马为,杨颖,吴永健,孙葳,邱林

• 1:中国医师协会心血管内科医师分会结构性心脏病学组
• 2:心源性脑卒中人群的高危预测模型及治疗策略的临床研究课题组
• 3:北京大学第一医院
• 4:中国医学科学院阜外医院

摘要(Abstract)：

随着对卵圆孔未闭（PFO）相关疾病认识的深入及经导管封堵术等治疗的广泛开展，PFO的精准诊断和评估（包括有无PFO、分流量、相关解剖）成为临床迫切需求。《卵圆孔未闭超声诊断中国专家共识》专家组参考国内外相关研究、共识及指南，达成超声技术（包括经胸/经食管超声心动图联合右心声学造影、对比增强经颅多普勒超声、心腔内超声）诊断PFO的临床应用专家共识，以指导临床实践。

关键词(KeyWords)： 卵圆孔未闭;封堵;超声心动图;经颅多普勒;共识

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划项目（2021YFC2501106、2021YFC2501100）

作者(Author): 马为,杨颖,吴永健,孙葳,邱林

参考文献(References)：

• [1] Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the fi rst 10 decades of life:an autopsy study of 965 normal hearts[J]. Mayo Clin Proc, 1984, 59(1):17-20. DOI:10.1016/s0025-6196(12)60336-x.
• [2] Furlan AJ, Reisman M, Massaro J, et al. Closure or medical therapy for cryptogenic stroke with patent foramen ovale[J]. N Engl J Med,2012, 366(11):991-999. DOI:10.1056/NEJMoa1009639.
• [3] Meier B, Kalesan B, Mattle HP, et al. Percutaneous closure of patent foramen ovale in cryptogenic embolism[J]. N Engl J Med,2013, 368(12):1083-1091. DOI:10.1056/NEJMoa1211716.
• [4] Carroll JD, Saver JL, Thaler DE, et al. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke[J]. N Engl J Med,2013,368(12):1092-1100. DOI:10.1056/NEJMoa1301440.
• [5] Mas JL,Derumeaux G,Guillon B,et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke[J]. N Engl J Med, 2017, 377(11):1011-1021. DOI:10.1056/NEJMoa1705915.
• [6] S?ndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke[J]. N Engl J Med, 2017, 377(11):1033-1042. DOI:10.1056/NEJMoa1707404.
• [7] Saver JL,Carroll JD,Thaler DE,et al. Long-term outcomes of pat ent foramen ovale closure or medical therapy after stroke[J]. N Engl J Med, 2017, 377:1022-1032. DOI:10.1056/NEJMoa1610057.
• [8] Lee PH,Song JK,Kim JS,et al. Cryptogenic stroke and highrisk patent foramen ovale:the DEFENSE-PFO trial[J]. J Am Coll Cardiol,2018,71(20):2335-2342. DOI:10.1016/j.jacc.2018.02.046.
• [9]张玉顺，蒋世良，何璐.经导管封堵卵圆孔未闭预防卒中——从争议到统一[J].中国介入心脏病学杂志，2019,27(6):301-302. DOI:10.3969/j.issn.1004-8812.2019.06.001.
• [10]周力，陈晖.卵圆孔未闭与偏头痛：争议与实践[J].中国介入心脏病学杂志，2021, 29(6):342-344. DOI:10.3969/j.issn.1004-8812.2021.06.010.
• [11]张玉顺，蒋世良，朱鲜阳.卵圆孔未闭相关卒中预防中国专家指南[J].心脏杂志，2021, 33(1):1-10. DOI:10.3969/j.issn.1004-8812.2021.06.010.
• [12] Silvestry FE, Cohen MS, Armsby LB, et al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale:from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions[J]. J Am Soc Echocardiogr,2015,28(8),910-958. DOI:10.1016/j.echo.2015.05.015.
• [13]李贺智，何亚峰，王琦光，等.卵圆孔未闭超声心动图及右心声学造影临床操作规范[J].中国实用内科杂志，2022, 42(5):376-380. DOI:10.19538/j.nk2022050106.
• [14]经食道超声心动图临床应用的中国专家共识专家组.卵圆孔未闭右心声学造影中国专家共识[J].中国循环杂志，2022,37(5):449-458. DOI:10.3969/j.issn.1000-3614.2022.05.001.
• [15]王新房，谢明星.超声心动图学[M]. 5版.北京：人民卫生出版社，2016:787-810.
• [16] Ho?da MK, Krawczyk-O?óg A, Koziej M, et al. Left-sided atrial septal pouch is a risk factor for cryptogenic stroke[J].J Am Soc Echocardiogr, 2018, 31(7):771-776. DOI:10.1016/j.echo.2018.01.023.
• [17] Lehrmann H, Schneider J, Jadidi AS, et al. Transseptal access for left atrial ablation:the catheter-probing techniques are not without risk[J]. J Cardiovasc Electrophysiol, 2014, 25(5):479-484. DOI:10.1111/jce.12356.
• [18] Schuchlenz HW, Saurer G, Weihs W, et al. Persisting eustachian valve in adults:relation to patent foramen ovale and cerebrovascular events[J]. J Am Soc Echocardiogr, 2004,17(3):231-233. DOI:10.1016/j.echo.2003.12.003.
