经胸超声心动图结合右心声学造影在判断卵圆孔未闭右向左分流中的临床价值

发布时间：2018-05-09 09:17

  本文选题：卵圆孔未闭 + 右心声学造影　； 参考：《第三军医大学学报》2017年16期

【摘要】：目的探讨经胸超声心动图(transthoracic echocardiography,TTE)结合右心声学造影在判断卵圆孔未闭(patent foramen ovale,PFO)右向左分流中的临床应用价值。方法收集2013年1月至2016年12月在我院心血管内科和神经内科接诊的不明原因脑卒中和偏头痛患者373例(其中脑卒中患者121例,偏头痛252例),为进一步诊断有无PFO,均接受TTE和右心声学造影检查,其中103例进行了经食道超声心动图(transesophageal echocardiography,TEE)检查。结果 (1)在静息状态下,373例患者TTE结果显示22例合并有PFO;在TTE未检出PFO的351例患者中,103例患者同时接受了TEE检查,结果显示49例患者合并PFO。(2)右心声学造影检查结果显示:186例患者在Valsalva状态和剧烈咳嗽时存在不同程度的右向右向左分流检出率为49.87%。其中轻度右向左分流(Ⅰ级)69例;中度分流(Ⅱ级)70例;重度分流(Ⅲ级)47例。(3)TTE检测出22例PFO和TEE检测出49例PFO患者,右心声学造影均显示中度以上右向左分流。(4)59例TTE结合右心声学造影证实为中度以上右向左分流且MRI证实有脑梗塞灶的患者,均在TTE引导下成功进行了PFO介入封堵术,术后1个月复查经右心声学造影显示,55例在Valsalva和剧烈咳嗽状态下右向左分流消失,4例仍有少量右向左分流。结论 TTE结合右心声学造影不仅能清晰显示PFO右向左分流的存在,并可判断右向左分流程度,为PFO的临床治疗提供直接依据;同时还能作为PFO封堵术后临床随访的重要工具。
[Abstract]:Objective to evaluate the clinical value of transthoracic echocardiography (TTE) combined with right voice angiography in the diagnosis of right to left shunt of patent foramen ovale (OFQ). Methods from January 2013 to December 2016, 373 patients with unknown causes of stroke and migraine, including 121 patients with cerebral apoplexy, were enrolled in the Department of Cardiovascular Medicine and Department of Neurology in our hospital. All the 252 patients with migraine were examined by TTE and right heart radiography in order to further diagnose PFO.103 of them were examined by transesophageal echocardiography (TEE). Results 1) in the rest state, the TTE results of 373 patients showed that 22 cases were complicated with PFO.103 out of 351 patients without PFO were examined by TEE at the same time in TTE. The results showed that the positive rate of right to left shunt was 49.87 in Valsalva state and severe cough in #number0# patients. The results showed that 49 cases were complicated with PFO.2The results showed that the positive rate of right to left shunt was 49.87%. Mild right to left shunt (grade 鈪，

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