平静呼吸状态cTTE检查。2例于检查结束后出现短暂心慌、胸闷、气短不适,未行特殊处理自行缓解。结果表明,重视心理护理、加强Valsalva动作或连续剧烈咳嗽训练及密切观察患者反应,对顺利完成cTTE检查具有重要意义。     

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。     

卵圆孔未闭经胸超声心动图声学造影及经食管超声心动图的单中心诊断数据分析

目的对卵圆孔未闭（PFO）的经胸超声心动图声学造影（cTTE）及经食管超声心动图（TEE）诊断数据进行分析,探讨cTTE和TEE检查的结果和临床意义。 方法回顾性选取2014年8月至2019年6月疑诊PFO相关疾病、在解放军总医院第一医学中心超声诊断科行cTTE及TEE检查的患者1164例。分析TEE、cTTE及二者联合方法对PFO的检出率,cTTE对右向左分流起源以及分流量的诊断评估结果,TEE对PFO形态结构特点的诊断结果。 结果1164例患者分为先兆偏头痛（MA）组314例、无先兆偏头痛（MO）组219例、隐源性脑梗死（CCI）和（或）短暂性脑缺血发作（TIA）组279例和其他病变组352例。cTTE和（或）TTE检出PFO 282例（282/1164,24.2%）。4组不同临床分组间PFO检出率差异有统计学意义（χ²=17.94,P<0.001）,其中MA患者PFO检出率最高（98/314,31.2%）。1164例患者中764例接受了cTTE检查,检出PFO170例（170/764,22.3%）;816例患者接受了TEE检查,检出PFO 221例（221/816,27.1%）。412例患者接受了cTTE和TEE联合检查,检出PFO125例（125/412,30.3%）。接受cTTE检查的764例患者中,cTTE检出右向左分流者474例（474/764,62.0%）。其中170例PFO右向左分流患者中,分流量为大量者居多（101/170,59.4%）;383例肺循环右向左分流患者中,分流量为少量者居多（185/383,48.3%）;79例二者合并存在者,分流量为大量者居多（54/79,68.4%）。TEE检出的221例PFO患者中,均可记录PFO宽度,平均宽度为（1.61±0.92）mm,狭长形态PFO78例,平均长度为（10.53±3.52）mm。TEE检出分流132例,其中左向右分流122例,右向左分流1例,双向分流9例;检出房间隔膨胀瘤14例,左心房房间隔袋20例,瓣膜丝状物41例。 结论MA、CCI和（或）TIA患者PFO检出率高于MO和其他疾病患者。TEE与cTTE联合应用可提高PFO检出率。cTTE对于右向左分流的检出以及右向左分流起源的判断具有重要价值。PFO相关疾病患者中,PFO右向左分流多为大量,半数以上存在肺循环右向左分流,在检查中需注意鉴别。     

超声心动图诊断卵圆孔未闭

卵圆孔未闭（PFO）在成人的发生率约20%~25%,其与年轻患者的隐源性卒中、短暂性脑缺血发等多种疾病有关。超声心动图在PFO的诊断、经皮封堵术中监测及术后随访中均有重要价值。本文对PFO的超声心动图诊断做一综述。     

改良下腔静脉加压法用于无痛经食管超声心动图诊断卵圆孔未闭

超声心动图是诊断卵圆孔未闭(patent foramen ovale,PFO)的主要方法.经食管超声心动图(trans-esophageal echocardiography,TEE)不受胸腔气体干扰,是诊断PFO的金标准;但部分患者难以忍受食管插管反应;而无痛TEE需要麻醉,患者无法配合完成瓦尔萨尔瓦动作.本研究观察...     

