Structural and compliant anatomy of the patent foramen ovale in patients undergoing transcatheter closure
Structural and compliant anatomy of the patent foramen ovale in patients undergoing transcatheter closure
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DOI：
10.1067/mhj.2000.108236
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发表时间：
2000-08-01
影响因子：
4.8
通讯作者：
Lock, JE
中科院分区：
文献类型：
--
作者：
Marshall, AC;Lock, JE
背景目前大多数心内闭合装置都是针对房间隔缺损的。然而，诸如卵圆孔未闭（PFO）等缺陷具有独特的结构特征，可能会影响设备的合理设计。随着对隐源性卒中患者经导管封堵PFO技术的兴趣日益浓厚，对这些特征有了更清晰的认识是必要的。方法回顾性分析21例卒中病史患者经导管非自定心装置封堵PFOs时的血管造影。结果PFO表现为一条长度不等的隧道（2.4 ~ 19.5 mm，平均9.1±4.7 mm），以中隔和原隔为界。缺陷的潜在面积小至12.2 mm(2)，大至121.1 mm(2)。随着装置的放置，隧道长度缩短或消失（0.5 +/- 1.6 mm），使更柔顺的鼻中隔向下移位。结论：在经导管闭合的PFO患者中，缺损最常见的表现是在较厚、较不柔顺的第二隔和较薄、较柔顺的原隔之间的隧道状缺损。虽然未受干扰的隧道长度变化很大，但隧道被缩短或通过放置非自定心装置而消除。观察到PFO解剖结构可被某些装置可预测地改变，这可能对装置设计或植入技术产生影响。
Background Most current intracardiac closure devices target the atrial septal defect. However, defects such as the patent foramen ovale (PFO) have unique structural features that may influence rational device design. With mounting interest in trans catheter techniques for closure of PFO in patients with cryptogenic stroke, a clearer understanding of these features is warranted.Methods Retrospectively, we reviewed angiograms obtained at the time of transcatheter closure of PFOs with a nonself centering device in a group of 21 patients with a history of stroke.Results The PFO appeared as a tunnel of varying length (2.4 to 19.5 mm, mean 9.1 +/- 4.7 mm) bounded by septum secundum and septum primum. The potential area of the defect was as small as 12.2 mm(2) and as large as 121.1 mm(2). With device placement, the tunnel length shortened or disappeared (0.5 +/- 1.6 mm) by inferior displacement of the more compliant septum primum.Conclusions In patients with PFO referred for transcatheter closure, the defect most commonly appeared as a tunnel-like defect between a thicker, less compliant septum secundum and a thinner, more compliant septum primum. Although the length of the undisturbed tunnel varied widely, the tunnel was shortened or eliminated by placement of a non-self-centering device. The observation that PFO anatomy can be predictably altered by some devices may have an impact on device design or implantation technique.