Wahl Andreas, Praz Fabien, Stinimann Jessica, Windecker Stephan, Seiler Christian, Nedeltchev Krassen, Mattle Heinrich P, Meier Bernhard
Cardiology, University Hospital Bern, Switzerland.
Swiss Med Wkly. 2008 Oct 4;138(39-40):567-72. doi: 10.4414/smw.2008.12255.
Percutaneous closure of patent foramen ovale (PFO) is generally performed using intra-procedural guidance by transoesophageal (TEE) or intracardiac (ICE) echocardiography. While TEE requires sedation or general anaesthesia, ICE is costly and adds incremental risk, and both imaging modalities lengthen the procedure.
A total of 825 consecutive patients (age 51 +/- 13 years; 58% male) underwent percutaneous PFO closure solely under fluoroscopic guidance, without intra-procedural echocardiography. The indications for PFO closure were presumed paradoxical embolism in 698 patients (95% cerebral, 5% other locations), an embolic event with concurrent aetiologies in 47, diving in 51, migraine headaches in 13, and other reasons in 16. An atrial septal aneurysm was associated with the PFO in 242 patients (29%).
Permanent device implantation failed in two patients (0.2%). There were 18 procedural complications (2.2%), including embolization of the device or parts of it in five patients with successful percutaneous removal in all cases, air embolism with transient symptoms in four patients, pericardial tamponade requiring pericardiocentesis in one patient, a transient ischaemic attack with visual symptoms in one patient, and vascular access site problems in seven patients. There were no long-term sequelae. Contrast TEE at six months showed complete abolition of right-to-left shunt via PFO in 88% of patients, whereas a minimal, moderate or large residual shunt persisted in 7%, 3%, and 2%, respectively.
This study confirms the safety and feasibility of percutaneous PFO closure without intra-procedural echocardiographic guidance in a large cohort of consecutive patients.
经皮卵圆孔未闭（PFO）封堵术通常在术中通过经食管（TEE）或心内（ICE）超声心动图引导进行。虽然TEE需要镇静或全身麻醉，ICE成本高且会增加额外风险，并且这两种成像方式都会延长手术时间。
共有825例连续患者（年龄51±13岁；58%为男性）仅在荧光透视引导下接受经皮PFO封堵术，术中未使用超声心动图。PFO封堵的适应证为：698例患者（95%为脑部，5%为其他部位）疑似反常栓塞，47例患者为合并病因的栓塞事件，51例患者为潜水相关，13例患者为偏头痛，16例患者为其他原因。242例患者（29%）的PFO与房间隔瘤相关。
2例患者（0.2%）永久性装置植入失败。有18例手术并发症（2.2%），包括5例装置或其部分栓塞，所有病例均成功经皮取出；4例患者出现有短暂症状的空气栓塞；1例患者发生心包填塞，需要进行心包穿刺；1例患者出现伴有视觉症状的短暂性脑缺血发作；7例患者出现血管穿刺部位问题。无长期后遗症。6个月时的对比TEE显示，88%的患者经PFO的右向左分流完全消失，而分别有7%、3%和2%的患者存在最小、中度或大量残余分流。
本研究证实了在一大组连续患者中，在无术中超声心动图引导的情况下进行经皮PFO封堵术的安全性和可行性。
