The Value Of Contrast-enhanced Ultrasound In Diagnosis Of Patent Foramen Ovale And The Follow-up Study Of Interventional Closure Of Patent Foramen Ovale

Part I The Value of Contrast-enhanced Ultrasound in Diagnosis of Patent Foramen Ovale Objective:To explore the value of contrast-enhanced transcranial doppler(c TCD),contrast transthoracic echocardiography(c TTE),contrast transesophageal echocardiography(c TEE)in the diagnosis of patent foramen ovale(PFO),to find the best diagnostic strategy and to provide a certain reference for patients to get reasonable diagnosis and treatment.Methods:A total of 147 patients with suspected PFO were collected from October 2019 to January 2022 and received c TCD,c TTE and c TEE.In turn,clinical data were collected,including age,sex,and history of cryptogenic stroke(CS),dizziness,migraine,transient ischemic attack(TIA),coronary heart disease and arrhythmia.Color Doppler flow signal or contrast agent microbubble passing through foramen ovale was used as the reference standard for diagnosing PFO,the sensitivity and specificity of the three tests for PFO diagnosis were compared,and the differences of the results of the three tests for right-to-left shunt(PFO-RLS)semi-quantitative grading were compared.The correlation between the shunt degree of PFO-RLS and the inner diameter of PFO and the length of tunnel was observed.Results:1.Among 147 suspected PFO patients,123 were positive for PFO,including 56 cases of CS,48 cases of migraine,13 cases of dizziness,4 cases of TIA,1 case of coronary heart disease and 1 case of arrhythmia.PFO was detected in 120 cases(97.56%,120/123),110 cases(89.43%,110/123)and 121 cases(98.37%,121/123)by c TCD,c TTE and c TEE,respectively.There were 3(2.44%,3/123)false negatives and 6(4.88%,6/123)false positives for c TCD.There were 13(10.57%,13/123)false negatives and 6(4.88%,6/123)false positives in c TTE.There were 2 cases(1.63%,2/123)of false negative cases in c TEE,and no false positive cases.There was no significant difference in the sensitivity of c TCD and c TEE in diagnosing PFO(97.56%,98.37%;P>0.05)were higher than those of c TTE(89.43%;all P<0.05).The specificity of c TEE in diagnosing PFO was 100%,which was higher than c TCD and c TTE(75.00%,75.00%;all P<0.05).2.The semi-quantitative grading of PFO-RLS by c TCD was higher than that by c TTE and c TEE(all P<0.05),the semi-quantitative grading of PFO-RLS by c TTE was higher than that by c TEE(P<0.05).3.The shunt degree of PFO-RLS was positively correlated with the inner diameter of PFO(r=0.674,P<0.05),and had no significant correlation with PFO tunnel length(r=-0.170,P>0.05).Conclusion:1.The sensitivity and semi-quantitative grading of c TCD were higher than those of c TTE,and its simple operation,low cost and strong repeatability make it a better method for screening PFO.2.With high specificity,c TEE can determine the source of RLS and accurately evaluate the anatomical morphology of PFO,which has important clinical guiding significance for patients undergoing further PFO interventional sealing.3.c TCD combined with c TEE is the best strategy for the diagnosis of PFO,which has important clinical significance for patients to get more reasonable diagnosis and treatment.Part II Follow-up study of interventional closure of Patent Foramen Ovale Objective:Follow-up study was conducted on patients undergoing Patent Foramen Ovale(PFO)interventional occlusion to evaluate the safety and short-term clinical efficacy of the treatment,so as to provide a certain reference for clinical practice.Methods:A retrospective analysis was performed on 60 patients who underwent PFO intervention in cardiac surgery from October 2019 to June 2021,and the general clinical data including age,sex and history of cryptogenic stroke(CS),dizziness,migraine,coronary heart disease and other diseases were collected.Patients were followed up 1month,3 months and 6 months after the surgery by telephone,outpatient service and wechat to inquire about the remission of symptoms,recurrence and complications.The migraine patients were evaluated by preoperative and postoperative headache impact factor score(HIT-6 score)to compare the remission of migraine symptoms at different follow-up times.Results:1.The study involved sixty patients,including 32 cases(53.33%)of CS,22 cases(36.66%)of migraine,5 cases(8.33%)of dizziness,and 1 case(1.67%)of coronary heart disease.2.Interventional closure was successful in all 58 patients,and failed in 2 patients with CS because the guide wire could not pass through the foramen ovale,with a success rate of 96.66%.Chest X-ray,electrocardiogram and transthoracic echocardiography were reviewd one day after surgery.No complications such as death,malignant arrhythmias,or displacement or detachment of occluders occurred in all patients during follow-up.3.No new infarct lesions were found in the head CT of 30 patients with CS after surgery.Dizziness did not recur in all 5 patients.No symptoms such as chest tightness and chest pain occurred in 1 coronary heart disease patient during follow-up.For 22 migraine patients,the symptoms were relieved to varying degrees,preoperative HIT-6score were(70.40±5.29).Compared with the preoperative symptoms,the HIT-6 score was lower than 1,3 and 6 months after surgery(all P<0.05).The HIT-6 score at 3 months after surgery was lower than at 1 month(P=0.000).The HIT-6 score at 6 months after surgery was lower than at 3 months(P=0.044).Conclusion:PFO interventional closure has high safety,few related complications,high success rate and the recent clinical effect is remarkable.For those with definite indications for surgery,interventional blocking therapy should be performed actively in early stage.