Seo Won-Woo, Kim Sung Eun, Park Myung-Soo, Lee Jun-Hee, Park Dae-Gyun, Han Kyoo-Rok, Oh Dong-Jin
Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Korean Circ J. 2017 Sep;47(5):776-785. doi: 10.4070/kcj.2016.0295. Epub 2017 Sep 11.
Trapped thrombus in patent foramen ovale (PFO) is a rare complication of pulmonary embolism that may lead to tragic clinical events. The aim of this study was to identify the optimal treatment for different clinical situations in patients with trapped thrombus in a PFO by conducting a literature review.
A PubMed database search was conducted from 1991 through 2015, and 194 patients (185 articles) with trapped thrombus in a PFO were identified. Patient characteristics, paradoxical embolic events, and factors affecting 60-day mortality were analyzed retrospectively.
Among all patients, 112 (57.7%) were treated with surgery, 28 with thrombolysis, and 54 with anticoagulation alone. Dyspnea (79.4%), chest pain (33.0%), and syncope (17.5%) were the most common presenting symptoms. Pretreatment embolism was found in 37.6% of cases, and stroke (24.7%) was the most common event. Surgery was associated with fewer post-treatment embolic events than were other treatment options (p=0.044). In the multivariate analysis, initial shock or arrest, and thrombolysis were independent predictors of 60-day mortality. Thrombolysis was related with higher 60-day mortality compared with surgery in patients who had no initial shock or arrest.
This systematic review showed that surgery was associated with a lower overall incidence of post-treatment embolic events and a lower 60-day mortality in patients with trapped thrombus in a PFO. In patients without initial shock or arrest, thrombolysis was related with a higher 60-day mortality compared with surgery.
卵圆孔未闭（PFO）合并被困血栓是肺栓塞的一种罕见并发症，可能导致严重的临床事件。本研究旨在通过文献综述确定PFO合并被困血栓患者不同临床情况下的最佳治疗方法。
检索1991年至2015年的PubMed数据库，共纳入194例（185篇文章）PFO合并被困血栓的患者。回顾性分析患者特征、反常栓塞事件及影响60天死亡率的因素。
所有患者中，112例（57.7%）接受手术治疗，28例接受溶栓治疗，54例仅接受抗凝治疗。最常见的症状为呼吸困难（79.4%）、胸痛（33.0%）和晕厥（17.5%）。37.6%的病例存在治疗前栓塞，最常见的事件为卒中（24.7%）。与其他治疗方法相比，手术治疗后栓塞事件较少（p=0.044）。多因素分析显示，初始休克或心脏骤停及溶栓是60天死亡率的独立预测因素。在无初始休克或心脏骤停的患者中，与手术相比，溶栓治疗的60天死亡率更高。
本系统评价表明，对于PFO合并被困血栓的患者，手术治疗后栓塞事件的总体发生率较低，60天死亡率也较低。在无初始休克或心脏骤停的患者中，与手术相比，溶栓治疗的60天死亡率更高。
