卵圆孔解剖特征对经皮卵圆孔未闭介入封堵术的影响
The influence of characteristics of patent foramen ovale on percutaneous interventional occlusion
李炜杰 1蒋威 2温健恒 2许兆延 1杨希立 1胡晖1
作者信息
- 1. 佛山市第一人民医院心血管内科(广东佛山,528000)
- 2. 佛山市第一人民医院儿科
- 折叠
摘要
目的:探讨经皮卵圆孔未闭(patent foramen ovale,PFO)介入封堵术中影响通过PFO的相关因素.方法:纳入在我院确诊PFO并行经皮介入封堵术患者183例,收集患者的基本特征、经食管心脏超声心动图、经胸右心声学造影(transthroracic contrast echocardiography,cTTE)、术中血流动力学等参数.以导管通过PFO时间60 s为截点,将患者分成容易通过组和非容易通过组,比较两组患者临床资料.使用logistic回归分析确定影响通过PFO的独立危险因素.结果:容易通过组的左心房面开口[(1.4±0.8)mm vs(0.8±0.6)mm]和右心房面开口[(1.9±1.6)mm vs(0.9±0.6)mm]均显著大于非容易通过组(均P＜0.05).静息状态和VAL-SAVA状态下两组患者右向左分流(right to left shunt,RLS)等级构成均差异有统计学意义(均P＜0.05).两组患者的隧道长度、术中心率、血压、肺动脉压力等参数均差异无统计学意义.多因素logistic回归分析显示,VAL-SAVA状态RLS≥2级是经皮介入封堵术中影响PFO通过的独立危险因素(OR=31.59,95％CI:7.61～131.17,P＜0.01).结论:cTTE评估的RLS等级作为独立影响因子预测介入封堵术中通过PFO的难易程度具有一定价值.
Abstract
Objective:To investigate factors that affecting passage through the patent foramen ovale(PFO)during percutaneous interventional occlusion.Methods:A total of 183 patients who were diagnosed with PFO and underwent percutaneous interventional occlusion in our hospital were included.Basic characteristics,parameters of transesophageal echocardiography,transthoracic contrast echocardiography(cTTE),and intraoperative hemody-namics were collected.Patients were divided into easy passage and non-easy passage groups based on catheter pas-sage through the PFO(within 60 seconds).Clinical data between the two groups were compared.Results:In the easy passage group,the opening size of left atrium and right atrium was(1.4±0.8)mm and(1.9±1.6)mm,re-spectively,which were significantly larger than those[left atrium(0.8±0.6)mm,right atrium(0.9±0.6)mm]in the non-easy passage group(both P＜0.05).There were significant differences in the composition of right to left shunt(RLS)grades in the resting and VALSAVA states between the two groups(both P＜0.05).However,there was no statistical difference in the parameters of tunnel length,heart rate,blood pressure,and pulmonary artery pressure.Multivariate logistic regression analysis showed that RLS grade(VALSAVA status)＞2 was an independent risk factor on the passage time of PFO in the percutaneous occlusion surgery(OR=31.59,95％CI:7.61-131.17,P＜0.01).Conclusion:RLS evaluated by cTTE as an independent influencing factor has predictive value for the difficulty of PFO passage during interventional occlusion.
关键词
卵圆孔未闭/经皮介入封堵术/经胸右心声学造影Key words
patent foramen ovale/percutaneous interventional occlusion/transthoracic contrast echocardio-graphy引用本文复制引用
基金项目
佛山市卫生健康局医学科研项目(20220365)
出版年
2024
NETL
NSTL
万方数据