匡永芳 朱海锋 郭远峰 张小娥 吴丽文

摘要：目的：探討经胸超声心动图与经食道超声心动图联合右心声学造影在卵圆孔未闭封堵术中的应用效果。方法：选取2018年5月至2020年5月在我院拟行卵圆孔未闭封堵术治疗的患者92例，根据随机数字表分为对照组（46例）与研究组（46例）。对照组患者采取经胸超声心动图联合右心声学造影检查进行术前评估、检测，术后随访检查，研究组患者采取经食道联合右心声学造影检查进行术前评估、检测，术后随访检查，比较两组卵圆孔未闭的检出率、卵圆孔未闭右向左分流半定量分级的检出情况、检查封堵术并发症情况，以及术后1、3、6个月随访检查卵圆孔未闭封堵成功率。结果：研究组患者卵圆孔未闭的检出率明显高于对照组（86.96%vs65.22%），并且研究组右向左分流半定量分级1级明显低于对照组（19.57%vs43.48%），3级明显高于对照组（50.00%vs19.57%，P<0.05）;对照组与研究组患者检查后并发症差异无统计学意义（4.35%vs8.70%，P>0.05）;研究组术后1、3、6个月随访卵圆孔未闭封堵成功率均高于对照组（P<0.05）。结论：卵圆孔未闭患者采取经食道联合右心声学造影检查较经胸超声联合右心声学造影检查可提高术前对卵圆孔未闭诊断率与右向左分流半定量分级检出准确率，为手术治疗提供更佳指导意见，对提高卵圆孔未闭封堵术成功率意义重大，且不会增加检查后并发症。

关键词：经胸超声心动图;经食道超声心动图;右心声学造影;卵圆孔未闭;封堵

中图分类号：R743.3文献标识码：BDOI：10？郾3969/j.issn.1001-0270.2021.04.09

Application Comparison of Transthoracic Echocardiography and Transesophageal Echocardiography Combined with Right-heart Echocardiography in Patent Foramen Ovale Occlusion

KUANG Yong-fang， ZHU Hai-feng， GUO Yuan-feng， ZHANG Xiao-e， WU Li-wen（corresponding author）

（Department of Ultrasound， The Sixth Affiliated Hospital of Guangzhou Medical University （Qingyuan Peoples Hospital）， Guangdong 511520，China）

Abstract： Objective： To investigate the effect of transthoracic echocardiography and transesophageal echocardiography combined with right-heart contrast echocardiography in patent foramen ovale occlusion. Methods： A total of 92 patients who were to be treated with patent foramen ovale occlusion in our hospital from May 2018 to May 2020 were selected and divided into a control group（46 cases） and a study group （46 cases） according to a random number table In the control group， patients in the control group took transthoracic echocardiography combined with right-heart echocardiography for preoperative evaluation， testing， and postoperative follow-up examinations. Patients in the study group took transesophageal combined with right-heart echocardiography for preoperative evaluation， testing， and postoperative follow-up. Check， compare the detection rate of patent foramen ovale in the two groups， the semi-quantitative grading of the detection of patent foramen ovale from right to left shunt， check the complications of occlusion， and 1， 3， and 6 months after surgery Follow-up to check the success rate of patent foramen ovale closure. Results： The detection rate of patent foramen ovale in the study group was significantly higher than that in the control group （86.96% vs 65.22%）， and the right-to-left shunt semi-quantitative grade 1 in the study group was significantly lower than the control group （19.57% vs 43.48%）， grade 3 was significantly higher than that of the control group （50.00% vs 19.57%， P<0.05）; there was no statistically significant difference in complications between the control group and the study group（4.35% vs 8.70%， P>0.05）; the success rate of patent foramen ovale occlusion was higher in the study group than in the control group at 1， 3， and 6 months postoperatively（P<0.05）. Conclusion： In patients with patent foramen ovale， the use of transesophageal combined with right-heart contrast echocardiography can improve the preoperative diagnosis rate of patent foramen ovale and right-to-left shunt semi-quantitative grading detection accuracy compared with transthoracic ultrasound combined with right-heart contrast echocardiography. It is of great significance to improve the success rate of patent foramen ovale occlusion and will not increase post-examination complications.

Key Words： transthoracic echocardiography; transesophageal echocardiography; right-heart echocardiography; patent foramen ovale; occlusion

卵圆孔是胎儿生长发育过程的重要生命通道。大多数胎儿一出生左房压高于右房压，使构成卵圆孔的原发隔与继发隔发生功能性闭合，1年后发生解剖闭合。若出生后超过3岁，卵圆孔未能被卵圆瓣充分闭合而导致房水平分流称作卵圆孔未闭。大约有1/4的成年人存在卵圆孔未闭，是目前成人中最为常见的先天性心脏疾病之一[1]。卵圆孔未闭患者在右心房压力大于左心房时，其心脏内房水平将出现右向左分流，有可能引发隐源性脑卒中、外周动脉栓塞、偏头痛等疾病，这使得卵圆孔未闭治疗日益受到患者与医师的重视与关注[2]。……