经皮装置植入封堵卵圆孔未闭对瓣膜关闭不全的影响。
Impact of percutaneous device implantation for closure of patent foramen ovale on valve insufficiencies.
作者信息
Wöhrle Jochen, Kochs Matthias, Spiess Jochen, Nusser Thorsten, Hombach Vinzenz, Merkle Nico
机构信息
Department of Internal Medicine II-Cardiology, University of Ulm, Albert-Einstein-Allee 23, Ulm 89081, Germany.
出版信息
Circulation. 2009 Jun 16;119(23):3002-8. doi: 10.1161/CIRCULATIONAHA.109.851014. Epub 2009 Jun 1.
BACKGROUND
In patients with percutaneous device implantation for closure of patent foramen ovale (PFO), a 10% incidence of new or worsened aortic regurgitation within 12 months has been reported with echocardiography. Cardiac magnetic resonance imaging is a powerful noninvasive tool to quantify volume and fraction of valve insufficiencies. We studied the acute and long-term impact of percutaneous device implantation for PFO closure on valve insufficiencies in cardiac magnetic resonance imaging.
METHODS AND RESULTS
Sequential cardiac magnetic resonance imaging studies were performed in 102 patients with cryptogenic ischemic events. Cardiac magnetic resonance imaging was performed before PFO closure, the day after device implantation, and at 12 months of follow-up. There was no difference in volumetric and hemodynamic parameters before PFO closure compared with 12 months of follow-up. With a cutoff for relevant regurgitation fraction of 5%, there were no statistically significant differences in regurgitation fraction of the semilunar and atrioventricular valves. The median fraction of aortic valve insufficiency was 3.9% (interquartile range [IQR] 2.0% to 5.1%) before PFO closure, 5.4% (IQR 4.1% to 5.9%) after device implantation, and 4.3% (IQR 3.3% to 6.0%) at 12 months of follow-up. The size and type of the occluder had no impact on aortic valve insufficiency. Median regurgitation fraction for the pulmonary valve was 3.6% (IQR 2.4% to 6.7%) before intervention, 7.3% (IQR 5.1% to 8.2%) after occluder implantation and 5.8% (IQR 4.8% to 7.4%) at 12 months of follow-up. Values for the mitral valve were 3.1% (IQR 1.4% to 6.0%), 5.5% (IQR 3.5% to 7.3%), and 3.8% (IQR 1.5% to 7.9%) and for the tricuspid valve were 5.4% (IQR 0.1% to 8.8%), 5.8% (IQR 1.4% to 9.2%), and 6.0% (IQR 1.1% to 8.4%), respectively.
CONCLUSIONS
Percutaneous PFO closure with device implantation has no impact on valve insufficiencies as determined by cardiac magnetic resonance imaging.
背景
据超声心动图报告，在经皮植入装置关闭卵圆孔未闭（PFO）的患者中，12个月内新发或加重主动脉瓣反流的发生率为10%。心脏磁共振成像（CMR）是一种强大的无创工具，可用于量化瓣膜反流的容积和分数。我们研究了经皮植入装置关闭PFO对CMR中瓣膜反流的急性和长期影响。
方法和结果
对102例不明原因缺血性事件患者进行了连续的CMR研究。在PFO关闭前、装置植入后第1天和随访12个月时进行CMR检查。与随访12个月时相比，PFO关闭前的容积和血流动力学参数无差异。以5%的相关反流分数为临界值，半月瓣和房室瓣的反流分数无统计学显著差异。PFO关闭前主动脉瓣反流的中位数分数为3.9%（四分位间距[IQR]2.0%至5.1%），装置植入后为5.4%（IQR 4.1%至5.9%），随访12个月时为4.3%（IQR 3.3%至6.0%）。封堵器的大小和类型对主动脉瓣反流无影响。干预前肺动脉瓣反流的中位数分数为3.6%（IQR 2.4%至6.7%），封堵器植入后为7.3%（IQR 5.1%至8.2%），随访12个月时为5.8%（IQR 4.8%至7.4%）。二尖瓣的值分别为3.1%（IQR 1.4%至6.0%）、5.5%（IQR 3.5%至7.3%）和3.8%（IQR 1.5%至7.9%），三尖瓣的值分别为5.4%（IQR 0.1%至8.8%）、5.8%（IQR 1.4%至9.2%）和6.0%（IQR 1.1%至8.4%）。
结论
经皮植入装置关闭PFO对CMR所确定的瓣膜反流无影响。
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