Martín Francisco, Sánchez Pedro L, Doherty Elizabeth, Colon-Hernandez Pedro J, Delgado Gabriel, Inglessis Ignacio, Scott Nandita, Hung Judy, King Mary Etta E, Buonanno Ferdinando, Demirjian Zareh, de Moor Michael, Palacios Igor F
Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Circulation. 2002 Aug 27;106(9):1121-6. doi: 10.1161/01.cir.0000027819.19722.ee.
Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO.
We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47+/-14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively.
Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.
经皮导管封堵卵圆孔未闭（PFO）可作为手术或长期抗凝治疗的替代方法，用于治疗反常栓塞合并PFO的患者。
我们报告了1995年至2001年间因反常栓塞接受经导管封堵PFO的110例连续患者（58例男性，平均年龄47±14岁）的即刻和长期临床及超声心动图结果。所有（100%）患者均获得手术成功，即装置成功植入且封堵有效（装置置入后无分流或仅有微量分流）。无住院死亡病例，1例装置移位需手术干预（0.9%），1例心包填塞需心包穿刺（0.9%）。观察到完全封堵率逐渐上升（装置置入后1天、6个月、1年和2年时分别为44%、51%、66%和71%）。平均随访2.3年时，2例患者发生复发性神经事件（1例致命性卒中，1例短暂性脑缺血发作），年复发风险为0.9%。此外，4例（3.6%）患者因装置位置不当或大量分流需要再次干预。Kaplan-Meier分析显示，1年和5年时无复发性栓塞事件和再次干预的生存率分别为96%和90%。
经导管封堵PFO对反常栓塞合并PFO的患者是一种安全有效的治疗方法。其成功率高，医院并发症发生率低，全身性复发性栓塞事件发生率低。
