Interventional Patent Foramen Ovale Closure And Its Short-term Follow-up Study Of 33 Cases In The Department Of Cardiology

Objective:Patent foramen ovale is a common congenital heart disease.It was reported that about 1/4 of adults have patent foramen ovale,but the not typical symptoms and relatively complicated examination procedures often lead to misdiagnosis.Recent studies have shown that the occurrence of migraine and cryptogenic stroke may relate to PFO.Clinicians have observed that the treatment of patent foramen ovale through intervention can relieve migraine symptoms and reduce stroke recurrence.But there is no consensus on whether it is used as therapy basis and first-line regimen.The purpose of this study was to analyze the cases of the clinical efficacy of interventional closure of oval foramen in Qilu Hospital of Shandong University,and explore the clinical efficacy of treatment of PFO to provide the theoretical basis.Materials and methods:The data of 33 patients with newly diagnosed PFO and received interventional closure in the Department of Cardiology,Qilu Hospital between August 2015 and February 2018 are reviewed.We collected their clinical history,examinations results and treatment regimen by retrospective analysis.And we carried out the regular follow-up of post-closure by clinics and telephone.During follow-up,electrocardiograms and transthoracic echocardiography were performed regularly to evaluate PFO closure efficacy and postoperative complications.We also calculated and compared both preoperative and postoperative HIT-6 score of migraine to evaluate the degree of migraine and observed whether there was a recurrence of stroke of CS patients.We try to provide the theoretical basis of the diagnosis and treatment of PFO through the observation of short-term follow up efficiency of patent foramen ovale closure.Results:1.General cases:In our research,33 patients were enrolled.The mean age was 38(Between 15 and 68)years old,median agemedian is 37.5 years old.14(42.4%)cases were male and 19(57.6%)were female.2.Causes of morbidity:22 patients developed onset of migraine,including 7 males and 15 females,with a ratio of 1:2 male to female.22 patients with migraine,including 5 patients with MA(22.7%),17 patients with MoA(77.3%),of which 5 cases suffered stroke after migraine,accounting for 22.7%of the total number of migraine patients.11 patients had onset of cryptogenic stroke(CS),among those,2 patients have more than one attack,7 patients are young persons(63.6%).3.Clinical conditions and related scores:In 22 patients with migraine,pre-closure HIT-6 score were 54 to 78(average 64.95±6.02 points).Among them,17 migraine without aura had pre-closure scores(65.47±6.56)points,and 5 migraine with aura patients had pre-closure scores(63.20±3.56)points.Five patients with migraine complicated with stroke,preoperation cranial CT or cranial MRI examination clearly identified neurological events(such as cerebral infarction,cerebral ischemic lesions,etc.),their pre-closure HIT-6 score were(62.40±2.30)points and the average NIHSS score was 1.2 points.In 11 stroke patients,the average NIHSS score was 3.45 points.4.Clinical aid examination:After routine inspection,the 33 patients undergone contrast transcranial Doppler sonography(c-TCD),transthoracic echocardiography(TTE),contrast transthoracic echocardiography(c-TTE),transesophageal echocardiography(TEE)and contrast transesophageal echocardiography(c-TEE).The positive rates of relevant tests were:c-TCD:81.82%,c-TTE:90.90%,c-TEE:84.85%.For the 11 cases of brain stroke,cranial brain CT or brain MRI examination clearly identified neurological events,including 8 cases of unilateral cerebral infarction,accounting for 72.73%,3 cases of bilateral cerebral infarction,accounting for 27.27%.5.All patients were given anti-platelet agents and agents facilitate circulation and brain cell metabolism.They were received the PFO interventional closure successfully,no device displacement and embolism.Patients after discharge were followed-up by outpatient service and telephone regularly in 1,3,6,12 months after operations.The postoperative scores of HIT-6 of patients developed onset of migraine between 36 to 61(44.68±7.28 points),compared with the preoperative scores(average 64.95±6.02 points),which showed that migraine were significantly improved(P=,P<0.05).5 patients were MA,after the closure,postoperative scores of HIT-6 is significally lower than the preoperative scores,all less than 49 points,the daily life affected by migraine had significantly improved.The post-closure scores of MoA are significantly lowered compared to that of pre-closure(45.58± 7.62 vs 65.47±6.57,P<0.05).For the 11 patients with stroke were received drug therapy without stoke recurred in 6 months after operation.There are 5 cases with complications,1 cases of atrial tachycardia,1 cases of sinus tachycardia and 3 cases of precordial discomfort.After a period of systemically treatment,complications improved or disappeared.ConclusionThe closure of PFO is an effective and safe therapy for PFO patients with migraine and cerebral stroke.So when facing patients with migraine or cryptogenic stroke,c-TCD,TTE,c-TTE,TEE and c-TEE may be essential to exclude or diagnose PFO.And the closure of PFO could be first-line and effective regimen for PFO with migraine and prevent recurrent stroke after excluding the contraindications.