Persisting eustachian valve in adults: Relation to patent foramen ovale and cerebrovascular events
Persisting eustachian valve in adults: Relation to patent foramen ovale and cerebrovascular events
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DOI：
10.1016/j.echo.2003.12.003
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发表时间：
2004-03-01
影响因子：
6.5
通讯作者：
Rehak, P
中科院分区：
文献类型：
--
作者：
Schuchlenz, HW;Saurer, G;Rehak, P
背景：咽鼓瓣（EV）（下腔静脉瓣膜）是胚胎右静脉窦瓣膜的残余物。从胚胎学角度来看，EV 引导含氧血液从下腔静脉穿过卵圆孔 (PFO) 进入体循环。经胸超声心动图显示大多数新生儿存在 EV，但通过经食管超声心动图研究的成人中 EV 的患病率尚不清楚。我们研究了 EV 的存在是否与 PFO 或隐源性中风相关。方法：对 211 名隐源性中风后接受经食管超声心动图的连续患者和 95 名连续无脑血管事件的患者研究了 EV 的频率和大小。在所有 306 名患者中，通过二维经食管超声心动图、彩色多普勒和对比超声心动图研究来研究 PFO 的存在。结果。总共 306 名患者中有 174 名 (57%) 发现了 EV。平均尺寸为 1.0 +/- 0.4 cm（范围：0.5-2-0）； 70% 的 EV 患者有 PFO（Cohen's kappa = 0.75；P < .001）。这种关系并未受到隐源性中风的显着影响。对照组中 PFO 的患病率为 30%，而疑似矛盾栓塞组的 PFO 患病率为 61% (P < .001)。因此，与对照患者相比，疑似矛盾栓塞患者的 EV 更为常见（211 名患者中分别有 143 名 [68%] 和 95 名患者中的 31 名 [33%]，P < 0.001）。两组之间 EV 的大小没有显着差异（1.1 vs 1.0 cm；P = .24）。结论：持续存在的 EV 是 PFO 患者中常见的现象。通过将血液从下静脉引导至心房。隔膜，持续的 EV 可能会阻止出生后 PFO 的自发闭合，因此可能间接导致反常栓塞的发生。
Background: The eustachian valve (EV) (valvula venae cavae inferioris) is a remnant of the embryonic right valve of the sinus venosus. Embryologically, the EV directs oxygenated blood from the inferior vena cava across the patent foramen ovale (PFO) into the systemic circulation. Transthoracic echocardiography shows the EV in the majority of newborns, but the prevalence of EV in adults studied with transesophageal echocardiography is unknown. We studied whether the presence of an EV is associated with PFO or with cryptogenic stroke.Methods: The frequency and size of the EV was studied in 211 consecutive patients undergoing transesophageal echocardiography after a cryptogenic stroke and in 95 consecutive patients without cerebrovascular events. in all 306 patients, the presence of a PFO was studied with 2-dimensional transesophageal echocardiographic, color Doppler, and contrast echocardiographic studies.Results. An EV was seen in 174 of 306 patients overall (57%). The mean size was 1.0 +/- 0.4 cm (range: 0.5-2-0); 70% of patients with an EV had a PFO (Cohen's kappa = 0.75; P < .001). This relationship was not significantly influenced by a cryptogenic stroke. The prevalence of PFO was 30% in the control group and 61% for those with presumed paradoxical embolism (P < .001). Thus, an EV was more common for patients with presumed paradoxical embolism than in control patients (143 of 211 [68%] vs 31 of 95 [33%], respectively, P < .001). There was no significant difference in the size of the EV between the 2 groups (1.1 vs 1.0 cm; P = .24).Conclusion: A persisting EV is a frequent finding in patients with a PFO. By directing the blood from the inferior cava to the interatrial. septum, a persisting EV may prevent spontaneous closure of PFO after birth and may, therefore, indirectly predispose to paradoxical embolism.