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。     

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。     

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。     

右心声学造影结合经食管超声检测卵圆孔未闭的关键护理要点分析

目的:探讨右心声学造影（cTTE）结合经食管超声（TEE）检测卵圆孔未闭（PFO）的关键护理要点。方法:选择2020年10月—2022年3月疑诊卵圆孔未闭并进行超声检查的50例病人为研究对象,在检查前进行心理疏导,指导Valsalva动作或连续剧烈咳嗽训练;在检查中注重医师、护士及病人的密切配合;检查后密切观察病人有无不适反应及并发症,总结关键护理要点。结果:50例病人均顺利完成静息状态及Valsalva动作下的cTTE检查;44例病人完成了TEE检查,1例有少量黏膜损伤出血,1例病人出现轻微过敏反应。结论:在cTTE和TEE检查中,应重视心理护理、加强Valsalva动作或连续剧烈咳嗽训练、密切观察病人反应,并加强医、护、患三者配合,以提高cTTE诊断准确率、TEE检查的成功率及降低不良反应。     

偏头痛与隐源性脑卒中患者卵圆孔未闭的声像图特征分析

目的 探讨存在卵圆孔未闭（PFO）的偏头痛和隐源性脑卒中（CS）患者经食管超声心动图和右心声学造影的声像图特征。方法 选取合并PFO的偏头痛患者162例（偏头痛组）、CS患者113例（CS组）,以经食管超声心动图观察PFO的形态、血流特点,以经食管右心声学造影观察PFO的造影特点及分流模式,比较2组间的差异。结果 偏头痛组与CS组间卵圆瓣长度、PFO入口和出口宽度、过隔血流所占比例、左心房内微气泡数量差异均无统计学意义（P均>0.05）。偏头痛组瓦氏动作时右心房内微气泡呈簇状通过PFO的比例（28/162,17.28%）明显小于CS组（36/113,31.86%）,差异有统计学意义（χ²=7.919,P=0.006）。偏头痛组患者平均年龄小于CS组,且以女性患者为多,而CS以男性患者居多,差异均有统计学意义（P均<0.001）。结论 偏头痛和CS患者的PFO形态学无明显差异。右心声学造影时,偏头痛和CS患者微气泡通过PFO进入左心房的模式存在差异,有望为临床预测CS提供新的指标。     

Migraine,patent foramen ovale and migraine triggers

Little information exists about a causal association between PFO and migraine. Some patients identify Valsalva-provoking activities (VPA) as migraine triggers. Therefore, we speculate about a pathogenic connection. The object of the study is to investigate the prevalence of right-to-left shunt (RLS) in a cohort of patients suffering migraine with aura (MA) and its possible association with migraine attacks triggered by VPA. We investigated the circumstances triggering the migraine attacks, in a consecutive series of 72 MA patients and in a series of migraine without aura age and gender-matched. The presence and extent of RLS was assessed by transcranial Doppler. Massive RLS appeared in 38.9% of MA and in 6.5% of migraine without aura (p<0.001). MA patients identified at least one VPA as headache trigger in 45.8%. A trend was found between these triggering activities and massive RLS, both in MAgroup OR 2.7 [1.02–7.17] and in all migraine patients OR 2.5 [1.01–6.11]. According to our results, patients with migraine who have larger RLS tend to recognize activities that increase the extent of the shunt as a trigger of their migraine attacks.     

High prevalence of patent foramen ovale in migraine with aura

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour–coded sonography (c–TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c–TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c–TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.     

偏头痛与卵圆孔未闭关系的研究

目的：探讨先兆性偏头痛、无先兆性偏头痛患者和正常人卵圆孔未闭（ PFO）发生率的差异。方法采用经颅多普勒超声（TCD）检测先兆性偏头痛组（29例）、无先兆偏头痛组（31例）和正常对照组（26名） PFO的发生率,比较各组差异。记录治疗前偏头痛患者的头痛频率、头痛发作日数和头痛程度等,并分析其与PFD分流量大小的相关性。结果先兆性偏头痛组、无先兆偏头痛组和正常对照组PFO发生率分别为72％、45％和31％,先兆偏头痛组PFO发生率较正常对照组高（ P＝0.008）,无先兆偏头痛组较正常对照组高,但比较差异尚无统计学意义（ P＝0.491）;PFO大小与头痛频率、头痛发作日数呈正相关（P均＜0.05）。结论先兆偏头痛患者的PFO发生率较高,提示此两种疾病可能有共同的病理学发病机制。     