• [19] Schneider B, Hofmann T, Justen MH, et al. Chiari’s network:normal anatomic variant or risk factor for arterial embolic events[J]. J Am Coll Cardiol, 1995, 26(1):203-210. DOI:10.1016/0735-1097(95)00144-o.
• [20] Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults:recommendations from the American Society of Echocardiography[J]. J Am Soc Echocardiogr,2019, 32(1):1-64. DOI:10.1016/j.echo.2018.06.004.
• [21]何璐，张玉顺.单中心1336例经导管封堵卵圆孔未闭患者主要并发症回顾性分析[J].中国介入心脏病学杂志，2019, 27(6):309-314.DOI:10.3969/j.issn.1004-8812.2019.06.003.
• [22] Kent DM, Saver JL, Kasner SE, ed al. Heterogeneity of treatment ef fects in an analysis of pooled individual patient data from randomized trials of device closure of patent foramen ovale after stroke[J]. JAMA, 2021, 326(22):2277-2286.DOI:10.1001/jama.2021.20956.
• [23] Schneider B, Zienkiewicz T, Jansen V, et al. Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy fi ndings[J]. Am J Cardiol,1996,77(14):1202-1209. DOI:10.1016/s0002-9149(96)00163-4.
• [24]中国医师协会超声医师分会．超声心动图检查指南[M]．北京：人民军医出版社，2016:79-83.
• [25] Fan S, Nagai T, Luo H, et al. Superiority of the combination of blood and agitated saline for routine contrast enhancement[J].J Am Soc Echocardiogr, 1999, 12(12):94-98. DOI:10.1016/s0894-7317(99)70120-3.
• [26] Velthuis S,Buscarini E,Gossage JR,et al. Clinical implications of pulmonary shunting on saline contrast echocardiography[J].J Am Soc Echocardiogr,2015,28(3):255-263. DOI:10.1016/j.echo.2014.12.008.
• [27]李越，刘若卓，翟亚楠，等.健康志愿者右心声学造影结果的初步分析[J].中华医学超声杂志（电子版），2014,11(2):135-141. DOI:10.3877/cma.j.issn.1672-6448.2014.02.011.
• [28] Takaya Y, Watanabe N, Ikeda M, et al. Importance of abdominal compression valsalva maneuver and microbubble grading in contrast transthoracic echocardiography for detecting patent foramen ovale[J]. J Am Soc Echocardiogr, 2020, 33(2):201-206. DOI:10.1016/j.echo.2019.09.018.
• [29] Jauss M,Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography[J]. Cerebrovascular Disease,2000,10(6):490-496. DOI:10.1159/000016119.
• [30] Yang Y,Guo ZN,Wu J,et al. Prevalence and extent of rightto-left shunt in migraine:a survey of 217 Chinese patients[J].Eur J Neurol, 2012, 19(10):1367-1372. DOI:10.1111/j.1468-1331.2012.03793.x.
• [31] Alqahtani F, Bhirud A, Aljohani S, et al. Intracardiac versus transesophageal echocardiography to guide transcatheter closure of interatrial communications:Nationwide trend and comparative analysis[J]. J Interv Cardiol, 2017, 30(3):234-241. DOI:10.1111/joic.12382.
• [32] Dani€els C,Weytjens C,Cosyns B,et al. Second harmonic transthoracic echocardiography:the new reference screening method for the detection of patent foramen ovale[J]. Eur J Echocardiogr,2004, 5(6):449-452. DOI:10.1016/j.euje.2004.04.004.
• [33]彭源，刘曼薇，方凌云，等.经食管与经胸超声心动图造影诊断卵圆孔未闭及右向左分流[J].中国医学影像技术，2021,37(12):1775-1778. DOI:10.13929/j.issn.1003-3289.2021.12.004.
• [34]李越，翟亚楠，魏丽群，等.经食管与经胸超声心动图造影检出卵圆孔未闭右向左分流效果比较[J].中华医学超声杂志（电子版），2013,10(11):44-48. DOI:10.3877/cma.j.issn.1672-6448.2013.11.011.
• [35] Filomena D, Cimino S, Maestrini V, et al. The evolving role of echocardiography in the assessment of patent foramen ovale in patients with left-side thromboembolism[J]. Echocardiography,2021, 38(4):657-675. DOI:10.1111/echo.15018.