栗政伟,胡海波,潘湘斌

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心

摘要(Abstract)：

卵圆孔未闭（PFO）是一种常见的先天性心脏病，已被证实与隐源性脑卒中、先兆性偏头痛、减压病等多种疾病有关。随着介入心脏病学的飞速发展，介入治疗已经成为PFO患者的首选技术。传统的PFO闭合术多采用金属盘状封堵器，虽然手术效果很好，但是与器械相关的并发症不可避免。因此，急需一种无需永久置入封堵器的经皮PFO封堵策略，实现“介入无置入，置入无残留”的绿色理念，以克服传统PFO封堵器的局限性。经导管PFO缝合术是一种更加符合PFO闭合解剖生理的技术，能够克服传统PFO封堵术的许多器械相关并发症，具有良好的安全性及有效性。本文对经导管PFO缝合术的相关研究进展进行综述，以期为临床上对这类疾病的处理提供新的思路。

关键词(KeyWords)： 卵圆孔未闭;经导管缝合;器械相关并发症;介入无置入

Abstract:

Keywords:

基金项目(Foundation): 北京市科学技术委员会“首都临床特色诊疗技术研究与转化应用”专项基金项目（Z201100005520075）;; 中国医学科学院中央级公益性科研院所基本科研业务费（2022-RW320-09）

