卵圆孔未闭经胸超声心动图声学造影及经食管超声心动图的单中心诊断数据分析

目的对卵圆孔未闭（PFO）的经胸超声心动图声学造影（cTTE）及经食管超声心动图（TEE）诊断数据进行分析，探讨cTTE和TEE检查的结果和临床意义。 方法回顾性选取2014年8月至2019年6月疑诊PFO相关疾病、在解放军总医院第一医学中心超声诊断科行cTTE及TEE检查的患者1164例。分析TEE、cTTE及二者联合方法对PFO的检出率，cTTE对右向左分流起源以及分流量的诊断评估结果，TEE对PFO形态结构特点的诊断结果。 结果1164例患者分为先兆偏头痛（MA）组314例、无先兆偏头痛（MO）组219例、隐源性脑梗死（CCI）和（或）短暂性脑缺血发作（TIA）组279例和其他病变组352例。cTTE和（或）TTE检出PFO 282例（282/1164，24.2%）。4组不同临床分组间PFO检出率差异有统计学意义（χ²=17.94，P<0.001），其中MA患者PFO检出率最高（98/314，31.2%）。1164例患者中764例接受了cTTE检查，检出PFO170例（170/764，22.3%）；816例患者接受了TEE检查，检出PFO 221例（221/816，27.1%）。412例患者接受了cTTE和TEE联合检查，检出PFO125例（125/412，30.3%）。接受cTTE检查的764例患者中，cTTE检出右向左分流者474例（474/764，62.0%）。其中170例PFO右向左分流患者中，分流量为大量者居多（101/170，59.4%）；383例肺循环右向左分流患者中，分流量为少量者居多（185/383，48.3%）；79例二者合并存在者，分流量为大量者居多（54/79，68.4%）。TEE检出的221例PFO患者中，均可记录PFO宽度，平均宽度为（1.61±0.92）mm，狭长形态PFO78例，平均长度为（10.53±3.52）mm。TEE检出分流132例，其中左向右分流122例，右向左分流1例，双向分流9例；检出房间隔膨胀瘤14例，左心房房间隔袋20例，瓣膜丝状物41例。 结论MA、CCI和（或）TIA患者PFO检出率高于MO和其他疾病患者。TEE与cTTE联合应用可提高PFO检出率。cTTE对于右向左分流的检出以及右向左分流起源的判断具有重要价值。PFO相关疾病患者中，PFO右向左分流多为大量，半数以上存在肺循环右向左分流，在检查中需注意鉴别。

Transthoracic contrast echocardiography and transoesophageal echocardiography for diagnosis of patent foramen ovale: a single-center data analysis

ObjectiveTo retrospectively analyze the diagnostic value of transthoracic contrast transthoracic echocardiography (cTTE) and transoesophageal echocardiography (TEE) in patients with clinically suspected patent foramen ovale (PFO). MethodsThe data of cTTE and TEE examinations in 1164 patients with suspected PFO-related diseases at the Department of Ultrasound of the First Medical Center of the PLA General Hospital from August 2014 to June 2019 were retrospectively analyzed. TEE, cTTE, and a combination of the two were used to detect PFO.The diagnostic performance of cTTE for right-to-left shunt and shunt flow, and that of TEE for the morphological and structural characteristics of PFO were analyzed. ResultsThere were 314 cases of migraine with aura(MA), 219 cases of migraine without aura (MO), 279 cases of cryptogenic cerebral infarction (CCI) and/or transient is chemic attack (TIA), and 352 cases of other diseases. A total of 282 (24.2%) cases of PFO were detected in 1164 patients. The difference in PFO detection rate between the four clinical groups was statistically significant (χ²=17.94, P<0.001), with the highest PFO detection rate observed in patients with MA (98/314, 31.2%). Of the 1164 patients, 764 underwent cTTE and 170 (170/764, 22.3%) PFOs were detected; 816 underwent TEE and 221 (221/816, 27.1%) PFOs were detected; 412 underwent combined cTTE and TEE examinations and 125(125/412, 30.3%) PFOs were detected. Of the 764 patients who underwent cTTE examination, 474 (474/764, 62.0%) had a right-to-left shunt in cTTE. Among the 170 patients with right-to-left shunt, 101(101/170, 59.4%) had a large amount of shunt flow (101/170, 59.4%); among 383 patients with pulmonary circulation-related right-to-left shunt, 185(185/383, 48.3%) had a small amount of shunt flow; among 79 patients with bidirectional shunt, 54(54/79, 68.4%) had a large amount of shunt flow. PFO width could be recorded in all 221 PFO patients detected by TEE, with an average width of (1.61±0.92) mm, and 78 cases of narrow and long PFO, with an average length of about (10.53±3.52) mm. The shunt was detected by TEE in 132 cases, of which 122 had a left-to-right shunt, 1 had a right-to-left shunt, and 9 had a bidirectional shunt. In addition, 14 cases of atrial septal aneurysm, 20 cases of left atrial septal pouch, and 41 cases of valve filaments were observed. ConclusionThe detection rate of PFO in patients with MA and CCI and/or TIA is significantly higher than that in patients with MO and other diseases. The combination of TEE and cTTE can improve the detection rate of PFO. The detection of right-to-left shunt and its origin mainly relies on cTTE. Most of the PFO-related right-to-left shunt in PFO-related diseases are medium-large. More than half of patients with PFO-related diseases have a pulmonary circulation-related right-to-left shunt, which highlights the importance of differential diagnosis between the two forms of shunt.