Rigatelli Gianluca, Cardaioli Paolo, Dell'Avvocata Fabio, Giordan Massimo, Braggion Gabriele, Chinaglia Mauro, Roncon Loris
Cardiovascular Diagnosis and Interventions Unit, Rovigo General Hospital, Verona, Italy.
Cardiovasc Revasc Med. 2010 Jan-Mar;11(1):29-33. doi: 10.1016/j.carrev.2008.04.002.
Relationships between migraine improvement after transcatheter patent foramen ovale (PFO) closure and both specific interatrial septum anatomy and different devices design have not been investigated yet. We sought to assess effectiveness of transcatheter PFO closure in reducing or curing migraine with aura in patients with previous paradoxical embolism in relation with specific interatrial septum anatomy and different closure devices.
We prospectively enrolled 34 patients (22 female and 12 male, mean age 40 + or - 3.7 years) who were referred to our centre over a 12-month period for PFO transcatheter closure and migraine with aura and previous paradoxical embolism. All procedures were performed using mechanical intracardiac echocardiographic guidance. Patients were assigned to Amplatzer PFO or ASD Multifenestrated Occluder and Premere Occlusion System implantation dependently from intracardiac echocardiography anatomical findings, which included short-channel with moderate atrial septal aneurysm (ASA) in 6 patients (17.6 %), long-channel with moderate ASA in 3 patients (8.8%), short-channel with huge ASA in 5 patients (14.7%), multifenestrated ASA in 4 patients (11.7%), long-channel PFO without ASA in 10 patients (29.4%), and long-channel PFO with mild ASA in 6 patients (17.6%). Accordingly, 18 patients received an Amplatzer Occluder (9 PFO Occluder and 7 ASD Multifenestrated Occluder), and 16 received a Premere Occlusion System. After a mean follow-up of 9.0 + or - 2.8 months, all patients improved their migraine symptoms (mean Migraine Disability Assessment Score 30 + or - 1.5 at baseline versus 6.0 + or - 2.9 in the follow up, P<.03) independently from specific interatrial septum anatomy and different closure devices.
Although our study had several limitations, it suggests that independently from interatrial septum anatomy and device type, PFO closure in patients with migraine with aura resulted in a high rate of migraine improvement.
经导管闭合卵圆孔未闭（PFO）后偏头痛改善与特定房间隔解剖结构和不同装置设计之间的关系尚未得到研究。我们旨在评估经导管闭合PFO对既往有反常栓塞的偏头痛伴先兆患者偏头痛减轻或治愈的有效性，该评估与特定房间隔解剖结构和不同闭合装置相关。
我们前瞻性纳入了34例患者（22例女性和12例男性，平均年龄40±3.7岁），这些患者在12个月期间因PFO经导管闭合、偏头痛伴先兆和既往反常栓塞被转诊至我们中心。所有手术均在心脏内超声心动图引导下进行。根据心脏内超声心动图解剖结果，患者被分配接受Amplatzer PFO或ASD多孔封堵器以及Premere封堵系统植入，解剖结果包括6例患者（17.6%）为短通道伴中度房间隔瘤（ASA）、3例患者（8.8%）为长通道伴中度ASA、5例患者（14.7%）为短通道伴巨大ASA、4例患者（11.7%）为多孔ASA、10例患者（（29.4%）为无ASA的长通道PFO以及6例患者（17.6%）为伴轻度ASA的长通道PFO。相应地，18例患者接受了Amplatzer封堵器（9例PFO封堵器和7例ASD多孔封堵器），16例患者接受了Premere封堵系统。平均随访9.0±2.8个月后，所有患者的偏头痛症状均得到改善（基线时平均偏头痛残疾评估评分30±1.5，随访时为6.0±2.9，P<0.03），且与特定房间隔解剖结构和不同闭合装置无关。
尽管我们的研究有几个局限性，但它表明，与房间隔解剖结构和装置类型无关，偏头痛伴先兆患者的PFO闭合导致偏头痛改善率很高。
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