Oto Ali, Aytemir Kudret, Ozkutlu Süheyla, Kaya Ergün Barış, Yorgun Hikmet, Canpolat Uğur, Ateş Ahmet Hakan, Ozkutlu Hilmi
Department of Cardiology, Hacettepe University, Ankara, Turkey.
Echocardiography. 2011 Nov;28(10):1074-80. doi: 10.1111/j.1540-8175.2011.01524.x. Epub 2011 Oct 4.
Percutaneous closure of patent foramen ovale (PFO) has been increasingly performed for several indications; mostly due to cryptogenic stroke. In this study we aimed to evaluate the safety and efficacy of transthoracic echocardiographic (TTE) guidance during percutaneous closure of PFO in using the Amplatzer and Occlutech Figulla PFO occluder devices.
Between October 2005 and March 2011, 139 patients (74 male, mean age: 40.4 ± 10.3) underwent transcatheter PFO closure. In all patients transesophageal echocardiography performed subsequently to diagnose, assess the size and evaluate for suitability of the defect for percutaneous closure. During the procedure fluoroscopy and TTE were used for guidance.
Among 139 patients, Amplatzer PFO occluder was used in 74 patients and in 65 of them Occlutech Figulla device was selected for occlusion. The indications for PFO closure were ischemic stroke in 98 (70.5%), recurrent transient ischemic attacks (TIA) in 40 (28.7%), peripheral embolism in 1 (0.8%) of the patients. In all patients, percutaneous intervention was performed successfully under TTE guidance. There have been no neurologic (recurrent strokes or TIAs) and cardiovascular complications during the immediate and long-term follow-up period (2-67 months, median 29). There was significant difference between the mean fluoroscopic time from the beginning which is 8.6 ± 3.4 min in the former versus 3.4 ± 1.9 min in the latter (P < 0.05).
Our study confirms the efficacy and safety of TTE guidance during percutaneous closure of PFO, which shortens the procedural time and obviates the need for general anesthesia or endotracheal intubation.
经皮闭合卵圆孔未闭（PFO）因多种适应证应用越来越多，主要是由于不明原因的卒中。在本研究中，我们旨在评估在使用Amplatzer和Occlutech Figulla PFO封堵器经皮闭合PFO过程中经胸超声心动图（TTE）引导的安全性和有效性。
2005年10月至2011年3月，139例患者（74例男性，平均年龄：40.4±10.3岁）接受了经导管PFO闭合术。所有患者随后均行食管超声心动图检查以诊断、评估缺损大小并评估经皮闭合的适用性。术中采用荧光透视和TTE引导。
139例患者中，74例使用了Amplatzer PFO封堵器，其中65例选择使用Occlutech Figulla装置进行封堵。PFO闭合的适应证为98例（70.5%）缺血性卒中、40例（28.7%）复发性短暂性脑缺血发作（TIA）、1例（0.8%）患者外周栓塞。所有患者在TTE引导下均成功进行了经皮干预。在近期和长期随访期（2 - 67个月，中位数29个月）内未出现神经学并发症（复发性卒中或TIA）及心血管并发症。前者从开始起的平均透视时间为8.6±3.4分钟，后者为3.4±1.9分钟，差异有统计学意义（P < 0.05）。
我们的研究证实了TTE引导在经皮闭合PFO过程中的有效性和安全性，其缩短了手术时间，无需全身麻醉或气管插管。
