Smolarek-Nicpoń Malwina, Smolka Grzegorz, Michalewska-Włudarczyk Aleksandra, Pysz Piotr, Lasek-Bal Anetta, Wojakowski Wojciech, Kułach Andrzej
Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
J Clin Med. 2025 Sep 15;14(18):6483. doi: 10.3390/jcm14186483.
A persistent connection between the atria, known as a patent foramen ovale (PFO), is present in approximately 25% of the general population. PFO closure is indicated in patients under 60 years of age who have experienced an embolic stroke of undetermined source (ESUS) or transient ischemic attack (TIA) confirmed by neurological imaging, and in selected cases of peripheral embolism. Follow-up after the procedure is indicated to confirm the position of the occluder, assess the effectiveness of the closure, and evaluate any potential thrombus formation on the device. We analyzed data from 75 consecutive patients who underwent percutaneous PFO closure procedures and were followed up for at least one year. The procedure was performed under fluoroscopy and transesophageal echocardiography (TEE) guidance, and occluder size selection was made using TEE multiplanar imaging (MPR). All patients had standard transthoracic echocardiography (TTE) at 1 and 6-12 months after the procedure. To assess the long-term efficacy, contrast-enhanced transcranial Doppler (ce-TCD) was performed at 12 months to record high-intensity transient signals (HITSs). Cases with positive ce-TCD had TEE performed. During follow-up evaluations after 1 and 6-12 months (TTE), we did not observe any device dislodgements, thrombi, or residual leaks visible in TTE. ce-TCD detected HITSs in eight patients, prompting additional TEE examinations performed in seven cases. In five out of seven patients, a leak around the occluder was identified, including two patients with grade 2 HITSs. Assessing the effectiveness of PFO occluder placement is crucial for the residual embolic risk and thus the necessity of antithrombotic therapy. Even low grades of HITSs observed in ce-TCD help to identify patients with residual leaks confirmed in TEE.
大约25%的普通人群存在心房之间的持续性连接，即卵圆孔未闭（PFO）。对于年龄在60岁以下、经神经影像学证实发生过不明来源栓塞性卒中（ESUS）或短暂性脑缺血发作（TIA）的患者，以及部分外周栓塞病例，建议进行PFO封堵。术后需要进行随访，以确认封堵器的位置，评估封堵效果，并评估装置上是否有潜在血栓形成。我们分析了75例连续接受经皮PFO封堵手术且随访至少一年的患者的数据。手术在荧光透视和经食管超声心动图（TEE）引导下进行，封堵器尺寸选择采用TEE多平面成像（MPR）。所有患者在术后1个月以及6 - 12个月进行标准经胸超声心动图（TTE）检查。为评估长期疗效，在12个月时进行对比增强经颅多普勒（ce - TCD）检查以记录高强度瞬态信号（HITSs）。ce - TCD结果为阳性的病例进行TEE检查。在术后1个月以及6 - 12个月的随访评估（TTE）中，我们未观察到TTE可见的任何装置移位、血栓或残余分流。ce - TCD在8例患者中检测到HITSs，促使其中7例患者接受了额外的TEE检查。在7例患者中的5例中，发现封堵器周围存在分流，其中2例患者有2级HITSs。评估PFO封堵器置入的有效性对于残余栓塞风险以及抗血栓治疗的必要性至关重要。即使在ce - TCD中观察到低等级的HITSs也有助于识别TEE证实存在残余分流的患者。
