卵圆孔未闭封堵术争论与发展PPT课件.ppt

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 2019; 33: 268. Medina et al. Circulation 2019; 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 2019; 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 surgery. However, passages of small emboli are impossible to prove. Higher CVA/TIA Recurrence Rate in Patients with PFO + ASA Mas et al. NEJM 2019; 345: 1740-6. 581 patients with cryptogenic stroke All treated with aspirin PFO相关临床综合症 体位相关呼吸困难 Platypnea orthodeoxia 减压病/高原性肺水肿 脑血管事件/TIA 偏头痛 Platypnoea Orthodeoxia 罕见 直立体位引起的呼吸困难，伴有低氧血症 机制：右向左房间分流 Aigner et al. Eur J Cardiothor Surg 2019; 33: 268. Medina et al. Circulation 2019; 104: 741. Platypnea Orthodeoxia 1949年至今已有文献报道近100例 PFO 常伴有: 主动脉瘤 胸廓畸形 肺切除术后 约50例已接受封堵术 减压病 对230名 无症状潜水者进行研究 27% 有PFO 需要减压舱治疗者: 19% 有PFO 2% 无 PFO Torti et al. Eur Heart J 2019; 25: 1014-20. 隐匿性脑卒中 40岁男性，突发失语 既往史无特殊. 无明显脑卒中病因. TEE: 发现房间隔瘤与 PFO. 常见伴发症: 50% 隐匿性脑卒中患者有 PFO. 推测机制: 静脉血栓反常性体循环栓塞症. PFO 通道内原位血栓形成造成栓塞 血栓流经 PFO 首例 PFO伴血栓形成报道于1876. 既往通过超声心动图及术中见到嵌顿于PFO的血栓. 但无法观察到小栓子的流程。 服用阿司匹林的PFO患者脑血管事件