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Retrospective analysis of main complications in 1336 cases of patent foramen ovale closure-a single center experience
何璐,张玉顺
摘要(Abstract):
目的探讨卵圆孔未闭(PFO)患者经导管介入治疗的并发症及其防治方法。方法回顾性分析西安交通大学第一附属医院结构性心脏病中心2012年1月至2016年12月诊断为PFO并行经导管介入治疗的患者共1336例,术后3、6、12、24个月通过心电图(ECG)和(或)24 h动态心电图(Holter)、经胸超声心动图(TTE)/经食管超声心动图(TEE)和TTE声学造影(c TTE)对其术中及术后主要并发症进行评价。结果 1336例患者中1320例手术成功,手术成功率98.8%。主要并发症发生率为0.1%(2/1336),其中1例于术中、另1例于术后2 h发生心脏压塞,均经心包穿刺后缓解。次要并发症发生率为1.3%(18/1336),其中短暂性心房颤动2例(0.1%)、血管通路并发症7例(0.5%)、术中ECG提示冠状动脉气栓9例(0.7%)。术后共498例患者完成24个月随访,其中24例(4.8%,24/498)发现中-大量残余右向左分流。结论经导管封堵PFO具有创伤小、成功率高、并发症发生率低等特点,是安全、有效的治疗方法。术前正确诊断、术中准确操作和术后认真随访可减少并发症的发生。
关键词(KeyWords): 卵圆孔未闭;经导管封堵术;并发症
基金项目(Foundation):
作者(Author): 何璐,张玉顺
参考文献(References):
- [1]张玉顺,朱鲜阳.RESPECT远期随访结果能否结束PFO封堵疗效的争论?心脏杂志,2016,28(4):377-379.
- [2]Kuijpers T,Spencer FA,Siemieniuk RAC,et al.Patent foramen ovale closure,antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke?A clinical practice guideline.Brit Med J,2018,362:k2515.
- [3]Mas JL,Derumeaux G,Guillon B,et al.Patent foramen ovale closure or anticoagulation vs.antiplatelets after stroke.N Engl JMed,2017,377(11):1011-1021.
- [4]S?ndergaard L,Kasner SE,Rhodes JF,et al.Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke.N Engl J Med,2017,377(11):1033-1042.
- [5]Saver JL,Carroll JD,Thaler DE,et al.Long-term outcomes of patent foramen ovale closure or medical therapy after stroke.N Engl J Med,2017,377(11):1022-1032.
- [6]杜亚娟,张玉顺,成革胜.TTE结合c TTE在成人PFO诊断及分流方向判定中的应用研究.中国超声医学杂志,2014,30(9):800-803.
- [7]Yue L,Zhai YN,Wei LQ.Which technique is better for detection of right-tolef t shunt in patients with patent f oramen ovale comparing contrast transthoracic echocardiography with contrast transesophageal.Echocardiography,2014,31(9):1050-1055.
- [8]张玉顺,朱鲜阳,孔祥清,等.卵圆孔未闭预防性封堵术中国专家共识.心脏杂志,2017,32(3):209-214.
- [9]Khairy P,O'Donnell CP,Landzberg MJ.Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli:a systematic review.Ann Intern Med,2003,139(9):753-760.
- [10]Wang JK,Tsai SK,Wu MH,et al.Short-and intermediate-term results of transcatheter closure of atrial septal defect with the amplatzer septal occluder.Am Heart J,2004,148(3):511-517.
- [11]Amin Z,Hijazi ZM,Bass JL,et al.PFO closure complications from the AGA registry.Catheter Cardiovasc Interv,2008,72(1):74-79.
- [12]Amin Z,Hijazi ZM,Bass JL,et al.Erosion of amplatzer septal occluder device after closure of secundum atrial septal defects:review of registry of complications and recommendations to minimize future risk.Catheter Cardiovasc Interv,2004,63(4):496-502.
- [13]Heinisch C,Bertog S,Wunderlich N,et al.Percutaneous closure of the patent foramen ovale using the HELEX septal occluder:acute and long-term results in 405 patients.EuroIntervention,2012,8(6):717-723.
- [14]Staubach S,Steinberg DH,Zimmermann W,et al.New onset atrial fibrillation after patent foramen ovale closure.Catheter Cardiovasc Interv,2009,74(6):889-895.
- [15]Furlan AJ,Reisman M,Massaro J,et al.Closure or medical therapy for cryptogenic stroke with patent foramen ovale.N Engl JMed,2012,366(11):991-999.
- [16]Meier B,Kalesan B,Mattle HP,et al.Percutaneous closure of patent foramen ovale in cryptogenic embolism.N Engl J Med,2013,368(12):1083-1091.
- [17]Taaffe M,Fischer E,Baranowski A,et al.Comparison of three patent foramen ovale closure devices in a randomized trial(amplatzer versus cardioseal-starflex versus helex occluder).Am J Cardiol,2008,101(9):1353-1358.
- [18]Alaeddini J,Feghali G,Jenkins S,et al.Frequency of atrial tachyarrhythmias following transcatheter closure of patent foramen ovale.J Invasive Cardiol,2006,18(8):365-368.
- [19]Johnson JN,Marquardt ML,Ackerman MJ,et al.Electrocardiographic changes and arrhythmias following percutaneous atrial septal defect and patent foramen ovale device closure.Catheter Cardiovasc Interv,2011,78(2):254-261.
- [20]Hornung M,Bertog SC,Franke J,et al.Long-term results of a randomized trial comparing three diff erent devices for percutaneous closure of a patent foramen ovale.Eur Heart J,2013,34(43):3362-3369.
- [21]Furlan AJ,Reisman M,Massaro J,et al.Closure or medical therapy for cryptogenic stroke with patent foramen ovale.N Engl JMed,2012,366(11):991-999.
- [22]Marchese N,Pacilli MA,Inchingolo V,et al.Residual shunt after percutaneous closure of patent foramen ovale with AMPLATZERoccluder devices-influence of anatomic features:a transcranial doppler and intracardiac echocardiography study.Euro Intervention,2013,9(3):382-388.
- [23]黄浩佳,胡海波.经导管卵圆孔未闭封堵术后残余分流影响因素及研究现状分析.心血管病学进展,2017,38(3):243-246.
- [24]Abaci A,Unlu S,Alsancak Y,et al.Short and long term complications of device closure of atrial septal defect and patent foramen ovale:meta-analysis of 28,142 patients from 203 studies.Catheter Cardiovasc Interv,2013,82(7):1123-1128.