经食管超声心动图结合右心声学造影诊断老年卵圆孔未闭的特征分析

doi:10.3969/j.issn.1003-9198.2026.06.011

摘要/Abstract

摘要： 目的探讨经食管超声心动图结合右心声学造影诊断老年卵圆孔未闭(patent foramen ovale,PFO)患者的特点。方法纳入2022年6月至2024年6月南京医科大学第一附属医院心超室收诊的769例PFO患者,按年龄分为中青年组(<60岁)和老年组(≥60岁),比较2组临床资料、PFO分流程度及心脏结构特点等。采用相关分析探讨临床特征与分流程度的相关性,并记录老年组经导管封堵术实施情况及随访结果。结果中青年组652例,老年组117例,老年组合并高血压、脑梗死及心房颤动比例均高于中青年组,合并头痛/偏头痛比例低于中青年组,差异有统计学意义(P＜0.01);2组性别、合并短暂性脑缺血发作比例差异无统计学意义(P＞0.05)。老年组中-大量分流(Ⅱ级+Ⅲ级)比例低于中青年组,且年龄与分流程度呈负相关(r=-0.117,P＜0.01)。老年组左房增大比例高于中青年组,差异具有统计学意义(P＜0.01),2组房间隔膨出瘤及肺动脉高压发生率差异均无统计学意义(P＞0.05)。老年组实施封堵术者术后1年内卒中再发生率低于未实施封堵者,头痛/偏头痛缓解率高于未实施封堵者,差异有统计学意义(P＜0.01)。结论老年PFO患者的临床特点具有其独特性与复杂性,经食管超声心动图结合右心声学造影可优化老年PFO的个体化诊疗活动。

关键词: 经食管超声心动图, 右心声学造影, 卵圆孔未闭, 右向左分流, 老年人

Abstract: Objective To investigate the utility of transesophageal echocardiography combined with agitated saline contrast echocardiography in the diagnosis of patent foramen ovale (PFO) in elderly patients and to evaluate the clinical characteristics of PFO. Methods A total of 769 patients with PFO admitted to Echocardiography Department of the First Affiliated Hospital with Nanjing Medical University from June 2022 to June 2024 were included. They were divided into the young and middle-aged group (<60 years old) and the elderly group (≥ 60 years old). The clinical data, PFO shunt degree and cardiac structural characteristics of the two groups were compared. The correlation between clinical characteristics and shunt degree was analyzed, and the implementation situation of the transcatheter closure procedure and the follow-up results in the elderly group were recorded. Results The study included 652 patients in the young and middle-aged group and 117 patients in the elderly group. The elderly group had a higher prevalence of hypertension, cerebral infarction, and atrial fibrillation, but a lower incidence of headache/migraine compared with the young and middle-aged group (all P<0.01). There were no significant differences in gender or the occurrence of transient ischemic attack (P>0.05). Moderate-to-large PFO shunts (grade Ⅱ+grade Ⅲ) were less common in the elderly group,and there was a negative correlation between age and the degree of shunt (r=0.117, P<0.01). Left atrial enlargement was more frequent in the elderly group (P<0.01), whereas no significant differences were observed in the incidence of atrial septal aneurysm or pulmonary hypertension. The elderly group who underwent the transcatheter closure procedure had a lower stroke recurrence rate, and a higher headache/migraine relief rate within one year after the procedure compared to those who did not undergo transcatheter closure procedure (P<0.01). Conclusions Elderly patients with PFO exhibit distinct and clinically complex characteristics. The combined use of transesophageal echocardiography and agitated saline contrast echocardiography supports optimized, individualized diagnostic and therapeutic strategies for elderly patients with PFO.

Key words: transesophageal echocardiography, agitated saline contrast echocardiography, patent foramen ovale, right-to-left shunt, aged

中图分类号:

R 541.1

许玉凤, 周敏, 沈欣, 雍永宏. 经食管超声心动图结合右心声学造影诊断老年卵圆孔未闭的特征分析[J]. 实用老年医学, 2026, 40(6): 597-601.

XU Yufeng, ZHOU Min, SHEN Xin, YONG Yonghong. Transesophageal echocardiography combined with agitated saline contrast echocardiography in the diagnosing and characteristic analysis of elderly patients with patent foramen ovale[J]. Practical Geriatrics, 2026, 40(6): 597-601.

