罗东,关璐茜,刘美君,陈宜婷,潘湘斌,胡海波

• 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)：

目的 探讨再次经导管介入封堵术治疗卵圆孔未闭（PFO）封堵术后残余右向左分流（rRLS）的近中期临床疗效。方法 回顾性纳入2021年7月至2025年8月在中国医学科学院阜外医院接受二次经导管介入封堵尝试的PFO封堵术后残余分流患者22例。术后即刻行房间隔选择性造影及右心声学造影检查判断即刻封堵效果，术后1、3、6、12个月行常规超声心动图、心电图、胸部X片检查及临床随访观察。分析rRLS再次介入封堵治疗的技术成功率、完全封堵率及随访期间临床症状改善情况。结果 22例rRLS患者中封堵成功13例，技术成功率为59.1%(13/22)。所用封堵器械包括Ⅱ代动脉导管未闭封堵器（ADOⅡ）9例、传统金属PFO封堵器3例及生物可降解PFO封堵器1例。9例封堵失败的rRLS患者中，8例继续接受药物治疗，1例行外科手术治疗。13例封堵成功患者术后即刻行cTTE检查均提示rRLS消失（0级分流），平均随访6～56(18.41±14.74)个月。末次随访cTTE检查证实，11例实现完全封堵（0级分流）且偏头痛、短暂性脑缺血发作等神经系统症状较术前均有明显改善；1例出现少量rRLS（Ⅰ级分流）但偏头痛症状未改善；1例术后6个月出现大量rRLS（Ⅲ级分流）但经利伐沙班治疗后较术前有明显缓解。封堵成功的患者临床症状改善率为92.3%(12/13)。术中及随访期间未出现再发脑卒中、封堵器脱落、心包积液、感染性心内膜炎、心房颤动等严重并发症。结论 对于伴有临床症状的PFO封堵术后rRLS患者，再次经导管介入治疗是安全有效的，近中期疗效良好，可显著改善患者相关临床症状，降低再发脑卒中风险。

关键词(KeyWords)： 卵圆孔未闭;残余分流;介入治疗

Abstract:

Keywords:

基金项目(Foundation): 北京市科技计划“首都临床诊疗技术研究及转化应用”专项基金项目（Z201100005520075）

作者(Author): 罗东,关璐茜,刘美君,陈宜婷,潘湘斌,胡海波

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