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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (06) : 546 -551. doi: 10.3877/cma.j.issn.1672-6448.2020.06.011

所属专题: 文献

心血管超声影像学

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
王一茹1, 邓玉姣1, 阳开秀1, 伊海瑞1, 罗渝昆1, 李越1,()   
  1. 1. 100853 北京,解放军总医院第一医学中心超声诊断科
  • 收稿日期:2019-07-22 出版日期:2020-06-01
  • 通信作者: 李越

Transthoracic contrast echocardiography and transoesophageal echocardiography for diagnosis of patent foramen ovale: a single-center data analysis

Yiru Wang1, Yujiao Deng1, Kaixiu Yang1, Hairui Yi1, Yukun Luo1, Yue Li1,()   

  1. 1. Department of Ultrasound, the First Medical Center, General Hospital of the People′s Liberation Army, Beijing 100853, China
  • Received:2019-07-22 Published:2020-06-01
  • Corresponding author: Yue Li
  • About author:
    Corresponding author: Li Yue, Email:
引用本文:

王一茹, 邓玉姣, 阳开秀, 伊海瑞, 罗渝昆, 李越. 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[J/OL]. 中华医学超声杂志(电子版), 2020, 17(06): 546-551.

Yiru Wang, Yujiao Deng, Kaixiu Yang, Hairui Yi, Yukun Luo, Yue Li. Transthoracic contrast echocardiography and transoesophageal echocardiography for diagnosis of patent foramen ovale: a single-center data analysis[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(06): 546-551.

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。

Objective

To retrospectively analyze the diagnostic value of transthoracic contrast transthoracic echocardiography (cTTE) and transoesophageal echocardiography (TEE) in patients with clinically suspected patent foramen ovale (PFO).

Methods

The data of cTTE and TEE examinations in 1164 patients with suspected PFO-related diseases at the Department of Ultrasound of the First Medical Center of the PLA General Hospital from August 2014 to June 2019 were retrospectively analyzed. TEE, cTTE, and a combination of the two were used to detect PFO.The diagnostic performance of cTTE for right-to-left shunt and shunt flow, and that of TEE for the morphological and structural characteristics of PFO were analyzed.

Results

There were 314 cases of migraine with aura(MA), 219 cases of migraine without aura (MO), 279 cases of cryptogenic cerebral infarction (CCI) and/or transient is chemic attack (TIA), and 352 cases of other diseases. A total of 282 (24.2%) cases of PFO were detected in 1164 patients. The difference in PFO detection rate between the four clinical groups was statistically significant (χ2=17.94, P<0.001), with the highest PFO detection rate observed in patients with MA (98/314, 31.2%). Of the 1164 patients, 764 underwent cTTE and 170 (170/764, 22.3%) PFOs were detected; 816 underwent TEE and 221 (221/816, 27.1%) PFOs were detected; 412 underwent combined cTTE and TEE examinations and 125(125/412, 30.3%) PFOs were detected. Of the 764 patients who underwent cTTE examination, 474 (474/764, 62.0%) had a right-to-left shunt in cTTE. Among the 170 patients with right-to-left shunt, 101(101/170, 59.4%) had a large amount of shunt flow (101/170, 59.4%); among 383 patients with pulmonary circulation-related right-to-left shunt, 185(185/383, 48.3%) had a small amount of shunt flow; among 79 patients with bidirectional shunt, 54(54/79, 68.4%) had a large amount of shunt flow. PFO width could be recorded in all 221 PFO patients detected by TEE, with an average width of (1.61±0.92) mm, and 78 cases of narrow and long PFO, with an average length of about (10.53±3.52) mm. The shunt was detected by TEE in 132 cases, of which 122 had a left-to-right shunt, 1 had a right-to-left shunt, and 9 had a bidirectional shunt. In addition, 14 cases of atrial septal aneurysm, 20 cases of left atrial septal pouch, and 41 cases of valve filaments were observed.

Conclusion

The detection rate of PFO in patients with MA and CCI and/or TIA is significantly higher than that in patients with MO and other diseases. The combination of TEE and cTTE can improve the detection rate of PFO. The detection of right-to-left shunt and its origin mainly relies on cTTE. Most of the PFO-related right-to-left shunt in PFO-related diseases are medium-large. More than half of patients with PFO-related diseases have a pulmonary circulation-related right-to-left shunt, which highlights the importance of differential diagnosis between the two forms of shunt.

