Luo Limin, Xie Zehan, Wu Qiaoyan, Liu Qiang, Hou Huiping, Wang Yongshi, Shu Xianhong
Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China.
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Cardiovasc Med. 2024 Jul 31;11:1428380. doi: 10.3389/fcvm.2024.1428380. eCollection 2024.
Percutaneous patent foramen ovale (PFO) closure is becoming more and more common for the treatment or prevention of PFO-associated right-to-left shunt (RLS). This study aims to investigate the value of transesophageal echocardiography (TEE) in percutaneous PFO closure, and to explore a new method that can improve intraoperative diagnosis and surgical safety.
Based on our inclusion and exclusion criteria, we enrolled 73 patients between 16 and 70 years old (average age 43.25 ± 14.87 years) who underwent percutaneous PFO closure at the Department of Cardiac Surgery, Zhongshan Hospital (Xiamen), Fudan University, from January 2022 to December 2023. Out of the 73 enrolled patients, there were 28 males (38.36%) and 45 females (61.64%), 29 migraine patients (39.73%), 14 patients (19.19%) with headache and dizziness, 14 patients (19.18%) with a history of cerebral infarction (CI), and 25 patients (34.25%) with CI, lacunar infarction or ischemic focus on magnetic resonance imaging (MRI). All patients received routine transthoracic echocardiography (TTE) and agitated saline contrast echocardiography (ASCE) before operations. Percutaneous closure of PFO was completed under the guidance of TEE. In 12 patients, the method of "injection of heparinized sterile saline through the delivery sheath" was used to observe their RLS, and the anatomical characteristics of the PFO according to the shunt path were monitored and evaluated. This method was also applied to some patients to guide the conveyor to pass through the foramen ovale (FO) channel safely and effectively, thereby improving the success rate of PFO closure.
The application of TEE during the procedure of percutaneous PFO closure, including preoperative evaluation, intraoperative guidance, and postoperative reevaluation, can offer further details about the anatomical and shunt characteristics of PFO, improve the diagnosis rate, and confirm the safety of the surgical path. It ensures the safety and reliability of the whole operation, greatly improving the success rate and reducing postoperative complications.
TEE guidance of percutaneous PFO closure has the advantages of minimal trauma, no radiation and real-time visualization, while injecting heparinized sterile saline through the delivery sheath is safer and more effective in improving the success rate and reducing postoperative complications.
经皮卵圆孔未闭（PFO）封堵术在治疗或预防PFO相关的右向左分流（RLS）方面越来越普遍。本研究旨在探讨经食管超声心动图（TEE）在经皮PFO封堵术中的价值，并探索一种可提高术中诊断及手术安全性的新方法。
根据纳入和排除标准，我们纳入了2022年1月至2023年12月在复旦大学附属中山医院（厦门）心脏外科接受经皮PFO封堵术的73例年龄在16至70岁之间（平均年龄43.25±14.87岁）的患者。在这73例纳入患者中，男性28例（38.36%），女性45例（61.64%）；偏头痛患者29例（39.73%），头痛头晕患者14例（19.19%），有脑梗死（CI）病史患者14例（19.18%），磁共振成像（MRI）显示有CI、腔隙性梗死或缺血灶患者25例（34.25%）。所有患者术前均接受常规经胸超声心动图（TTE）及经胸盐水负荷试验对比超声心动图（ASCE）检查。在TEE引导下完成经皮PFO封堵术。对12例患者采用“经输送鞘管注射肝素化无菌生理盐水”的方法观察其RLS情况，并根据分流路径监测和评估PFO的解剖特征。该方法还应用于部分患者，以指导输送装置安全有效地通过卵圆孔（FO）通道，并提高PFO封堵成功率。
TEE在经皮PFO封堵术过程中的应用，包括术前评估、术中引导及术后复查，能够提供有关PFO解剖及分流特征的更多细节，提高诊断率，并确认手术路径的安全性。它确保了整个手术的安全可靠，大大提高了成功率并减少了术后并发症。
TEE引导经皮PFO封堵术具有创伤小、无辐射及实时可视化的优点，而经输送鞘管注射肝素化无菌生理盐水在提高成功率及减少术后并发症方面更安全有效。
