经食管超声心动图对无既往卒中史成年人卵圆孔未闭所致右向左分流的诊断

Transesophageal echocardiographic diagnosis of right to left shunting across the foramen ovale in adults without prior stroke.

作者信息

Louie E K, Konstadt S N, Rao T L, Scanlon P J

机构信息

Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153.

出版信息

J Am Coll Cardiol. 1993 Apr;21(5):1231-7. doi: 10.1016/0735-1097(93)90251-u.

DOI:10.1016/0735-1097(93)90251-u

PMID:8459082

Abstract

OBJECTIVES

The purpose of this study was to estimate the prevalence of potential right to left interatrial shunting and to quantify the morphologic characteristics of the fossa ovalis in adults without a prior history of stroke or systemic embolism.

BACKGROUND

Paradoxic embolization through a patent foramen ovale is an important cardiac mechanism for embolic stroke. Although anatomic and physiologic data obtained by transesophageal echocardiography increase the frequency of demonstration of potential cardiac sources of systemic embolism and occasionally can conclusively demonstrate the mechanism for embolic stroke, the prevalence and prognostic implications of these findings in neurologically healthy persons are still being actively investigated.

METHODS

Intraoperative transesophageal saline contrast echocardiography was performed on 50 adult patients without prior history of stroke or systemic embolism who were undergoing elective cardiovascular surgery.

RESULTS

No patient had a manifest atrial septal defect by right heart oximetric measurements or transesophageal Doppler echocardiographic examination. Eleven of the 50 patients demonstrated right to left atrial passage of saline contrast medium during apnea or after release of 20-cm H2O positive airway pressure, signifying patency of the foramen ovale. These 11 patients with a patent foramen ovale had increased total excursion of the flap valve (septum primum) of the fossa ovalis (1.3 +/- 0.7 cm) compared with findings in the 39 patients without a patent foramen ovale (0.3 +/- 0.5 cm, p < 0.001). All patients with a patent foramen ovale exhibited some mobility of the septum primum and 73% of these patients had > or = 1 cm total excursion of the septum primum. In contrast, 56% of patients without a patent foramen ovale exhibited no motion of the septum primum out of the plane of the atrial septum. The maximal diameter of the fossa ovalis was greater in patients with (1.4 +/- 0.4 cm) than in patients without (1.0 +/- 0.3 cm, p < 0.003) a patent foramen ovale.

CONCLUSIONS

Hypermobility of the septum primum and enlargement of the fossa ovalis are morphologic findings that occur in the presence of a patent foramen ovale.

摘要

目的

本研究旨在评估潜在的右向左心房分流的患病率，并量化无卒中或系统性栓塞病史的成年人卵圆窝的形态学特征。

背景

通过卵圆孔未闭的反常栓塞是栓塞性卒中的重要心脏机制。尽管经食管超声心动图获得的解剖和生理数据增加了发现潜在系统性栓塞心脏来源的频率，偶尔还能确凿地证明栓塞性卒中的机制，但这些发现对神经功能正常者的患病率和预后意义仍在积极研究中。

方法

对50例无卒中或系统性栓塞病史且正在接受择期心血管手术的成年患者进行术中经食管盐水对比超声心动图检查。

结果

通过右心血氧饱和度测量或经食管多普勒超声心动图检查，无一例患者有明显的房间隔缺损。50例患者中有11例在屏气时或释放20 cm H2O的气道正压后出现盐水对比剂从右向左心房通过，表明卵圆孔未闭。与39例卵圆孔未闭的患者相比，这11例卵圆孔未闭的患者卵圆窝瓣（原发隔）的总偏移增加（1.3±0.7 cm）（0.3±0.5 cm，p<0.001）。所有卵圆孔未闭的患者均表现出原发隔有一定活动度，其中73%的患者原发隔总偏移≥1 cm。相比之下，56%的卵圆孔未闭患者原发隔在房间隔平面外无活动。卵圆孔未闭患者的卵圆窝最大直径（1.4±0.4 cm）大于无卵圆孔未闭患者（1.0±0.3 cm，p<0.003）。