表1 cTTE对PFO相关疾病患者右向左分流起源及分流量的诊断分析结果[例(%)]
图1 经胸右心声学造影评估卵圆孔未闭右向左分流不同分流量图像。图a示左心房内无微泡(无右向左分流);图b示左心房内少量微泡显影;图c示左心房内中量微泡显影;图d示左心房内大量微泡显影
图2 经食管超声心动图诊断卵圆孔未闭图像。图a示原发隔与继发隔之间的缝隙(箭头所示);图b~d示原发隔与继发隔间局部微量左向右分流(箭头所示),其中图b、c为非标准食道中段双房上、下腔静脉切面,图d为食管中段主动脉瓣短轴切面
1
Ham H, Virmani R, Ladieh E, et a1. Patent foramen ovale: current pathology, pathophysiology, and clinical status [J]. J Am Coil Cardiol, 2005, 46(9): 1768-1776.
2
Mckenzie JA, Edwards W, Hagler DJ. Anatomy of the patent foramen ovale for the interventionalist [J]. Catheter Cardiovase Interv, 2009, 73(6): 821-826.
3
Hoffman JIE, Kaplan S. The incidence of congenital heart disease [J]. J Am Coll Cardiol, 2002, 39(12): 1890-1900.
4
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts [J]. Mayo Clin Proc, 1984(1), 59: 17-20.
5
Cohnheim J. Thrombose und Embolie. In: Vorlesungenüber Allgemeine pathologie [J]. Berlin: Hirschwald, 1877, 1: 134.
6
Brogno D, Lancaster G, Rosenbaum M. Embolus Interuptus [J]. N Engl J Med, 1994, 330(24): 1761-1762.
7
Nellessen U, Daniel WG, Matheis G, et al. Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery [J]. J Am Coll Cardiol, 1985, 5(4): 1002-1004.
8
Khessali H, Mojadidi MK, Gevorgyan R, et al. The effect of patent foramen ovale closure on visual aura without headache or typical aura with migraine headache [J]. JACC Cardiovasc Interv, 2012, 5(6): 682-687.
9
Mojadidi MK, Mahmoud AN, Patel NK, et al. Cryptogenic Stroke and Patent Foramen Ovale: Ready for Prime Time? [J]. J Am Coll Cardiol, 2018, 72(10): 1183-1185.
10
Lafère P, Balestra C, Caers D, et al. Patent foramen ovale (PFO), personality traits, and iterative decompression sickness. Retrospective analysis of 209 cases [J]. Front Psychol, 2017, 8: 1328
11
李越,翟亚楠,魏丽群, 等. 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 [J/CD]. 中华医学超声杂志(电子版), 2014, 10(11): 44-48.
12
Mojadidi MK, Ruiz JC, Chertoff J, et al. Patent Foramen Ovale and Hypoxemia [J]. Cardiol Rev, 2019, 27(1): 34-40.
13
Sharma A, Gheewala N, Silver P. Role of patent foramen ovale in migraine etiology and treatment: a review [J]. Echocardiography, 2011, 28(8): 913-917.
14
Zeller JA, Frahm K, Baron R, et al. Platelet-leukocyte interaction and platelet activation in migraine: a link to ischemic stroke? [J]. J Neurol Neurosurg Psychiatry, 2004, 75(7): 984-987.
15
陈步星,付强,王春雪. 卵圆孔未闭是否需要及时关闭? [J]. 中华心血管病杂志, 2018, 46(11): 846-848.
16
Martín M, Secades S, Campos AG, et al. Patent foramen ovale and stroke: rethinking the need for systematic transesophageal echocardiography [J]. Minerva Med, 2012, 103(5): 413-414.
17
Nakayama R, Takaya Y, Akagi T, et al. Identification of high-risk patent foramen ovale associated with cryptogenic stroke: development of a scoring system [J]. J Am Soc Echocardiogr, 2019, 32(7): 811-816.
18
Silvestry FE, Cohen MS, Armsby LB, et al. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions [J]. J Am Soc Echocardiogr, 2015, 28(8): 910-958.
19
Strachinaru M, Castro-Rodriguez J, Verbeet T, et al. The left atrial septal pouch as a risk factor for stroke: A systematic review [J]. Arch Cardiovasc Dis, 2017, 110(4): 250-258.
20
Hołda MK, Koziej M. Left-Sided Atrial Septal Pouch as a Risk Factor of Cryptogenic Stroke: A Systematic Review and Meta-Analysis [J]. Cerebrovasc Dis, 2018, 46(5-6): 223-229.
21
Wolf RC, Spiess J, Vasic N, et al. Valvular strands and ischemic stroke [J]. Eur Neurol, 2007, 57(4): 227-231.
22
Rhee HY, Choi HY, Kim SB, et al. Acute Ischemic Stroke in a Patient with a Native Valvular Strand [J]. Case Rep Neurol, 2010, 2(2): 91-95.
23
翟亚楠,李越,魏丽群. 先兆性偏头痛患者二尖瓣及主动脉瓣纤维性丝状物的发生情况[J]. 中国医学科学院学报, 2015, 37(2): 147-151.
24
李越,刘若卓,翟亚楠. 健康志愿者右心声学造影结果的初步分析 [J/CD]. 中华医学超声杂志(电子版), 2014, 11(2): 135-141.
25
Lovering AT, Stickland MK, Kelso AJ, et al. Direct demonstration of 25- and 50-microm arteriovenous pathways in healthy human and baboon lungs [J]. Am J Physiol Heart Circ Physiol, 2007, 292(4): H1777-H1781.
26
Sinha RS, Hussain Z, Bhatia N, et al. Risk of Recurrent Neurologic Stroke or Transient Ischemic Attack in Patients with Cryptogenic Stroke and Intrapulmonary Shunt [J]. Echocardiography, 2016, 33(2): 276-280.
27
Chessa M, Drago M, Krantunkov P, et al. Differential diagnosis between patent foramen ovale andpulmonaryarteriovenous fistula in two patients with previouscryptogenicstrokecaused by presumed paradoxical embolism [J]. J Am Soc Echocardiogr, 2002, 15(8): 845-846.
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