Bissessor Naylin, Wong Allison W, Hourigan Lisa A, Jayasinghe Rohan S, Scalia Greg S, Burstow Darryl J, Griffiths Lyn R, Savage Michael, Walters Darren L
The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia; Gold Coast Hospital, Queensland, Australia; Genomics Research Centre, Griffith Institute Medical Research, Griffith University, Southport, Queensland, Australia; University of California, Los Angeles, Los Angeles, CA, USA.
University of California, Los Angeles, Los Angeles, CA, USA.
Cardiovasc Revasc Med. 2011 May-Jun;12(3):164-169. doi: 10.1016/j.carrev.2010.06.001. Epub 2010 Oct 20.
Transcatheter closure of patent foramen ovale (PFO) has rapidly evolved as the preferred management strategy for the prevention of recurrent cerebrovascular events in patients with cryptogenic stroke and presumed paradoxical embolus. There is limited outcome data in patients treated with this therapy particularly for the newer devices.
Data from medical records, catheter, and echocardiography databases on 70 PFO procedures performed was collected prospectively.
The cohort consisted of 70 patients (mean age 43.6 years, range 19 to 77 years), of whom 51% were male. The indications for closure were cryptogenic cerebrovascular accident (CVA) or transient ischemic attack (TIA) in 64 (91%) and peripheral emboli in two (2.8%) patients and cryptogenic ST-elevation myocardial infarction in one (1.4%), refractory migraine in one (1.4%), decompression sickness in one (1.4%), and orthodeoxia in one (1.4%) patient, respectively. All patients had demonstrated right-to-left shunting on bubble study. The procedures were guided by intracardiac echocardiography in 53%, transesophageal echocardiography in 39%, and the remainder by transthoracic echo alone. Devices used were the Amplatzer PFO Occluder (AGA Medical) (sizes 18-35 mm) in 49 (70%) and the Premere device (St. Jude Medical) in 21 (30%). In-hospital complications consisted of one significant groin hematoma with skin infection. Echocardiographic follow-up at 6 months revealed that most patients had no or trivial residual shunt (98.6%), while one patient (1.4%) had a mild residual shunt. At a median of 11 months' follow-up (range 1 month to 4.3 years), no patients (0%) experienced further CVA/TIAs or paradoxical embolic events during follow-up.
PFO causing presumed paradoxical embolism can be closed percutaneously with a low rate of significant residual shunting and very few complications. Recurrent index events are uncommon at medium-term (up to 4 years) follow-up.
经导管闭合卵圆孔未闭（PFO）已迅速发展成为预防不明原因卒中且推测为反常栓塞患者复发性脑血管事件的首选治疗策略。关于这种治疗方法的疗效数据有限，尤其是对于较新的器械。
前瞻性收集了70例PFO手术的病历、导管及超声心动图数据库的数据。
该队列包括70例患者（平均年龄43.6岁，范围19至77岁），其中51%为男性。闭合的适应证分别为不明原因脑血管意外（CVA）或短暂性脑缺血发作（TIA）64例（91%）、外周栓塞2例（2.8%）、不明原因ST段抬高型心肌梗死1例（1.4%）、难治性偏头痛1例（1.4%）、减压病1例（1.4%）以及直立性低氧血症1例（1.4%）。所有患者在气泡试验中均显示有右向左分流。手术分别由心腔内超声心动图引导53%、经食管超声心动图引导39%，其余仅由经胸超声心动图引导。使用的器械为Amplatzer PFO封堵器（AGA Medical）（尺寸18 - 35 mm）49例（70%），Premere器械（圣犹达医疗公司）21例（30%）。院内并发症包括1例伴有皮肤感染的严重腹股沟血肿。6个月时的超声心动图随访显示，大多数患者无或仅有微量残余分流（98.6%），而1例患者（1.4%）有轻度残余分流。在中位随访11个月（范围1个月至4.3年）时，随访期间无患者（0%）发生进一步的CVA/TIA或反常栓塞事件。
导致推测为反常栓塞的PFO可经皮闭合，显著残余分流率低且并发症极少。在中期（长达4年）随访中，复发性指数事件并不常见。
