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目的探讨经导管房间隔结构异常封堵治疗缺血性卒中患者的临床效果及预后。方法以2015年5月至11月在首都医科大学附属北京天坛医院接受房间隔结构异常封堵治疗的缺血性卒中患者为研究对象。封堵术前,所有入选患者均经经颅多普勒超声(contrast transcranial Doppler ultrasound,c TCD)发泡试验证实有右向左分流(right-left shunt,RLS)以及经食管超声证实存在卵圆孔未闭(patent foramen ovale,PFO)或房间隔缺损(atrial septal defect,ASD)。封堵术后复查c TCD发泡试验及经胸超声心动图,观察手术效果,完全封堵及合并症情况,评价疗效及安全性。结果本研究共纳入10例患者,平均年龄(48±14)岁,其中男性8例,女性2例,PFO患者8例,ASD患者2例。所有患者术前c TCD发泡试验均证实为大量RLS。PFO直径1.1~2.0 mm,平均(1.7±0.3)mm。ASD直径分别为4.5 mm和3.4 mm。手术成功率100%。8例PFO患者使用的封堵器型号均为18/25 mm,2例ASD封堵器的型号分别为12 mm和10 mm。封堵术后仅1例PFO患者在c TCD发泡试验中有中等量残余分流,完全封堵率90%。术后1、3、6个月随访,未见封堵器移位及表面血栓形成,未见脑缺血事件复发。结论经导管PFO/ASD封堵术在缺血性卒中患者中应用是安全、有效的,能显著减少右向左分流,但需注意封堵术后中远期残余右向左分流的随访观察。
Objective To investigate the clinical effect and prognosis of transcatheter atrial septal anomalies in patients with ischemic stroke. Methods From May 2015 to November 2015, patients with ischemic stroke undergoing atrial septal abnormal occlusion in Beijing Tiantan Hospital, Capital Medical University were enrolled. Before occlusion, all patients were confirmed by transcranial Doppler ultrasound (c TCD) foam test with right-left shunt (RLS) and transesophageal echocardiography to confirm the presence of oval Patent foramen ovale (PFO) or atrial septal defect (ASD). Postoperative closure of c TCD foam test and transthoracic echocardiography to observe the effect of surgery, complete occlusion and complications, evaluate the efficacy and safety. Results A total of 10 patients were enrolled in this study, with an average age of 48 ± 14 years. There were 8 males and 2 females, 8 PFO patients and 2 ASD patients. All patients preoperative c TCD foam test confirmed a large number of RLS. PFO diameter of 1.1 ~ 2.0 mm, an average of (1.7 ± 0.3) mm. The ASD diameters are 4.5 mm and 3.4 mm respectively. Surgical success rate of 100%. The occluder models used in 8 PFO patients were both 18/25 mm and the two ASD occluders models were 12 mm and 10 mm respectively. Only one patient with PFO after occlusion had a moderate residual shunt in the c TCD foaming test, with a complete occlusion rate of 90%. One, three and six months postoperative follow-up, no occluder displacement and surface thrombosis, no recurrence of cerebral ischemia. Conclusion Transcatheter closure of PFO / ASD in patients with ischemic stroke is safe and effective, can significantly reduce the right to left shunt, but should pay attention to the long-term residual right to left shunt after closure of the follow-up observation.