参考文献

[1] 张玉顺, 蒋世良, 朱鲜阳. 卵圆孔未闭相关卒中预防中国专家指南[J]. 心脏杂志, 2021, 33(1): 1-10.
[2] ELGENDY A Y, SAVER J L, AMIN Z, et al. Proposal for updated nomenclature and classification of potential causative mechanism in patent foramen ovale-associated stroke[J]. JAMA Neurol, 2020, 77(7): 878-886.
[3] LE MOIGNE E, TIMSIT S, BEN SALEM D, et al. Patent foramen ovale and ischemic stroke in patients with pulmonary embolism: a prospective cohort study[J]. Ann Intern Med, 2019, 170(11): 756-763.
[4] 万林姗, 宋秀娟, 刘燕燕, 等. 偏头痛与卵圆孔未闭的研究进展[J]. 中国现代医学杂志, 2023, 33(10): 48-54.
[5] LEE H J, LIM D S, LEE J, et al. Decompression illness in divers with or without patent foramen ovale: a cohort study[J]. Ann Intern Med, 2023, 176(7): 934-939.
[6] 中国医师协会心血管内科医师分会结构性心脏病学组, 心源性脑卒中人群的高危预测模型及治疗策略的临床研究课题组. 卵圆孔未闭超声诊断中国专家共识[J]. 中国介入心脏病学杂志, 2023, 31(1): 4-11.
[7] MAZZUCCO S, LI L, BINNEY L, et al. Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis[J]. Lancet Neurol, 2018, 17(7): 609-617.
[8] 王浩, 吴伟春, 施怡声, 等. 卵圆孔未闭右心声学造影中国专家共识[J]. 中国循环杂志, 2022, 37(5): 449-458.
[9] TAKAYA Y, NAKAYAMA R, AKAGI T, et al. Importance of saline contrast transthoracic echocardiography for evaluating large right-to-left shunt in patent foramen ovale associated with cryptogenic stroke[J]. Int J Cardiovasc Imaging, 2022, 38(3): 515-520.
[10]韩文博, 陈步星. 老年卵圆孔未闭是否封堵?[J]. 中国循证心血管医学杂志, 2023, 15(3): 382-384.
[11]ESWARADASS P V, QAZI E, MENON B K. Embolic stroke of undetermined source (ESUS) unraveled: the may-thurner syndrome[J]. Can J Neurol Sci, 2016, 43(5): 713-714.
[12]MOJADIDI M K, KUMAR P, MAHMOUD A N, et al. Pooled analysis of PFO occluder device trials in patients with PFO and migraine[J]. J Am Coll Cardiol, 2021, 77(6): 667-676.
[13]闫丹丹, 邵珲, 杜亚娟, 等. 卵圆孔未闭封堵治疗隐源性脑卒中预防复发效果的meta分析[J]. 心脏杂志, 2019, 31(1): 57-64.
[14]张美娟, 夏宇航, 黄小华. 房颤和高血压引起的左心房增大与血浆脑钠肽之间的关系[J]. 当代医学, 2020, 26(3): 6-9.
[15]杨柳, 宋丽, 吴碧华. 托吡酯片对偏头痛患者脑血管病变和神经元放电的影响分析[J]. 北方药学, 2018, 15(4): 21-22.
[16]PARK S W, LIM M N, KIM W J, et al. Quantitative assessment the longitudinal changes of pulmonary vascular counts in chronic obstructive pulmonary disease[J]. Respir Res, 2022, 23(1): 29.
[17]CHEN P L, WANG C S, HUANG J A, et al. Patent foramen ovale closure in non-elderly and elderly patients with cryptogenic stroke: a hospital-based cohort study[J]. Front Neurol, 2023, 14: 1190011.
[18]黄梦婷, 李超, 刘学, 等. 经食管超声引导下介入封堵术对老年卵圆孔未闭的临床疗效观察[J]. 北京医学, 2023, 45(9): 758-762, 767.
[19]张蕾, 张晓春, 张源, 等. 老年卵圆孔未闭患者经导管封堵效果的单中心分析[J]. 复旦学报(医学版), 2022, 49(3): 376-383.
[20]ALPERI A, GUEDENEY P, HORLICK E, et al. Trans-catheter closure of patent foramen ovale in older patients with cryptogenic thromboembolic events[J]. Circ Cardiovasc Interv, 2022, 15(7): e011652.
[21]张宝荣. 老年卵圆孔未闭相关隐源性卒中研究进展[J]. 心电与循环, 2024, 43(5): 415-419, 431.