The influence of characteristics of patent foramen ovale on percutaneous interventional occlusion
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摘要: 目的 探讨经皮卵圆孔未闭(patent foramen ovale，PFO)介入封堵术中影响通过PFO的相关因素。 方法 纳入在我院确诊PFO并行经皮介入封堵术患者183例，收集患者的基本特征、经食管心脏超声心动图、经胸右心声学造影(transthroracic contrast echocardiography，cTTE)、术中血流动力学等参数。以导管通过PFO时间60 s为截点，将患者分成容易通过组和非容易通过组，比较两组患者临床资料。使用logistic回归分析确定影响通过PFO的独立危险因素。 结果 容易通过组的左心房面开口[(1.4±0.8) mm vs (0.8±0.6) mm]和右心房面开口[(1.9±1.6) mm vs (0.9±0.6) mm]均显著大于非容易通过组(均P＜0.05)。静息状态和VALSAVA状态下两组患者右向左分流(right to left shunt，RLS)等级构成均差异有统计学意义(均P＜0.05)。两组患者的隧道长度、术中心率、血压、肺动脉压力等参数均差异无统计学意义。多因素logistic回归分析显示，VALSAVA状态RLS≥2级是经皮介入封堵术中影响PFO通过的独立危险因素(OR=31.59，95%CI：7.61~131.17，P＜0.01)。 结论 cTTE评估的RLS等级作为独立影响因子预测介入封堵术中通过PFO的难易程度具有一定价值。Abstract: Objective To investigate factors that affecting passage through the patent foramen ovale (PFO) during percutaneous interventional occlusion. Methods A total of 183 patients who were diagnosed with PFO and underwent percutaneous interventional occlusion in our hospital were included. Basic characteristics, parameters of transesophageal echocardiography, transthoracic contrast echocardiography (cTTE), and intraoperative hemodynamics were collected. Patients were divided into easy passage and non-easy passage groups based on catheter passage through the PFO (within 60 seconds). Clinical data between the two groups were compared. Results In the easy passage group, the opening size of left atrium and right atrium was (1.4±0.8)mm and (1.9±1.6)mm, respectively, which were significantly larger than those [left atrium (0.8±0.6) mm, right atrium (0.9±0.6) mm] in the non-easy passage group (both P < 0.05). There were significant differences in the composition of right to left shunt (RLS) grades in the resting and VALSAVA states between the two groups (both P < 0.05). However, there was no statistical difference in the parameters of tunnel length, heart rate, blood pressure, and pulmonary artery pressure. Multivariate logistic regression analysis showed that RLS grade (VALSAVA status) ≥2 was an independent risk factor on the passage time of PFO in the percutaneous occlusion surgery (OR=31.59, 95%CI: 7.61-131.17, P < 0.01). Conclusion RLS evaluated by cTTE as an independent influencing factor has predictive value for the difficulty of PFO passage during interventional occlusion.
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表 1 患者基本资料
Table 1. Basic characteristic of enrolled patients
例(%), X±S 项目 数据 人口学特征 女性 122(66.7) 年龄/岁 42.6±13.0 BMI/(kg/m2) 23.0±3.4 PFO相关结构 隧道长度/mm 9.8±4.3 左房面开口/mm 1.3±0.8 右房面开口/mm 1.8±1.5 膨出瘤 10(5.5) 欧式瓣 3(1.6) RLS分流量 静息状态 0级 73(39.9) 1级 44(24.0) 2级 23(12.6) 3级 43(23.5) VALSAVA状态 0级 3(1.6) 1级 12(6.6) 2级 17(9.3) 3级 151(82.5) 右心导管测压 PASP/mmHg 27.0±4.9 mPAP/mmHg 17.5±3.1 术中心率/(次/min) 74.6±10.2 术中收缩压/mmHg 125.8±16.2 术中舒张压/mmHg 77.3±10.2 PFO成功封堵 177(96.7) 1 mmHg=0.133 kPa。PASP：肺动脉收缩压；mPAP：肺动脉平均压。 
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表 2 两组患者的临床资料比较
Table 2. Comparison of characteristic between groups
例(%), X±S 项目 容易通过组(164例) 非容易通过组(19例) P 女性 110(67.1) 12(63.2) 0.730 年龄/岁 42.6±13.1 42.3±13.1 0.920 BMI/(kg/m2) 23.0±3.5 23.1±3.2 0.910 隧道长度/mm 9.9±4.3 8.9±4.5 0.310 左房面开口/mm 1.4±0.8 0.8±0.6 0.003 右房面开口/mm 1.9±1.6 0.9±0.6 0.009 膨出瘤 10(6.1) 0 0.270 RLS分流量 静息状态 0.003 0级 58(35.4) 15(78.9) 1级 42(25.6) 2(10.5) 2级 22(13.4) 1(5.3) 3级 42(25.3) 1(5.3) VALSAVA状态 ＜0.001 0级 1(0.6) 2(10.5) 1级 4(2.4) 8(42.1) 2级 14(8.5) 3(15.8) 3级 145(88.4) 6(31.6) PASP/mmHg 27.0±4.8 27.3±5.9 0.540 mPAP/mmHg 17.5±3.1 17.3±3.0 0.820 术中心率/(次/min) 74.6±10.3 74.5±9.1 0.980 术中收缩压/mmHg 125.3±16.2 129.9±15.6 0.240 术中舒张压/mmHg 77.2±10.2 77.9±9.8 0.770
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表 3 影响PFO通过的logistic回归分析结果
Table 3. Logistic regression analysis results of factors affecting passage through PFO
变量 单因素分析 多因素分析 OR 95%CI P OR 95%CI P 右房面开口 2.80 1.44~5.44 0.002 1.24 0.23~6.76 0.810 左房面开口 3.76 1.62~8.72 0.002 2.76 0.68~11.28 0.160 RLS分流量(静息状态)≥2级 5.44 1.22~24.34 0.027 2.01 0.38~10.72 0.410 RLS分流量(VALSAVA状态)≥2级 35.33 9.96~125.35 ＜0.001 31.59 7.61~131.17 ＜0.010 隧道长度 1.07 0.94~1.21 0.310 心率 1.00 0.96~1.05 0.983 BMI 0.99 0.86~1.14 0.913
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