Evaluating the clinical efficacy of right atrial angiography in the transcatheter closure of patent foramen ovale
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摘要: 目的 探讨右心房造影在卵圆孔未闭(PFO)介入封堵术中的临床应用价值。方法 选择2021年1月—2021年9月于我院行介入封堵术的PFO患者185例。经右股静脉送6F猪尾巴导管至右心房行高压造影(投照体位LAO450+CRA10-150，对比剂量25 mL，压力500 PSI，注射速率18 mL/s)，初步显示PFO的位置、形态及有无并发房间隔缺损等，测量其直径；使用多功能端侧孔导管从右心房顺利通过PFO至左心房，通过手推对比剂(8~10 mL)行选择性造影，显示PFO的直径、形态，并再次测量。选择合适的封堵器，建立静脉输送轨道并送入封堵器输送系统，释放封堵器前再次行右心房造影明确是否存在房间隔残余分流。术后3 d、1个月和3个月复查心脏彩超，并于术后6个月复查发泡试验。结果 右心房造影可清晰显示PFO，其中隧道型106例(57.30%)，火山口型56例(30.27%)，裂隙型23例(12.43%)。此外，术中发现8例合并小的继发房间隔缺损；右心房造影与选择性造影测量PFO直径无统计学差异[(3.12±0.98) mm∶(3.06±0.65) mm，P＞0.05]。根据造影结果，直径 < 3 mm者选择18/18 mm封堵器(2例)，直径3~4 mm者选用18/25 mm封堵器(112例)或25/25 mm封堵器(60例)；直径>5 mm或合并小房间隔缺损者选用30/30 mm封堵器(7例)或25/35 mm封堵器(4例)。所有病例封堵成功，造影证实封堵效果满意，未见残余分流。术后3 d复查心脏彩超提示封堵器位置、形态良好，未出现心包积液、残余分流等。随访6个月，患者无恶性心律失常、脑卒中与偏头痛复发。结论 右心房造影安全有效，可清晰显示PFO位置、形态及大小，精准引导导管通过PFO通道。Abstract: Objective To evaluate the clinical efficacy of right atrial angiography in the transcatheter closure of patent foramen ovale(PFO).Methods A total of 185 PFO patients received percutaneous closure were selected in our hospital from January 2021 to September 2021. A 6F pig tail catheter was sent to the right atrium via the right femoral vein for high pressure right atrial angiography(RAG)(position LAO450+CRA100-150, contrast dose 25 ml, pressure 500PSI, injection rate 18 ml/s), which initially showed the location, shape, and presence or absence of atrial septal defect, then the diameter of PFO was measured. Multifunctional catheter was used to smoothly through the PFO from the right atrium to the left atrium, and the hand-pushing contrast agent(8-10 ml) was conducted to selectively measure the diameter of PFO. We selected the suitable occluder, and established the venous delivery track and sent it to the occluder delivery system. RAG was conducted again to inspect whether there is residual atrial septal shunt before releasing the occluder. Transthoracic echocardiography(TTE) was re-examined at 3 days, 1 month, and 3 months after surgery, and the foaming experiment was re-examined 6 months after surgery.Results RAG can clearly show PFO, including 106 cases(57.30%) of tunnel tube type, 56 cases(30.27%) of crater type, and 23 cases(12.43%) of fissure type. In addition, 8 cases with small secondary atrial septal defect were found during the operation. There was no statistical difference between the PFO diameter measured by RAG and selectively angiography[(3.12±0.98) mm vs. (3.06±0.65) mm,P> 0.05]. According to RAG, 18/18 mm occluders(2 cases) were selected for those with a diameter of < 3 mm, 18/25 mm(112 cases) or 25/25 mm occluders(60 cases) were selected for those with a diameter of 3-4 mm; 30/30 mm(7 cases) or 25/35 mm occluder(4 cases) were selected for those with a diameter>5 mm or combined small atrial septal defect, respectively. All cases were successfully completed transcatheter closure, the satisfactory effect of operation was confirmed by angiography and there was no residual shunt. Re-examination of TTE indicated that the position and shape of the occluder were normal, without any pericardial effusion or residual shunt. During the 6-month follow-up, no malignant arrhythmia, stroke or migraine recurrence were reported.Conclusion RAG is safety and effectively. It can clearly show the position, shape and diameter of the PFO, and accurately guide the catheter through the PFO channel.
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图 1 RAG示意图和RAG时右房压力测定
Figure 1. Schematic diagram of RAG and measurement of right atrial pressure during RAG
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