卵圆孔未闭后经导管残余右至左分流闭合的成功经验。

Lu He, Xiao-Qin Liu, Xing-Ye Wang, Ya-Juan Du, Yu-Shun Zhang
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引用次数: 0

摘要

背景:卵圆孔未闭(PFO)闭塞后残留分流与卒中复发有关,文献有限,涉及此类病例的具体处理。在此,我们报告二次介入治疗的经验。方法:从2020年7月到2023年1月,经胸超声心动图(cTTE)造影筛查的PFO闭塞1年以上并残留右至左分流(rRLS)的患者构成研究人群。对基础、程序和随访资料进行回顾性分析。结果:本中心共收治35例大rRLS患者。14例患者行经导管rRLS闭合术。经食管超声心动图(TEE)清晰显示彩色血流谱,其中12例显示rRLS较大。TEE显示rRLS左侧出口附近有一个小出口,cTEE两例显示rRLS小出口。I型rRLS占71.4%,残余PFO和残余房间隔缺损(ASD)分别占14.3%。经导管二次介入治疗成功12例(85.7%)。无并发症发生。6例I型rRLS用ASD闭塞器封闭,2例用ADO-II装置封闭。2例残余PFO和2例残余ASD植入PFO闭塞器。术后6个月行cTTE, 12例患者完全闭合。结论:TEE不仅有助于改善介入策略,减少原发性闭塞的残留分流,而且有助于筛选真正适合进行二次干预的患者。ASD闭塞器可作为I型rRLS的替代设备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Successful experience of transcatheter residual right-to-left shunting closure after patent foramen ovale occlusion.

Background: Residual shunt after patent foramen ovale (PFO) occlusion is associated with recurrent stroke, and limited literature address the specific management of such cases. Herein we report our experience with secondary interventional treatment.

Methods: From July 2020 to January 2023, patients who underwent PFO occlusion for more than one year with residual right-to-left shunting (rRLS) screened by contrast transthoracic echocardiography (cTTE) constituted the study population. A retrospective analysis of the basic, procedural, and follow-up data was performed.

Results: A total of 35 patients with large rRLS were admitted to our center. Fourteen patients underwent transcatheter rRLS closure. Transesophageal echocardiography (TEE) clearly showed the color blood flow profile, and cTEE showed a large rRLS in 12 cases. TEE showed a small outlet near the left exit of the rRLS, and cTEE showed a small rRLS in two cases. Type I rRLS accounted for 71.4%, residual PFO, and residual atrial septal defect (ASD) for 14.3%, respectively. Secondary transcatheter interventions were successful in 12 patients (85.7%). No complications were observed. Six cases of type I rRLS were closed with ASD occluders and two with an ADO-II device. Two residual PFO and two residual ASD were implanted with PFO occluders. cTTE was performed six months after the procedure, with complete closure in 12 patients.

Conclusion: TEE not only helps to improve interventional strategies to reduce residual shunt in primary occlusion but also helps in the screening of patients who are truly suitable for secondary intervention. ASD occluders can be considered as an alternative device for type I rRLS.

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