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存在大型欧氏瓣时卵圆孔未闭的诊断难题

Challenging Diagnosis of Patent Foramen Ovale in Presence of a Large Eustachian Valve.

作者信息

Boukhris Marouane, Masson Jean-Bernard, Potvin Jeannot

机构信息

Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada.

出版信息

J Saudi Heart Assoc. 2021 Feb 3;33(2):135-137. doi: 10.37616/2212-5043.1249. eCollection 2021.

DOI:10.37616/2212-5043.1249
PMID:34183910
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8143726/
Abstract

We report the case of a 39-year-old woman who presented with cryptogenic stroke. Conventional and contrast echocardiography modalities noticed a large Eustachian valve (EV) but failed to identify any right-to-left shunt. Conversely, contrast-transcranial Doppler revealed a grade 3 right-to-left shunt. Contrast echocardiography was repeated with bubble injections through both an upper extremity and a femoral vein, 10 min apart from each other. While no shunt was observed following upper extremity injection, >20 bubbles crossed the inter-atrial septum when contrast was injected via femoral vein confirming the diagnosis of patent foramen ovale.

摘要

我们报告了一例39岁患有隐源性卒中的女性病例。常规及经对比剂增强的超声心动图检查发现一个大的欧氏瓣（EV），但未发现任何右向左分流。相反，经颅多普勒对比剂增强检查显示有3级右向左分流。通过上肢和股静脉分别间隔10分钟注射微泡，重复进行经对比剂增强的超声心动图检查。上肢注射后未观察到分流，但经股静脉注射对比剂时，有超过20个微泡穿过房间隔，从而确诊为卵圆孔未闭。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/f0837f5a2fff/sha-33-135f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/846c0a8d0568/sha-33-135f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/f3a4752a967f/sha-33-135f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/06fd071d5c5c/sha-33-135f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/e0416708e0bb/sha-33-135f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/5160d0a5cdb4/sha-33-135f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/f0837f5a2fff/sha-33-135f6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/846c0a8d0568/sha-33-135f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/f3a4752a967f/sha-33-135f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/06fd071d5c5c/sha-33-135f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/e0416708e0bb/sha-33-135f4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/5160d0a5cdb4/sha-33-135f5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8467/8143726/f0837f5a2fff/sha-33-135f6.jpg

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引用本文的文献

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本文引用的文献

1
Patent foramen ovale and stroke.卵圆孔未闭与中风。
J Neurol. 2018 Aug;265(8):1943-1949. doi: 10.1007/s00415-018-8865-0. Epub 2018 Apr 21.
2
Sensitivity of transcranial Doppler versus intracardiac echocardiography in the detection of right-to-left shunt.经颅多普勒超声与心内超声心动图检测右向左分流的敏感性比较。
JACC Cardiovasc Imaging. 2010 Apr;3(4):343-8. doi: 10.1016/j.jcmg.2009.12.012.
3
A large Eustachian valve is a confounder of contrast but not of color Doppler transesophageal echocardiography in detecting a right-to-left shunt across a patent foramen ovale.
在经食管超声心动图检测卵圆孔未闭导致的右向左分流时，大的欧氏瓣是造影剂成像的干扰因素，但不是彩色多普勒成像的干扰因素。
Int J Cardiol. 2006 May 24;109(3):375-80. doi: 10.1016/j.ijcard.2005.06.022. Epub 2005 Jul 14.
4
Persisting eustachian valve in adults: relation to patent foramen ovale and cerebrovascular events.成人持续存在的欧氏瓣：与卵圆孔未闭及脑血管事件的关系
J Am Soc Echocardiogr. 2004 Mar;17(3):231-3. doi: 10.1016/j.echo.2003.12.003.