经胸和经食管超声心动图诊断卵圆孔未闭的对比研究

目的 对比研究经胸超声心动图TTE和经食管超声心动图TEE对卵圆孔未闭(patent foramen ovale，PFO)的诊断方法和诊断价值，及对卵圆孔未闭的临床意义。方法 运用经胸及经食管超声心动图检查，诊断卵圆孔未闭24例，根据患者有无合并其他心脏疾患及合并的心脏疾患的血流动力学特点将患者分为卵圆孔未闭组及卵圆孔开放组。结果 经胸超声心动图通过CDFI观察房水平的穿隔血流对卵圆孔未闭的诊断准确率为58．3％。经食管超声心动图检查能对所有患者做出正确诊断。卵圆孔未闭组可见卵圆孔瓣上缘与继发隔之间裂缝，CDFI显示源于卵圆孔瓣与继发隔交界边缘处的穿隔血流；卵圆孔开放组可见卵圆孔瓣上缘与继发隔之间出现回声缺失，但卵圆孔瓣尚完整，CDFI于缺口处探及垂直于房间隔的穿隔分流束。结论 经食管超声心动图是目前卵圆孔未闭诊断金标准的首选方法。卵圆孔未闭可导致反常栓塞，应予以积极治疗。

Comparative Study on Diagnosis of Patent Foramen Ovale with Transthoracic and Transesophageal Echocardiography

Objective:To comparatively study the values of transthoracic echocardiography (TTE)and transesophageal echocardiography(TEE)for diagnosis of patients with patent formamen ovale(PFO)and to study the clinical significance of PFO as well.Methods:Twenty-four patients with PFO,divided into PFO group and re-opened PFO group according to with and without other heart diseases and the hemodynamic features of combined heart diseases,were examined by TTE and TEE.Results:TEE achived a 58.3% diagnostic accuracy rate in patients with PFO by observing trans-diazoma blood stream at atrial level using CDFI,where as TEE could provide accurate diagnosis for all patients.In the PFO group,a crack was observed between the upper side of foramen ovale and the secondary diazoma;a trans-diazoma blood stream was shown from the junction border between foramen ovale and the secondary diazoma on CDFI;in re-opened PFO group,the echo between the upper side of foramen ovale and the secondary diazoma disappeared.while the foramen ovale became complete;however,on CDFI a bundle of blood stream perpendicular to the secomdary diazoma on the nick(the defect portion)could be seen.Conclusions:TEE is the first choice of golden standard for diagnosis of PFO at present.Patent foramen ovale will cause paradoxical embolism and should be treated as early as possible.