卵圆孔未闭封堵术争论与发展（中英文）课件.pptVIP

CLOSURE originally 1600 patients, now FDA allowed reduction to 900. Enrolled 700. Metallic wires and synthetic fabrics. BioSTAR uses acellular porcine intestinal collagen layer matrix mounted on a STAR-flex device. Patent Foramen Ovale Closure:Controversies and Accomplishments May 9, 2009 Andrew D. Michaels, MD, MAS, FACC, FAHA Director, Cardiac Catheterization Laboratory and Interventional Cardiology University of Utah, Salt Lake City, Utah Fetal Circulation During fetal life, oxygenated blood returning from the umbilical vein enters the RA through the IVC. Blood flow is directed by the Eustachian valve from the IVC to the fossa ovalis and through the PFO. Post-Natal Septal Development In Utero After Birth Hagen, Scholz. Mayo Clin Proc 1984; 59: 17-20. 75% of Population 25% of Population Clinical Syndromes Associated with PFO Platypnea orthodeoxia Decompression sickness/high-altitude pulmonary edema CVA/TIA Migraine Platypnoea Orthodeoxia Uncommon syndrome Dyspnea induced by upright posture, with associated hypoxemia Mechanism: right-to-left interatrial shunting Aigner et al. Eur J Cardiothor Surg 2008; 33: 268. Medina et al. Circulation 2001; 104: 741. Platypnea Orthodeoxia ~100 cases in literature since 1949 PFO associated with: Aortic aneurysm Chest deformity Post-pneumonectomy ~50 have undergone device closure Decompression Sickness 230 asymptomatic divers surveyed 27% had a PFO Decompression chamber required: 19% with a PFO 2% without a PFO Torti et al. Eur Heart J 2004; 25: 1014-20. Cryptogenic Stroke Case 40 yo man with sudden aphasia. No medical history. No obvious cause of stroke. TEE: atrial septal aneurysm and PFO. Associations: 50% of people with cryptogenic stroke have a PFO. Presumed mechanism: Paradoxical embolism of venous thrombus. In-situ thrombosis within PFO tunnel with embolization. Thrombus in transit through PFO First case of PFO with thrombus described in 1876. Thrombus caught in PFO has been seen by echo and at surge