Zhang Han, Liu Weiwei, Ma Jie, Liu Huanling, Li Lin, Zhou Jinling, Wang Shanshan, Li Shanshan, Wang Wei, Wang Yueheng
Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
Department of Vascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
Diagnostics (Basel). 2022 Sep 21;12(10):2283. doi: 10.3390/diagnostics12102283.
When patent foramen ovale (PFO) combines with the prominent Eustachian valve or Chiari network (EV/CN), contrast transthoracic echocardiography (cTTE) may miss the diagnosis of PFO. We sought to determine the characteristics of right-to-left shunt (RLS) in PFO patients with prominent EV/CN on cTTE and identify the causal factors of missed diagnosis. We consecutively enrolled 98 patients who suffered from PFO-related stroke and with prominent EV/CN. All patients were divided into the delayed and non-delayed groups according to the characteristics of RLS on cTTE. The characteristics of RLS were compared with those of 42 intrapulmonary shunt patients. The anatomical characteristics of PFO and EV/CN were analyzed in the 98 PFO patients. Upon cTTE, significantly delayed occurrence and longer duration of the RLS in the delayed group were found both at rest and during the Valsalva maneuver, similar to the intrapulmonary shunt. Multivariate logistic analysis revealed that the length of EV/CN (>19 mm) and the diameter of PFO at the left atrium aspect (<1.2 mm) were high-risk factors for missed diagnosis. In conclusion, RLS showed delayed emergence and disappearance in some of the PFO patients with prominent EV/CN. The length of EV/CN and the diameter of PFO may have been related to the missed diagnosis of PFO.
当卵圆孔未闭（PFO）合并显著的欧氏瓣或希阿里网（EV/CN）时，经胸超声心动图造影（cTTE）可能会漏诊PFO。我们试图确定cTTE检查时合并显著EV/CN的PFO患者中右向左分流（RLS）的特征，并找出漏诊的相关因素。我们连续纳入了98例患有PFO相关卒中且合并显著EV/CN的患者。根据cTTE上RLS的特征将所有患者分为延迟组和非延迟组。将RLS的特征与42例肺内分流患者的特征进行比较。对98例PFO患者的PFO和EV/CN的解剖特征进行分析。在cTTE检查中，延迟组在静息和Valsalva动作时RLS出现明显延迟且持续时间更长，这与肺内分流相似。多因素逻辑回归分析显示，EV/CN长度（>19 mm）和左心房侧PFO直径（<1.2 mm）是漏诊的高危因素。总之，在一些合并显著EV/CN的PFO患者中，RLS出现和消失延迟。EV/CN长度和PFO直径可能与PFO漏诊有关。
