[TCT2008]PFO的经皮封堵术是安全、有效的

发布于:2008-10-17 09:39

Percutaneous PFO Closure Safe, Effective

Eustaquio Onorato 认为，在有经验的中心，进行PFO的经皮封堵是一种微创、有效和安全的过程，但并非完全无风险。

Onorato和他的同事评估PFO封堵术和其他封堵器在局部大脑缺血患者的治疗效果，他们使用785个单独的设备，包括Amplatzer封堵器（n=675）、GORE Helex Septal封堵器（n=7）、4PFO Star X封堵器（n=4）、CARDIAIntrasept封堵器（n=67）和St. Jude Premere PFO封堵器（n=31）。

这项研究从1999年2月开始到2008年10月结束，共研究病例821例（平均年龄48岁）。包括进行心脏病或者神经病学测试、核磁共振/CT、TT/TE回声、SAV、静脉多普勒和TCD。PFO适应证包括：血栓、中风、TIA、偏头痛、大动脉错位、外周和冠状动脉栓塞等等。所有的过程都是在局部麻醉的情况下通过透视和腔内超声心动图来完成的。患者六个月后接受抗血小板治疗。

结果：
主要合并症包括1例大面积肺栓塞引起的早期死亡、5例患者晚期死亡、1例严重的心包积液， 3例部分癫痫症，和3例短暂性脑缺血（见表）。1.9 ％的患者发生阵发性房颤。

所有患者均未发生装置栓塞、感染性心内膜炎、致命的中风和/或大面积中风。一位高凝状态的病人，虽然接受了抗凝治疗但在封堵器的右侧出现栓塞。

Onorato提出，心脏病学家应该和神经科医生之间的合作是非常必要的，只有实现了两者之间的联合，才能使PFO封堵术切实成为临床上患者的一种替代疗法。此外，PFO封堵术在偏头痛、去饱和作用、减压病、TGA和OSA治疗上的仍有待进一步确定。

（医心评论：朱婧译马秀芹校）

Percutaneous PFO Closure Safe, Effective

Key Points:

Long-term echocardiographic evaluation is necessary in patients with prothrombotic states.

By TCT Daily Staff

Percutaneous patent foramen ovale closure is a minimally invasive, effective and safe procedure in experienced centers, but is not totally ‘risk free,’ according to Eustaquio Onorato, MD, of the cardiology department and cardiac cath lab at S. Orsola Hospital FBF in Brescia, Italy.

Onorato and colleagues assessed the outcome of transcatheter PFO closure with different occluder devices in patients with ischemic cerebral events.

They used 785 individual devices, including the Amplatzer PFO Occluder (n=675), the GORE Helex Septal Occluder (n=7), the 4PFO Star X (n=4), the CARDIAIntrasept (n=67), and the St. Jude Premere PFO System (n=31).

The study was conducted between February 1999 and October 2008 in 821 patients (mean age, 48 years). Multidisciplinary work-up consisted of cardiologic and neurologic exam, nuclear magnetic resonance (flair)/CT, TT/TE echo, SAV and venous Doppler and ce-transcranial Doppler.

Indications for PFO closure included: thromboembolic events (n=783), stroke (n=346), TIA (n=447), migraine with or without aura (n=166), transpostion of great arteries (n=3), platypnea-orthodeoxia (n=5), scuba diving (n=14), refractory hypoxemia (n=2), and peripheral and coronary artery embolism (n=16).

All procedures were performed using local anesthesia under fluoroscopic and intracardiac echocardiographic guidance. Patients received antiplatelet therapy for six months after the procedure.

Results

Major complications consisted of one early death due to massive pulmonary thromboembolism, five late deaths, one case of severe pericardial effusion, three cases of partial epileptic disorder, and three cases of transient cerebral ischemia (see Table).

Paroxysmal atrial fibrillation was recorded in 1.9% of patients, according to Onorato.

No device embolization, infective endocarditis, fatal stroke and/or major stroke occurred.

One patient who was affected by hypercoagulable state despite anticoagulation therapy had thrombosis on the right side of the occluder device.

Onorato suggested that cardiologists need to forge relationships with neurologists to channel potential candidates to PFO closure.

Close cooperation between the neurologist and cardiologist is essential. In addition, the role of PFO closure in the management of migraine, desaturation, decompression sickness, TGA, and OSA remains to be defined, he said.

Disclosures: