Yang Jie, Lei Wen-Rui, Wang Jun-Wei, Xiao Ze-Zhou, Sun Chun-Ping, Lin Xue-Feng, Zheng Shao-Yi, Zhu Peng
Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Cardiovasc Diagn Ther. 2023 Aug 31;13(4):728-735. doi: 10.21037/cdt-22-513. Epub 2023 Jun 27.
Percutaneous closure of the patent foramen ovale (PFO) is primarily guided by fluoroscopy in the catheter room, during which procedure both the guidewire and sheath need to pass through the PFO. We performed PFO closure using a transesophageal echocardiography (TEE)-guided approach and only the sheath was passed through the PFO during the procedure. This study aimed to evaluate the feasibility and safety of PFO closure using this technique.
A retrospective observational study was performed. A total of 117 consecutive adult patients underwent percutaneous PFO closure without fluoroscopy, under the sole guidance of TEE in our hospital between December 2018 and December 2021. The data of each patient consisted of preoperative, operative, and postoperative variables collected. The primary outcome is that the occluder was successfully released. The secondary outcomes included perioperative and follow-up transthoracic echocardiography (TTE), Headache impact test-6 (HIT-6) score and clinical symptoms.
Transvenous PFO closure under TEE guidance was successful in all cases. The sample consisted of 93 females and 24 males with an average age of 42.3±7.8 years. There were 28 patients with preoperative cerebral infarction [Risk of Paradoxical Embolism (RoPE) score >6 points] and 89 patients with migraine. All patients underwent a preoperative TEE to confirm the presence of PFO, and contrast-enhanced transcranial Doppler (c-TCD) acoustic contrast suggested grades 3 to 4. The average time of surgery for patients (puncture to removal of the sheath) was 32 minutes. Three cases of vagus nerve reflex manifestations during surgery and two cases of transient ventricular arrhythmia all improved after symptomatic treatment. There were no instances of metal allergy, hemolysis, or other acute vascular procedural complications. For all 89 patients with migraine, significant relief or resolution was achieved during the first six-month follow-up (P<0.001).
As a monotherapy, percutaneous closure of PFO guided by TEE where only the sheath passes through the PFO during the operation is an effective procedure with a high success rate and a low complication rate.
卵圆孔未闭（PFO）的经皮封堵主要在导管室中由荧光透视引导，在此过程中，导丝和鞘管都需要穿过PFO。我们采用经食管超声心动图（TEE）引导的方法进行PFO封堵，术中仅鞘管穿过PFO。本研究旨在评估使用该技术进行PFO封堵的可行性和安全性。
进行一项回顾性观察研究。2018年12月至2021年12月期间，我院共有117例连续成年患者在TEE的单独引导下，未使用荧光透视进行经皮PFO封堵。收集每位患者术前、术中及术后的变量数据。主要结局是封堵器成功释放。次要结局包括围手术期和随访期间的经胸超声心动图（TTE）、头痛影响测试-6（HIT-6）评分及临床症状。
所有病例在TEE引导下经静脉PFO封堵均成功。样本包括93名女性和24名男性，平均年龄为42.3±7.8岁。有28例术前脑梗死患者[反常栓塞风险（RoPE）评分>6分]和89例偏头痛患者。所有患者均接受术前TEE以确认PFO的存在，对比增强经颅多普勒（c-TCD）声学造影提示为3至4级。患者的平均手术时间（穿刺至拔除鞘管）为32分钟。3例手术期间出现迷走神经反射表现，2例出现短暂性室性心律失常，经对症治疗后均有所改善。未发生金属过敏、溶血或其他急性血管手术并发症。在最初的六个月随访期间，所有89例偏头痛患者的症状均得到显著缓解或消失（P<0.001）。
作为一种单一疗法，在术中仅鞘管穿过PFO的情况下，由TEE引导的经皮PFO封堵是一种有效的手术方法，成功率高且并发症发生率低。
