【摘要】 目的 探讨TTE、CTTE、c-TCD、TEE应用于指导PFO介入封堵的临床价值。方法 收集本院疑诊PFO的68例患者接受上述检查的相关资料。结果 TTE初诊PFO的65例患者中，7例(10.7%)被TEE排外PFO,TTE排除PFO的3例(4.4%)有偏头痛或脑卒中史的患者被TEE确诊PFO。61例患者经CTTE与c-TCD联合定量跨隔分流，RLS=I级5例(8.2%),RLS=II级5例(8.2%),RLS≥III级51例(83.6%),RLS≥III级的51例患者均成功实施了经导管介入封堵手术。CTTE加Valsalva动作的阳性率高于静息状态(72.1%VS 44.3%,P<0.05),C-TCD加Valsalva动作的阳性率也高于静息状态(85.2%VS 49.1%,P<0.05)。CTTE与c-TCD的RLS≥III级总检出率相当(72.1%VS 85.2%,P>0.05),CTTE与c-TCD联合应用则RLS≥III级的检出率高于单用其中任何方法(100%VS 72.1%VS 85.2%,均P<0.05)。结论 因存在假阴性和假阳性，TTE只可用作PFO的初筛手段，CTTE与c-TCD联合应用可对PFO患者的跨隔分流定性和定量，是判断介入封堵指征的重要手段。TEE可提供PFO三维形态及比邻结构信息，指导封堵器选择，提高手术成功率，减少并发症。三种方法联合应用对确诊PFO和辅助介入封堵术前决策有重要临床价值。更多还原

【Abstract】 Objective To explore the clinical value of TTE,CTTE,c-TCD and TEE in guiding PFO interventional occlusion.Methods The relevant data of 68 patients suspected of PFO receiving the above examination were collected.Results Among the 65 patients initially diagnosed with PFO by TTE,7 cases(10.7%)were eliminated PFO by Tee, and 3(4.4%)patients with a history of migraine or stroke who were excluded PFO by TTE but were confirmed by Tee.61 patients underwent quantitative transseptal shunt combined with TTE and c-TCD,RLS=Grade I in 5 patients(8.2%),RLS=Grade II in 5 patients(8.2%),RLS≥Grade III in 51 patients(83.6%),and 51 patients with RLS≥III underwent transcatheter interventional closure successfully. The positive rate of CTTE plus Valsalva was higher than that of resting state(72.1% VS 44.3%,P<0.05). The positive rate of C-TCD plus Valsalva was also higher than that of resting state(85.2% VS 49.1%,P<0.05). The overall detection rate of RLS≥III was similar between TTE and c-TCD(72.1% VS 85.2%,P>0.05). The detection rate of RLS≥III was higher in combination of TTE and c-TCD than that in any of these methods alone(100% VS 72.1% VS 85.2%,all P<0.05).Conclusions Because of the existence of false negative and false positive, TTE can only be used as a primary screening method for PFO. The combined application of CTTE and c-TCD can make qualitative and quantitive of transseptal shunt in patients with PFO,and it is an important means to judge the indication of transcatheter closure. TEE can provide three-dimensional shape and adjacent structure information of PFO,guide the choice of occluder, improve the success rate of surgery and reduce complications. The combined application of the three methods has important clinical value in the diagnosis of PFO and the preoperative decision-making of interventional occlusion.更多还原