Hausmann D, Mügge A, Daniel W G
Department of Internal Medicine, Hannover Medical School, Germany.
J Am Coll Cardiol. 1995 Oct;26(4):1030-8. doi: 10.1016/0735-1097(95)00288-9.
We sought to analyze the morphologic and functional characteristics of the patent foramen ovale in patients with different clinical likelihoods for paradoxic embolism.
The incidence of patent foramen ovale is increased in patients with otherwise unexplained arterial ischemic events. Because signs of venous thrombosis are absent in most patients, the diagnosis of paradoxic embolism is often questioned, even when patent foramen ovale is the only potential explanation for the ischemic event.
Seventy-eight patients with a patent foramen ovale detected by contrast transesophageal echocardiography were studied: 21 patients with an otherwise unexplained arterial ischemic event and clinical evidence implying paradoxic embolism (group I), 30 patients with an unexplained ischemic event but no clinical evidence for paradoxic embolism (group II) and 27 patients without an ischemic event (group III).
During transesophageal contrast echocardiography, patients in group I had more severe right to left shunting (mean +/- SD 52 +/- 16% of the left atrial area filled with contrast medium) and a wider opening of the patent foramen ovale (7.1 +/- 3.6-mm separation between the septum primum and the septum secundum) than did patients in group II (35 +/- 15% and 4.4 +/- 3.2 mm, respectively, p < 0.001) or group III (23 +/- 12% and 3.0 +/- 2.0 mm, respectively, p < 0.001). The incidence of atrial septal aneurysm was similar in the three groups. Severe contrast shunting (> or = 50% of the left atrial area filled with contrast medium) and wide opening of the patent foramen ovale (> or = 5-mm separation) revealed a high sensitivity (71% and 86%, respectively) and high specificity (86% and 96%, respectively) for identification of group I patients.
Right to left contrast shunting is more severe and opening of the patent foramen ovale is larger in patients with ischemic arterial events considered to be due to paradoxic embolism. In patients with a patent foramen ovale as the only potential cause for ischemic events and no signs of venous thrombosis, morphologic and functional variables assessed by transesophageal echocardiography may be helpful in estimating the likelihood of paradoxic embolism.
我们试图分析不同临床疑似反常栓塞患者卵圆孔未闭的形态学和功能特征。
在不明原因的动脉缺血事件患者中，卵圆孔未闭的发生率增加。由于大多数患者没有静脉血栓形成的迹象，即使卵圆孔未闭是缺血事件的唯一潜在解释，反常栓塞的诊断也常常受到质疑。
对78例经对比经食管超声心动图检测出卵圆孔未闭的患者进行研究：21例有不明原因的动脉缺血事件且有临床证据提示反常栓塞的患者（I组），30例有不明原因缺血事件但无反常栓塞临床证据的患者（II组），以及27例无缺血事件的患者（III组）。
在经食管对比超声心动图检查期间，I组患者的右向左分流更严重（平均±标准差，左心房内充满造影剂的面积为52±16%），卵圆孔未闭的开口更宽（原发隔与继发隔之间的间距为7.1±3.6毫米），高于II组患者（分别为35±15%和4.4±3.2毫米，p<0.001）或III组患者（分别为23±12%和3.0±2.0毫米，p<0.001）。三组房间隔瘤的发生率相似。严重的对比剂分流（左心房内充满造影剂的面积≥50%）和卵圆孔未闭的宽开口（间距≥5毫米）对识别I组患者具有较高的敏感性（分别为71%和86%）和较高的特异性（分别为86%和96%）。
在被认为是由反常栓塞引起的缺血性动脉事件患者中，右向左对比剂分流更严重，卵圆孔未闭的开口更大。在卵圆孔未闭是缺血事件的唯一潜在原因且无静脉血栓形成迹象的患者中，经食管超声心动图评估的形态学和功能变量可能有助于估计反常栓塞的可能性。