Closing the gap on patent foramen ovale and cryptogenic stroke

Introduction: The treatment options for prevention of recurrent of cryptogenic stroke in patients with patent foramen ovale (PFO) have been intensely debated in the recent decades. The suggested options were percutaneous closure of PFO versus medical therapy. However, up to these date there is a controversy regarding the indication of percutaneous closure. Multiple meta-analysis and recent randomized control trials showed the benefit of PFO closure when compared with medical therapy alone.

Areas covered: The article reviews the prevalence, physiology, diagnosis and treatment options of PFO after cryptogenic stroke. Furthermore, it will discuss the results of randomized control trials that compared the PFO closure to medical therapy.

Expert opinion: The association between PFO and unexplained cryptogenic stroke has been well established in the multiple studies. The diagnosis and management of PFO might be challenging in some cases. Although multiple studies showed that PFO closure is associated with lower rates of recurrent stroke in patients presenting with cryptogenic stroke, the indication and patient selection for this intervention are not well established yet in the guidelines.     

经胸超声心动图在卵圆孔未闭封堵术中的应用

目的 探讨经胸超声心动图（TFE）在卵圆孔未闭（PFO）封堵术中的应用价值。方法回顾性分析43例PFO患者在封堵术前、术中及术后的TTE图像特征。结果 TTE在术前可清晰显示PFO的大小、形态和分流方向,能帮助介入医师选择合适的封堵器;术中可准确地评价PFO患者封堵器的位置、形态及其与周边的临近结构关系;术后可有效地监控PFO患者预后情况。结论 TTE在PFO封堵术前确诊、术中引导、监护及术后随访均具有重要的作用。     

Patent foramen ovale and cryptogenic stroke: contemporary evidence and treatment

Introduction: Patent foramen ovale (PFO) is a common anatomical variant in the adult circulation. It is a channel allowing communication between the left and right atria and is a remnant of the foetal circulation. In approximately 25% of the population, this channel persists into adulthood. PFO has been proposed as a potential pathophysiological mechanism for cryptogenic stroke.

Areas covered: This review will examine the contemporary evidence for both the association between cryptogenic stroke and PFO and the management of this condition. The authors hope to provide a comprehensive overview of the current evidence and best practice in relation to PFO closure. In addition, the authors will propose some potential avenues for future research in this controversial area and try to predict how PFOs in cryptogenic stroke will be managed in the near future.

Expert commentary: In carefully selected patients with cryptogenic stroke, PFO closure represents an evidence based treatment option for the prevention of further ischemic neurological events. A multidisciplinary approach is necessary to ensure appropriate patient selection for the procedure. This should include a vascular neurologist/stroke physician and an interventional cardiologist with an interest in PFO closure.     

Lower patent foramen ovale detection with transthoracic echocardiography in atrial fibrillation

Background Patent foramina ovale (PFO) are small defects within the atrial septum that may play a role in paradoxical embolism, stroke and migraines. The relationship between PFO and atrial fibrillation (AF) has not been formally studied. We prospectively studied patients with a history of AF, versus those without (controls), in order to compare PFO prevalence among them. Methods Sixty-one patients with AF and forty-one controls completed the study, all undergoing transthoracic echocardiography using agitated saline microbubbles and a Valsalva maneuver. Results In the control group, 12/41 participants (29.2%) had PFOs compared to 5/61 (8.2%) in the AF group (P < 0.01). PFO positive patients within the entire study population demonstrated greater leftward inter-atrial septal shifting (82% vs 49%, P < 0.05). There was also reduced leftward inter-atrial septal shift observed within the AF group compared to controls (32/61 (52%) vs 31/41 (76%), P < 0.05). Conclusion This study is the first to demonstrate an apparent lower rate of PFO in patients with AF, using bubble contrast echocardiography.