Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
The Labatt Family Heart Centre, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
JACC Cardiovasc Interv. 2018 Jun 11;11(11):1095-1104. doi: 10.1016/j.jcin.2018.03.008.
The aim of this study was to assess the incidence of persistently positive results on agitated saline contrast injection after patent foramen ovale (PFO) closure, the underlying mechanism, and management.
Transcatheter intervention to close a PFO is reasonable in highly selected patients younger than 60 years, after a thorough cardioneurological investigation following a cryptogenic stroke, particularly in the presence of thromboembolic disease or in patients at high risk for venous thrombosis. The U.S. Food and Drug Administration approved the Amplatzer PFO Occluder in October 2016 for such an indication. Confirmation of PFO closure is usually verified by an agitated saline contrast injection during an echocardiographic examination. The appearance of bubbles in the left atrium raises the concern of incomplete closure or other sources of shunting.
The medical records and echocardiograms of patients who were treated with transcatheter closure of a PFO for cryptogenic stroke were reviewed.
From January 1998 through December 2015, 880 patients were taken to the catheter laboratory for PFO closure, of whom 568 patients, 320 men (56.3%), underwent transcatheter closure of a PFO using an Amplatzer PFO Occluder, at a mean age of 48.1 ± 12.9 years. The incidence of right-to-left shunting (RLS) was 19.5% at a mean of 4 months' follow-up, which reduced to 8.4% at 11 ± 2 months. Sources of RLS were identified in 10 (1.8%); pulmonary arteriovenous malformation (n = 4) was the most common etiology, followed by leak through the device (n = 3). All patients with additional sources of RLS were treated percutaneously. At 2-year follow-up, 16 patients (2.8%) persisted with only mildly positive results on agitated saline contrast injection, without an apparent additional source of shunting.
Coexistence of a PFO and an additional lesion responsible for RLS is uncommon, but not rare; the majority are amenable to transcatheter or surgical intervention.
本研究旨在评估卵圆孔未闭（PFO）封堵术后持续出现盐水激发试验阳性的发生率、潜在机制和处理方法。
对于经过详细心脑疾病调查后确诊的隐源性卒中且年龄小于 60 岁的高度选择性患者，经导管 PFO 封堵术是合理的治疗选择，尤其是存在血栓栓塞性疾病或静脉血栓形成高危因素的患者。美国食品和药物管理局于 2016 年 10 月批准 Amplatzer PFO 封堵器用于此类适应证。通常通过超声心动图检查中的盐水激发试验来确认 PFO 封堵是否成功。左心房出现气泡提示封堵不完全或存在其他分流源。
回顾接受经导管 PFO 封堵术治疗隐源性卒中的患者的病历和超声心动图记录。
1998 年 1 月至 2015 年 12 月，880 例患者因 PFO 接受导管室治疗，其中 568 例（320 例男性，占 56.3%）接受 Amplatzer PFO 封堵器经导管 PFO 封堵术，平均年龄为 48.1 ± 12.9 岁。封堵术后 4 个月平均右向左分流（RLS）发生率为 19.5%，11 ± 2 个月时降至 8.4%。10 例（1.8%）患者确定存在 RLS 分流源，其中肺动静脉畸形（n=4）最常见，其次是封堵器漏（n=3）。所有存在其他分流源的患者均接受了经皮治疗。2 年随访时，16 例（2.8%）患者仅在盐水激发试验中出现轻微阳性结果，无明显其他分流源。
PFO 与导致 RLS 的其他病变共存并不罕见，但也不常见；大多数患者可通过经导管或手术干预进行治疗。
