The Study Of Transcatheter Closure In Migraine Patients With Patent Foramen Ovale

Background:Migraine is a common episodic neurovascular disorder, which affects the life and work of the patients seriously. Patent foramen ovale(PFO) is a congenital cardiac disorder that the septum primum and septum secondum incomplete merge resulting in the patency. The incidence is about 25% in the general population. In recent years, more and more studies have suggested a close relationship between migraine and PFO. With the advent of modern intravascular procedures, PFO closure has be used in the treatment of migraine widely,but the clinical effect in dispute still need further discussion and research.Objective:This study through the follow-up and evaluation of the degree of headache relief in migraine patients with PFO who received treatment of transcatheter closure.To evaluate the effect of transcatheter closure in migraine patients with PFO, and to investigate the relationship between migraine and PFO.Methods: Patients with migraine diagnosed in our hospital were collected from March 2014 to March 2015,who were conformed to diagnostic criteria of the International Classification of Headache Disorders 2nd edition(ICHD-II) – 2004 recognizes of migraine with aura(MA) and migraine without aura(MO). The right heart contrast echocardiograp was performed using 8ml physiological saline+1ml air +1 drop autologous venous blood were rapidly administrated through an antecubital vein after at rest or during Valsalva manoeuvre. According to whether microbubble appearing in left atrium after complete opacification of right atrium within 3~5 circles, the results were classified by a four-level semi-quantitative categorization,and further confirmed by the transesophageal echocardiography(TEE) confirmed then measure and record the size of PFO. Right heart contrast echocardiography and TEE were conducted by the physician after formal training. 56 patients who were diagnosed the PFO and agree transcatheter therapy in the cases were taken the percutaneous transcatheter closure therapy in the department of cardiology of the hospital. There were 35 cases of MA, male 13,female 22, mean age(43.74±7.72)ys, 21 cases of MO, male 7, female 14, mean age(42.90±7.84)ys.Transthroracic echocardiography(TTE) were used for guidence in the transcatheter therapy.TTE was hold on at 1 month after the transcatheter closure.The right heart contrast echocardiogray and the head CT were screened at 6 months after transcatheter closure.The nerve specialist fill in registration form after unified training, including the basic information of the patients(such as name, age and gender,past medical history and medication history, etc.) and a review of the headache.The Headache Impact Test-6(HIT-6) score was measured before and at 1,3,6,12 months after closure in all patients. We compared the HIT-6 scores before and after closure,and analyzed the HIT-6 in groups in corresponding time. Make correlation analysis between the HIT-6 score and the size of PFO preoperatively.Results: 56 patients were operated successfully.No residual shunt was detected by TEE at 1 month after transcatheter closure. There were 4 patients still existing a RLS by right heart contrast echocardiography,1 case existing a RLS after Valsalva manoeuvre. No new stroke was detected by CT at 6 months after transcatheter closure. No obvious complications occurred in traoperative and postoperative. The HIT-6 score at 1 month(56.86±5.40),3 months(51.54±5.58),6 months(48.46±6.89),12 months(43.77±6.47) after closure compared with the before(57.97±6.47)were reduced in MA gronp, the difference were statistically significant(p < 0.05 in all). The HIT-6 score at 1 month(54.24±4.69)after closure were no significant decreased compared with the before(55.43±6.07)in MO gronp, The difference has no statistically significant(P > 0.05). And at 3 months( 51.38±4.59, 6 months(51.67±4.65),12 months(49.29±4.94)after closure were reduced, the difference were statistically significant(p < 0.05 in all).Compared between groups, The HIT-6 score reduced at 6 months(48.46±6.89),12 months(43.77±6.47) after closure in MA gronp compared with the HIT-6 score in MO group at 6 months(51.67±4.65),12 months(49.29±4.94)after closure were reduced,the difference were statistically significant(p < 0.05 in all). The degree of two groups with headache impacted daily life and the size of PFO has no obvious correlation(P > 0.05).Conclusion:1. PFO with RLS is one of the mechanism of migraine,but the exact mechanism needed to be confirmed by large sample and further clinical research.2. Transcatheter closure can terminate or ease headache symptoms in migraine patients with PFO, and has an obvious effect in MA.3. There was no obvious correlation between the degree of migraine headache and the size of PFO.