Guan Luxi, Luo Dong, Liu Meijun, Li Zhengwei, Pan Xiangbin, Hu Haibo
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Catheter Cardiovasc Interv. 2025 Sep 9. doi: 10.1002/ccd.70149.
Patent foramen ovale (PFO) has been identified as a potential risk factor for cryptogenic stroke (CS). Although transesophageal echocardiography (TEE) is considered the gold standard for PFO detection, false-negative results remain a clinical concern, particularly in CS patients with high suspicion of PFO-related etiology.
To evaluate the clinical utility of transcatheter PFO exploration (TPFOE) in CS patients with negative TEE findings but high suspicion of PFO-related etiology.
Between January 2019 and May 2022, 30 CS patients with high suspicion of PFO-related etiology were enrolled. All showed grade III/IV RLS on contrast transthoracic echocardiography (cTTE) despite negative TEE. Each patient underwent TPFOE. Patients with confirmed PFO proceeded directly to immediate PFO closure, whereas negative cases received antiplatelet therapy alone. Follow‑up with transthoracic echocardiography (TTE), chest X‑ray, and electrocardiography (ECG) was performed at 12 h and at 1, 3, 6, and 12 months after the procedure.
The study cohort comprised 14 males and 16 females, with a median age of 41.5 years (interquartile range: 34-48 years). TPFOE successfully identified PFO in 28 patients (93.3%), all of whom subsequently underwent successful interventional closure. Follow-up TTE confirmed ideal device position and morphology without residual shunting. The remaining two patients (6.7%) had negative exploration results, and they received antiplatelet therapy alone. No recurrent cerebrovascular events were reported in any patient during the follow-up period.
TEE, though the gold standard for PFO diagnosis, carries a non‑negligible false‑negative rate. In CS patients with negative TEE but high suspicion of PFO-related etiology, TPFOE demonstrated potential as an adjunctive technique to increase PFO detection. Further studies are warranted to better define its diagnostic value for PFO in this patient population.
卵圆孔未闭（PFO）已被确定为不明原因卒中（CS）的潜在危险因素。尽管经食管超声心动图（TEE）被认为是检测PFO的金标准，但假阴性结果仍然是一个临床问题，尤其是在高度怀疑与PFO相关病因的CS患者中。
评估经导管卵圆孔探查（TPFOE）在TEE检查结果为阴性但高度怀疑与PFO相关病因的CS患者中的临床应用价值。
2019年1月至2022年5月，纳入30例高度怀疑与PFO相关病因的CS患者。尽管TEE检查结果为阴性，但所有患者在经胸对比超声心动图（cTTE）上均显示III/IV级右向左分流（RLS）。每位患者均接受TPFOE。确诊为PFO的患者直接进行即刻PFO封堵，而检查结果为阴性的患者仅接受抗血小板治疗。在术后12小时以及术后1、3、6和12个月进行经胸超声心动图（TTE）、胸部X线和心电图（ECG）随访。
研究队列包括14名男性和16名女性，中位年龄为41.5岁（四分位间距：34 - 48岁）。TPFOE成功识别出28例患者（93.3%）的PFO，所有这些患者随后均成功进行了介入封堵。随访TTE证实封堵器位置和形态理想，无残余分流。其余2例患者（6.7%）探查结果为阴性，他们仅接受抗血小板治疗。随访期间，所有患者均未报告复发性脑血管事件。
TEE虽是PFO诊断的金标准，但其假阴性率不可忽视。在TEE检查结果为阴性但高度怀疑与PFO相关病因的CS患者中，TPFOE显示出作为增加PFO检出率的辅助技术的潜力。有必要进一步研究以更好地明确其在该患者群体中对PFO的诊断价值。
