案例报告:是否有一个年龄限制,超出这个年龄限制后,不应该提供PFO关闭?
Eustaquio Maria Onorato1, Eleonora Melotti1, Marco Doldi1
1University Cardiology Department, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.
Frontiers in cardiovascular medicine
|September 15, 2025
概括
通过皮肤关闭 patent foramen ovale (PFO) 有效地治疗了老年患者的大动脉根的中风. 这一案例凸显了PFO关闭作为选择老年人患有源不明的栓塞性中风 (ESUS) 的可行选择.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 血管医学 血管医学
背景情况:
- 随机对照试验支持专利卵巢孔 (PFO) 关闭,而不是对年轻患者进行不确定的源头 (ESUS) 栓塞性中风的医疗治疗.
- 在患有高风险PFO的老年患者中,皮肤间PFO闭合的疗效仍然不清楚,因为缺乏随机试验.
- 大动脉根扩大可以改变心间隔膜 (IAS) 动态,可能会增加老年人的右至左分流 (RLS) 和ESUS风险.
研究的目的:
- 描述一个成功通过皮肤进行专利卵孔 (PFO) 关闭的病例,该病例发生在一位患有源不明的栓塞性中风 (ESUS) 的老年患者身上.
- 在ESUS的背景下,说明大动脉根扩大对PFO相关的右至左分流 (RLS) 的潜在影响.
主要方法:
- 一名65岁的男性患有ESUS呈现急性心脏病发作;诊断包括通过道类型PFO通过右到左的显著分流 (RLS).
- 图像检测显示大动脉根扩大压缩右心室,减少IAS长度,并增加PFO分流器的移动性.
- 通过自扩张的尼醇网状装置成功关闭PFO,使用光镜和旋转内心心回声学 (rICE) 引导.
主要成果:
- 在局部麻醉和轻度镇静下,皮肤间PFO关闭程序在技术上是成功的.
- 两个月的随访显示了正确的设备放置,没有残留的分流,通过对比心声学和跨的多普勒检测得到证实.
- 患者的演讲表明大动脉根解剖,PFO和ESUS之间存在联系.
结论:
- 透皮PFO关闭可以是一个安全有效的治疗选择,精心挑选的老年患者与ESUS和高风险的PFO.
- 大动脉根扩大可以通过改变心腔间隔膜 (IAS) 形态和通过PFO增加右至左的分流 (RLS) 来促进ESUS.
- 这一案例强调了在评估ESUS患者时考虑衰老心脏的解剖学变异的重要性.
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