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。

Value of different right atrial pressurization methods in evaluating occult right to left shunt of patent foramen ovale by contrast transthoracic echocardiography

ObjectiveTo compare the effects of different right atrial pressurization methods on the detection of occult right to left shunt (RLS) of patent foramen ovale (PFO) by contrast transthoracic echocardiography (C-TTE), in order to improve the detection sensitivity of C-TTE. MethodsA retrospective analysis was performed on 70 patients with PFO diagnosed by surgery or esophageal echocardiography at Sichuan Provincial People's Hospital from March 2019 to July 2020. All patients had negative C-TTE results in the resting state in the right heart. At the same time, all patients completed three right atrial pressurization methods: cough hard (CH), successful Valsalva maneuver (SVM), and SVM immediately followed by CH (SVM-CH). The effects of the three pressurization methods on the detection of RLS by SVM-CH were compared. ResultsWe applied three right atrial pressurization modes (CH, SVM-CH, SVM) and two combined modes (SVM and CH, SVM and SVM-CH) for C-TTE detection of PFO occult RLS. The detection rates were 71.43%, 95.71%, 81.43%, 97.14%, and 100%, respectively, and the detection rates for large RLS were 10.00%, 54.28%, 35.71%, 55.72%, and 71.43%, respectively. CH, SVM-CH, SVM, CH and SVM, SVM and SVM-CH were used for C-TTE, respectively, and the overall difference in the quantification of RLS was statistically significant (χ²=37.771, P＜0.001). Thirty-four of the 70 patients underwent transesophageal echocardiography (TEE). SVM and SVM-CH were used to increase the right atrial pressure for C-TTE, and the detection rate of occult RLS by C-TTE (100%, 34/34) was higher than that by TEE (82.35%, 28/34). Among the 34 patients, C-TTE was detected by SVM-CH, but not by SVM in three cases, all of which showed long fissure PFO on TEE. ConclusionUsing SVM and SVM-CH to increase the right atrial pressure for C-TTE is helpful to improve the detection rate of PFO occult RLS by C-TTE, and the detection rate for PFO occult RLS by C-TTE combined with reasonable right atrial pressurization mode is better than TEE.