切换至 "中华医学电子期刊资源库"

中华心脏与心律电子杂志 ›› 2022, Vol. 10 ›› Issue (02) : 84 -87. doi: 10.3877/cma.j.issn.2095-6568.2022.02.003

所属专题: 总编推荐

结构性心脏病

神经系统症状为主的房间隔缺损患者的特征及疗效分析
娄宇轩1, 华杨1, 杨丰泽1, 史倞1, 孙伟1, 孔祥清2,()   
  1. 1. 210029 南京,南京医科大学第一附属医院(江苏省人民医院)心血管内科
    2. 215008 苏州,苏州市立医院心内科
  • 收稿日期:2022-05-10 出版日期:2022-06-25
  • 通信作者: 孔祥清

Characteristics of patients with atrial septal defect presenting with neurological symptoms and the efficacy of occlusion

Yuxuan Lou1, Yang Hua1, Fengze Yang1, Jing Shi1, Wei Sun1, Xiangqing Kong2,()   

  1. 1. Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing 210029, China
    2. Department of Cardiology, Suzhou Municipal Hospital, Suzhou 215008, China
  • Received:2022-05-10 Published:2022-06-25
  • Corresponding author: Xiangqing Kong
引用本文:

娄宇轩, 华杨, 杨丰泽, 史倞, 孙伟, 孔祥清. 神经系统症状为主的房间隔缺损患者的特征及疗效分析[J/OL]. 中华心脏与心律电子杂志, 2022, 10(02): 84-87.

Yuxuan Lou, Yang Hua, Fengze Yang, Jing Shi, Wei Sun, Xiangqing Kong. Characteristics of patients with atrial septal defect presenting with neurological symptoms and the efficacy of occlusion[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2022, 10(02): 84-87.

目的

探讨以右向左分流致神经系统症状为临床表现的房间隔缺损患者的临床特征及封堵疗效。

方法

纳入2019年1月至2021年10月在南京医科大学第一附属医院神经内科就诊主诉为偏头痛或卒中相关症状的房间隔缺损患者,且由经颅多普勒超声发泡试验(c-TCD)证实存在右向左分流,收集其基本信息、c-TCD、经胸超声心动图(TTE)、经食管超声心动图(TEE)、右心导管检查结果,分析患者临床特征。术后随访0.5~1.5年,偏头痛患者完善头痛影响测定量表(HIT-6)评分及偏头痛失能程度评估问卷(MIDAS评分),评估封堵疗效。

结果

研究共纳入14例患者,年龄(55.8±12.4)岁,其中女9例(57.1%,9/14)。偏头痛6例,脑卒中8例,TTE及右心导管检查提示无右心代偿性增大,肺血管阻力<3 Wood,评估不存在右心容量超负荷。14例患者均行经皮房间隔缺损封堵术。与术前相比,6例偏头痛患者术后HIT-6及MIDAS评分均明显降低(P=0.024;P=0.027)。8例缺血性卒中患者均无脑卒中复发。

结论

成人房间隔缺损而无右心容量负荷升高者首发症状可以表现为神经系统症状,且c-TCD检查可为阳性。介入封堵治疗可有效缓解症状。

Objective

To explore the clinical characteristics and the efficacy of occlusion in patients with atrial septal defect (ASD), presenting predominantly with neurological symptoms caused by right to left shunt.

Methods

Patients with ASD who complained of migraine or stroke related symptoms in the Department of Neurology, the First Affiliated Hospital with Nanjing Medical University from January 2019 to October 2021 were enrolled, and the right to left shunt was confirmed by contrast transcranial Doppler (c-TCD). The data of basic information, c-TCD, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and right heart catheterization were collected to analyze the clinical characteristics of the patients. The postoperative follow-up ranged from 0.5 to 1.5 years. Migraine patients needed to complete the headache impact test (HIT-6) and the migraine disability assessment scale (MIDAS) to evaluate the efficacy of occlusion.

Results

A total of 14 patients were enrolled in the study, with an average age of (55.8±12.4) years, including 9 women (57.1%,9/14). There were 6 cases of migraine and 8 cases of stroke. Echocardiography and right cardiac catheterization showed that there was no compensatory enlargement in the right heart. Pulmonary vascular resistance was <3 Wood. There was no right cardiac volume overload. All the 14 patients underwent transcutaneous closure of atrial septal defect. The HIT-6 and MIDAS scores of 6 migraine patients were significantly lower than those before operation (P=0.024; P=0.027). There was no stroke recurrence in 8 patients with ischemic stroke.

Conclusion

The initial symptom of atrial septal defect in adult without increased right ventricular volume load can be manifested as neurological symptoms, and c-TCD could be positive. Transcatheter closure therapy can effectively alleviate the symptoms of patients.

