单纯经胸超声心动图引导下行经皮卵圆孔未闭封堵术的临床研究

目的:本研究探讨单纯经胸超声心动图(TTE)引导下,行经皮卵圆孔未闭(PFO)封堵术的安全性及有效性。方法:回顾性分析2016年3月至2017年7月期间,在我院成功实施的单纯TTE引导下经皮PFO封堵术的患者35例,其中男性12例,女性23例。平均年龄(34.8±13.8)岁,平均体重(58.3±11.5)kg。术后即刻以超声心动图检查评价治疗效果,并于术后1个月、3个月进行门诊或电话随访。结果:所有患者均成功在TTE引导下行经皮PFO封堵术。5例患者因声窗不清晰,而加用食道超声辅助引导。患者的平均手术时间(穿刺至拔除鞘管)为(22.1±6.0)min。1例患者术后即刻存在微量残余分流,24 h后消失;1例术后发现少量心包积液,对症治疗后好转。35例患者的平均住院时间为(3.3±0.5)d,均康复出院,未出现外周血管损伤、心脏穿孔等并发症。术后1个月、3个月随访时,所有患者均未出现脑卒中、心包积液、封堵器脱落、残余分流等并发症。结论:单纯TTE引导下经皮PFO封堵术安全、有效,可以避免使用X线及对比剂,近期效果满意。

Safety and Efficacy of Percutaneous Closure of Patent Foramen Ovale Guided Solely by Transthoracic Echocardiography

Objectives: Our study observed the safety and efficacy of percutaneous closure of Patent Foramen Ovale(PFO) guided solely by transthoracic echocardiography(TTE).Methods: Clinical data of 35 PFO patients(12 male) treated by percutaneous closure solely guided by TTE in our institute from 2016-03 to 2017-07 were retrospectively analyzed. The mean age of patients was(34.8 ± 13.8) years, mean body weight was(58.3 ± 11.5) kg. TTE was performed immediately after percutaneous closure, the clinical follow-up was conducted at 1 month and 3 months after the procedure.Results: Percutaneous closure was successful in all patients under the guidance of TTE. TTE and transesophageal echocardiography(TEE) guidance was required in 5 cases because the TTE images were not clear enough. The mean procedural time(from puncture to sheath removal) was(22.1 ± 6.0) minutes. There was 1 case of residual shunt immediately post procedure, which disappeared spontaneously at 24 hours post procedure, 1 patient developed a small amount of pericardial effusion, which also disappeared after conservative treatment. The mean hospital stay was(3.3±0.5) days. All patients discharged without complications such as peripheral vascular injury or cardiac perforation. No patients suffered from stroke, pericardial effusion, occluder malposition, or residual shunt during follow-up at 3 months post operation.Conclusions: TTE guided percutaneous closure of PFO is safe and effective, this technique avoids the radiation and use of contrast agent in selected patients and short-term results are satisfactory in this patient cohort.