PDF(Pubmed)
Abstract：
UNASSIGNED: Even though the optimal management of a moderate or large residual shunt following patent foramen ovale (PFO) closure is open to question, recent data confirmed that it is associated with an increased risk of stroke recurrence.
UNASSIGNED: A 48-year-old woman, a migraineur with visual aura, was diagnosed with a PFO associated with a huge multifenestrated atrial septal aneurysm (mfASA) and a moderate right-to-left shunt, detectable only after a Valsalva maneuver on contrast-transthoracic echocardiography. Brain magnetic resonance imaging showed a 1-mm silent white matter lesion in the right frontal lobe. Although the indication was not supported by guidelines, a transcatheter PFO closure was performed at another center with implantation of a large, equally sized, double-disc device (Figulla UNI 33/33 mm). At 6-month follow-up, a 2D/3D transesophageal echocardiography (TEE) color Doppler showed incorrect orientation of the device, which was not parallel to the interatrial septum, with two discs failing to capture the aortic muscular rim and partially protruding in the right atrium; furthermore, a 4 mm × 7 mm ASA fenestration was documented with a residual bidirectional shunt. Thereafter, the same team performed a minimally invasive cardiac surgery under femoro-femoral cardiopulmonary bypass; however, the procedure proved ineffective and was complicated by postoperative pericarditis with pericardial effusion, requiring further rehospitalization 1 month later due to persistent pericarditis, bilateral pleuritis, phrenic nerve palsy, and atrial flutter, which was treated with amiodarone. The patient asked for a second opinion, and our multidisciplinary heart team decided to offer a percutaneous redo intervention. An uneventful implantation of a regular PFO occluder (Figulla Flex II 16/18 mm) across the septal defect was performed successfully. Twelve-month follow-up with 2D TTE color Doppler and contrast transcranial Doppler showed correct position and good interaction between the two devices, with no residual shunt.
UNASSIGNED: In addition to the incorrect indication for PFO closure and the failure of minimally invasive surgery, the procedural mishap in this case could have been due to the inappropriate implantation of the first large device within the tunnel. It would have been better to deploy the same large device in the most central fenestration, covering the PFO and a greater part of the remaining mfASA at the same time.
UNASSIGNED: A 48-year-old woman, a migraineur with visual aura, was diagnosed with a PFO associated with a huge multifenestrated atrial septal aneurysm (mfASA) and a moderate right-to-left shunt, detectable only after a Valsalva maneuver on contrast-transthoracic echocardiography. Brain magnetic resonance imaging showed a 1-mm silent white matter lesion in the right frontal lobe. Although the indication was not supported by guidelines, a transcatheter PFO closure was performed at another center with implantation of a large, equally sized, double-disc device (Figulla UNI 33/33 mm). At 6-month follow-up, a 2D/3D transesophageal echocardiography (TEE) color Doppler showed incorrect orientation of the device, which was not parallel to the interatrial septum, with two discs failing to capture the aortic muscular rim and partially protruding in the right atrium; furthermore, a 4 mm × 7 mm ASA fenestration was documented with a residual bidirectional shunt. Thereafter, the same team performed a minimally invasive cardiac surgery under femoro-femoral cardiopulmonary bypass; however, the procedure proved ineffective and was complicated by postoperative pericarditis with pericardial effusion, requiring further rehospitalization 1 month later due to persistent pericarditis, bilateral pleuritis, phrenic nerve palsy, and atrial flutter, which was treated with amiodarone. The patient asked for a second opinion, and our multidisciplinary heart team decided to offer a percutaneous redo intervention. An uneventful implantation of a regular PFO occluder (Figulla Flex II 16/18 mm) across the septal defect was performed successfully. Twelve-month follow-up with 2D TTE color Doppler and contrast transcranial Doppler showed correct position and good interaction between the two devices, with no residual shunt.
UNASSIGNED: In addition to the incorrect indication for PFO closure and the failure of minimally invasive surgery, the procedural mishap in this case could have been due to the inappropriate implantation of the first large device within the tunnel. It would have been better to deploy the same large device in the most central fenestration, covering the PFO and a greater part of the remaining mfASA at the same time.
摘要：
■即使卵圆孔未闭（PFO）闭合后中度或大量残留分流的最佳管理仍存在疑问，最近的数据证实，它与卒中复发的风险增加有关。
■一个48岁的女人,一个有视觉光环的偏头痛者，被诊断为与巨大的多开窗房间隔动脉瘤（mfASA）和中度右向左分流相关的PFO，只有在经胸超声造影进行Valsalva操作后才能检测到。脑磁共振成像显示右额叶有1毫米的无声白质病变。尽管该指示没有得到指南的支持，在另一个中心进行了经导管PFO封堵，并植入了一个大的，大小相等,双盘装置（FigullaUNI33/33毫米）。在6个月的随访中，2D/3D经食管超声心动图(TEE)彩色多普勒显示装置方向不正确,它不平行于房间隔，两个椎间盘无法捕获主动脉肌肉边缘，并在右心房部分突出；此外，记录了4mm×7mmASA开窗并伴有残留的双向分流。此后,同一团队在股-股体外循环下进行了微创心脏手术；然而，该手术被证明无效，并因术后心包炎伴心包积液而并发，由于持续性心包炎，需要在1个月后再次住院，双侧胸膜炎,膈神经麻痹,和房扑,用胺碘酮治疗。病人要求第二种意见，我们的多学科心脏团队决定提供经皮重做介入治疗.成功地在间隔缺损上顺利地植入了常规PFO封堵器（FigullaFlexII16/18mm）。用2DTTE彩色多普勒和对比经颅多普勒进行为期12个月的随访显示，两种设备之间的位置正确且相互作用良好。没有残余分流。
■除了PFO闭合的指征不正确和微创手术失败外，这种情况下的程序事故可能是由于在隧道内不适当地植入了第一个大型设备。最好在最中央的开窗处部署相同的大型设备，同时覆盖PFO和大部分剩余的mfASA。
■一个48岁的女人,一个有视觉光环的偏头痛者，被诊断为与巨大的多开窗房间隔动脉瘤（mfASA）和中度右向左分流相关的PFO，只有在经胸超声造影进行Valsalva操作后才能检测到。脑磁共振成像显示右额叶有1毫米的无声白质病变。尽管该指示没有得到指南的支持，在另一个中心进行了经导管PFO封堵，并植入了一个大的，大小相等,双盘装置（FigullaUNI33/33毫米）。在6个月的随访中，2D/3D经食管超声心动图(TEE)彩色多普勒显示装置方向不正确,它不平行于房间隔，两个椎间盘无法捕获主动脉肌肉边缘，并在右心房部分突出；此外，记录了4mm×7mmASA开窗并伴有残留的双向分流。此后,同一团队在股-股体外循环下进行了微创心脏手术；然而，该手术被证明无效，并因术后心包炎伴心包积液而并发，由于持续性心包炎，需要在1个月后再次住院，双侧胸膜炎,膈神经麻痹,和房扑,用胺碘酮治疗。病人要求第二种意见，我们的多学科心脏团队决定提供经皮重做介入治疗.成功地在间隔缺损上顺利地植入了常规PFO封堵器（FigullaFlexII16/18mm）。用2DTTE彩色多普勒和对比经颅多普勒进行为期12个月的随访显示，两种设备之间的位置正确且相互作用良好。没有残余分流。
■除了PFO闭合的指征不正确和微创手术失败外，这种情况下的程序事故可能是由于在隧道内不适当地植入了第一个大型设备。最好在最中央的开窗处部署相同的大型设备，同时覆盖PFO和大部分剩余的mfASA。
