Permanent Right-to-Left Shunt Is the Key Factor in Managing Patent Foramen Ovale
Permanent Right-to-Left Shunt Is the Key Factor in Managing Patent Foramen Ovale
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DOI：
10.1016/j.jacc.2011.06.064
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发表时间：
2011-11-15
影响因子：
24
通讯作者：
Nanjundappa, Aravinda
中科院分区：
文献类型：
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作者：
Rigatelli, Gianluca;Dell'Avvocata, Fabio;Nanjundappa, Aravinda
目的：与Valsalva手法诱导的右向左分流术患者相比，我们试图前瞻性评估永久性右向左分流术患者的卒中风险和经导管卵圆孔未闭（PFO）关闭的影响。PFO的病理生理学和适当的治疗仍远未完全阐明：特别是永久性右向左分流的作用仍不清楚。方法：2006年3月至2010年10月，我们招募了320例经颅多普勒和经胸/经食管超声心动图显示自发性永久性右至左分流的PFO闭合患者中的180例（平均年龄44±10.9岁，98例女性）。所有患者均符合目前经导管闭合的标准指征，术前行经食管超声心动图和脑磁共振成像，随后在超声心动图引导下进行经导管PFO闭合。我们将这些患者（Permanent组）的临床超声心动图特征与其余140例仅在Valsalva手术（Valsalva组）中进行右向左分流的患者（Valsalva组）进行比较。结果与Valsalva组患者相比，Permanent组患者磁共振成像多发缺血性脑病变、既往卒中复发、外周动脉栓塞、先兆偏头痛频次增加，房间隔动脉瘤及耳咽管突出频次增加。永久性分流的存在使卒中复发的风险最高（优势比：5.9,95%可信区间：2.0 ~ 12,p < 0.001）。两组在关闭手术后缺血事件复发方面无差异。结论：尽管样本量小，但我们的研究表明，永久性右至左分流术的患者与未行静脉分流术的患者相比，有更高的潜在矛盾栓塞风险。[J]中华医学会心脏科杂志，2011;58 (2):557 - 561
Objectives We sought to prospectively evaluate risk of stroke and impact of transcatheter patent foramen ovale (PFO) closure in patients with permanent right-to left shunt compared with those with Valsalva maneuver-induced right-toleft shunt.Background Pathophysiology and properly management of PFO still remain far from being fully clarified: in particular, the contribution of permanent right-to-left shunt remains unknown.Methods Between March 2006 and October 2010, we enrolled 180 (mean age 44 +/- 10.9 years, 98 women) of 320 consecutive patients referred to our center for transcatheter PFO closure, who had spontaneous permanent right-toleft shunt on transcranial Doppler and transthoracic/transesophageal echocardiography. All patients fulfilled the standard current indications for transcatheter closure and underwent preoperative transesophageal echocardiography and brain magnetic resonance imaging, with subsequent intracardiac echocardiographic-guided transcatheter PFO closure. We compared the clinical echocardiographic characteristics of these patients (Permanent Group) with the rest of 140 patients with right-to-left shunt only during Valsalva maneuver (Valsalva Group).Results Compared with the Valsalva Group patients, patients of the Permanent Group had increased frequency of multiple ischemic brain lesions on magnetic resonance imaging, previous recurrent stroke, previous peripheral arteries embolism, migraine with aura, and-more frequently-atrial septal aneurysm and prominent Eustachian valve. The presence of permanent shunt confers the highest risk of recurrent stroke (odds ratio: 5.9, 95% confidence interval: 2.0 to 12, p < 0.001). No differences were recorded between the 2 groups with regard to recurrence of ischemic events after the closure procedure.Conclusions Despite its small-sample nature, our study suggests that patients with permanent right-to-left shunt have potentially a higher risk of paradoxical embolism compared with those without. (J Am Coll Cardiol 2011;58:2257-61) (C) 2011 by the American College of Cardiology Foundation