作者(Author): 栗政伟,胡海波,潘湘斌

参考文献(References)：

• [1]刘亚洋,李鹤,朱源生.卵圆孔未闭封堵术中心腔内超声的临床应用价值研究[J].中国介入心脏病学杂志,2023,31(5):333-338.DOI:10.3969/j.issn.1004-8812.2023.05.003.
• [2]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:10.12125/j.chj.202101022.
• [3]McKenzie JA,Edwards WD,Hagler DJ.Anatomy of the patent foramen ovale for the interventionalist[J].Catheter Cardiovasc Interv,2009,73(6):821-826.DOI:10.1002/ccd.21889.
• [4]邱林,朱航,马为,等.卵圆孔未闭相关疾病研究2023年度进展[J].中国介入心脏病学杂志,2024,32(1):9-13.DOI:10.3969/j.issn.1004-8812.2024.01.003.
• [5]Maron BA,Shekar PS,Goldhaber SZ.Paradoxical Embolism[J].Circulation,2010,122(19):1968-1972.DOI:10.1161/CIRCULATIONAHA.110.961920.
• [6] Nakayama R,Takaya Y,Akagi T,et al.Identification of highrisk patent foramen ovale associated with cryptogenic stroke:development of a scoring system[J].J Am Soc Echocardiogr,2019,32(7):811-816.DOI:10.1016/j.echo.2019.03.021.
• [7]Lee PH,Song JK,Kim JS,et al.Cryptogenic stroke and highrisk patent foramen ovale:the DEFENSE-PFO trial[J].J AmColl Cardiol,2018,71(20):2335-2342.DOI:10.1016/j.jacc.2018.02.046.
• [8]Kent DM,Saver JL,Kasner SE,et al.Heterogeneity of treatment effects 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.
• [9]Iskander B,Anwer F,Oliveri F,et al.Amplatzer patent foramen ovale occluder device-related complications[J].Cureus,2022,14(4):e23756.DOI:10.7759/cureus.23756.
• [10]Onorato EM,Grancini L,Monizzi G,et al.Noblestitch~?system for PFO clo sure:a novel but judicious alternative to traditional devices-a case report[J].Front Cardiovasc Med,2023,10:1095661.DOI:10.3389/fcvm.2023.1095661.
• [11]Neto A,Resende CX,Tavares Silva M,et al.A new era in patent foramen ovale closure-a percutaneous suture-based'deviceless'technique(NobleStitch~?):experience of a Portuguese center[J].Rev Port Cardiol,2023,42(1):53-59.DOI:10.1016/j.repc.2021.08.015.
• [12] Cannata F,Stankowski K,Donia D,et al.Percutaneous suture-based patent foramen ovale closure:a state-of-the-art review[J].Trends Cardiovasc Med,2024,34(6):404-413.DOI:10.1016/j.tcm.2023.10.004.
• [13]Gaspardone A,De Marco F,Sgueglia GA,et al.Novel percutaneous suture-mediated patent foramen ovale closure technique:early results of the NobleStitch EL Italian Registry[J].EuroIntervention,2018,14(3):e272-e279.DOI:10.4244/EIJ-D-18-00023.
• [14]潘湘斌,李泽夫.中国原创心血管器械研发的新领域——室间隔缺损可降解封堵器获批上市的启示[J].中国循环杂志,2022,37(8):766-768.DOI:10.3969/j.issn.1000-3614.2022.08.002.
• [15]Ruiz CE,Kipshidze N,Chiam PT,et al.Feasibility of patent foramen ovale closure with no-device left behind:firstin-man percutaneous suture closure[J].Catheter Cardiovasc Interv,2008,71(7):921-926.DOI:10.1002/ccd.21550.
• [16]Gaspardone A,Sgueglia GA,De Santis A,et al.Predictors of residual right-to-left shunt after percutaneous suturemediated patent fossa ovalis closure[J].JACC Cardiovasc Interv,2020,13(18):2112-2120.DOI:10.1016/j.jcin.2020.06.004.
• [17] Stout PA,Tabrizi NS,Tribble M,et al.NobleStitch patent foramen ovales closure for recurrent strokes in a patient with COVID-19 on extracorporeal membrane oxygenation[J].J Cardiothorac Vasc Anesth,2023,37(2):261-265.DOI:10.1053/j.jvca.2022.10.014.
• [18]Chaudhry-Waterman N,Shapiro S,Thompson J.U se of the NobleStitch~(TM)EL for the treatment of patients with residual right-to-left shunt following device closure of PFO[J].Clin Case Rep,2021,9(4):1929-1932.DOI:10.1002/ccr3.3906.
• [19]Giordano M,Gaio G,Marzullo R,et al.Patent foramen ovale closure with NobleStitch EL system in a case of Ebstein's anomaly after a failed device closure attempt[J].J Cardiovasc Med(Hagerstown),2024,25(7):559-562.DOI:10.2459/JCM.0000000000001615.
• [20]Beneduce A,Ancona MB,Moroni F,et al.A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure[J].EuroIntervention,2022,18(1):63-67.DOI:10.4244/EIJ-D-21-00242.
• [21]Zannoni J,Popolo Rubbio A,Tusa MB,et al.Mechanisms of ineffective patent foramen ovale closure using the percutaneous suture-mediated NobleStitch system[J].Euro Intervention,2022,18(1):68-70.DOI:10.4244/EIJ-D-21-01021.
• [22] Scoccia A,Ielasi A,Laricchia A,et al.Percutaneous suture-based closure of patent foramen ovale:initial results of a multi-center experience in a highly selected population[J].Cardiovasc Revasc Med,2022,43:147-149.DOI:10.1016/j.carrev.2022.03.031.
• [23]Witte LS,Renkens MPL,Gasecka A,et al.Anatomical predictors for suture-based closure of the patent foramen ovale:a multicenter experience[J].Catheter Cardiovasc Interv,2023,102(2):273-280.DOI:10.1002/ccd.30691.
• [24]Gaetti G,Beneduce A,La Fauci D,et al.Suturemediated patent foramen ovale closure using the NobleStitch EL:results from a hospital-based HTA[J].Int J Environ Res Public Health,2022,19(13):7863.DOI:10.3390/ijerph19137863.
• [25] Gaspardone A,Cinque A,Beggio E,et al.Percutaneous suture-mediated patent foramen ovale closure:two-year clinical follow-up[J].Minerva Cardiol Angiol,2023,71(2):169-174.DOI:10.23736/S2724-5683.21.05718-5.
• [26]Gaspardone A,Sgueglia G A,Gaspardone C,et al.A new echocardiographic index to select patients for PFO suturemediated percutaneous closure[J].Catheter Cardiovasc Interv,2023,101(5):837-846.DOI:10.1002/ccd.30604.
• [27]Gaio G,Giordano M,Fusco F,et al.Combined use of Noblestitch EL system and amplatzer device to close a patent foramen ovale with complex anatomy[J].Can J Cardiol,2023,39(5):700-702.DOI:10.1016/j.cjca.2023.02.009.
• [28] Poulin MF,Kavinsky CJ.Refining the NobleStitch PFO closure technique using an anatomy-tailored approach[J].Catheter Cardiovasc Interv,2023,101(7):1245-1246.DOI:10.1002/ccd.30661,
• [29]Kluck B,Ramic D,Gupta R.Achieving PFO closure with the NobleStitch Technique[J].Catheter Cardiovasc Intery,2023,102(2):281-282.DOI:10.1002/ccd.30748.