表1 14例房间隔缺损患者的一般资料
表2 14例房间隔缺损患者术前与术后24 h超声心动图结果比较(
xˉ±s
[1]
Zanchetta M, Rigatelli G, Ho SY. A mystery featuring right-to-left shunting despite normal intracardiac pressure[J]. Chest, 2005, 128(2):998-1002.
[2]
中国医师协会神经内科医师分会神经超声专业委员会, 中华医学会神经病学分会神经影像协作组. 中国神经超声的操作规范(二)[J]. 中华医学杂志, 2017, 97(41):3208-3212.
[3]
Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC Guidelines for the management of adult congenital heart disease[J]. Eur Heart J, 2021, 42(6):563-645.
[4]
Rigatelli G, Dell'avvocata F, Tarantini G, et al. Clinical, hemodynamic, and intracardiac echocardiographic characteristics of secundum atrial septal defects-related paradoxical embolism in adulthood[J]. J Interv Cardiol, 2014, 27(6):542-547.
[5]
Liu K, Wang BZ, Hao Y, et al. The correlation between migraine and patent foramen ovale[J]. Front Neurol, 2020, 11:543485.
[6]
Wilmshurst P, Nightingale S. Relationship between migraine and cardiac and pulmonary right-to-left shunts[J]. Clin Sci (Lond), 2001, 100(2):215-220.
[7]
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline from the American Heart Association/American Stroke Association[J]. Stroke, 2021, 52(7):e364-e467.
[8]
王仲朝, 李天亮, 张宝霞. 脑梗死合并小房间隔缺损介入封堵2例报道[J]. 中西医结合心脑血管病杂志, 2017, 15(10):1285-1286.
[9]
Smilowitz NR, Subashchandran V, Berger JS. Atrial septal defect and the risk of ischemic stroke in the perioperative period of noncardiac surgery[J]. Am J Cardiol, 2019, 124(7):1120-1124.
[10]
Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke[J]. Neurology, 2000, 888:1172–1179.
[11]
Bannan A, Shen R, Silvestry FE, et al. Characteristics of adult patients with atrial septal defects presenting with paradoxical embolism[J]. Catheter Cardiovasc Interv, 2009, 74(7):1066-1069.
[12]
Ashina M. Migraine[J]. N Engl J Med. 2020, 383(19):1866-1876.
[13]
张茴燕. 偏头痛与房间隔缺损关系的研究进展[J]. 中风与神经疾病杂志, 2017, 34(2):186-188.
[14]
Nyboe C, Nymann AH, Ovesen AS, et al. The burden of migraine in adults with atrial septal defect: A nationwide cohort study[J]. Sci Rep, 2019, 9(1):7410.
[15]
Manolis AS. Impact of percutaneous closure of interatrial shunts on migraine attacks: single-operator series and review of the literature[J]. Rev Recent Clin Trials, 2017, 12(2): 129-138.
[1] 陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 959-965.
[2] 孔莹, 惠品晶, 丁亚芳, 周炳元. 基于对比增强经颅多普勒的多模式超声评估卵圆孔未闭相关右向左分流的临床意义[J/OL]. 中华医学超声杂志(电子版), 2024, 21(04): 345-351.
[3] 张焱, 刘春媚, 姚瑾, 陈苗苗, 徐雯, 黄品同. 超声O-RADS分类和临床特征对不同病理类型卵巢浆液性肿瘤的诊断价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(03): 268-274.
[4] 顾盼盼, 董传莉, 宋梦瑶, 瞿色华, 杨小迪, 周瑞. 不完全性川崎病患儿临床特征及冠状动脉损害情况分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 446-451.
[5] 丁科, 张亚琼, 刘杰, 邓莉平, 张永喜, 熊勇. 获得性免疫缺陷综合征相关淋巴瘤患者的临床特征及生存状况的变化趋势[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 278-284.
[6] 张超, 张珍, 马梁, 穆欢欢, 刘彩玲. 腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 675-678.
[7] 颜晓敏, 崔嵘嵘. 23例乳腺佩吉特病的经验交流[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 353-354.
[8] 高佳, 姜吉询, 王鑫, 吴婷, 向江明. 病理性乳头溢液单中心临床分析附168例报告[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 323-326.
[9] 杨柳, 陈佳, 孙雅娟, 陈娇, 谭明超, 龚明福. 抗中性粒细胞胞浆抗体相关性血管炎的胸部CT 及临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 744-749.
[10] 杨攀, 黄晓寒, 邓才霞, 周利航, 周向东, 罗虎. SMARCA4缺失的胸部未分化肿瘤临床特征及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 529-534.
[11] 何俊, 易淑华, 陈婷婷, 杨玉, 李红雨, 谢飞, 何健. 妊娠并发社区获得性肺炎临床特征及降钙素原和炎症指数对其诊断意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 421-425.
[12] 李广林, 唐凯, 卢秀珍. 部分调节性内斜视的临床研究进展[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(03): 177-181.
[13] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[14] 刘昌恩, 李岩, 张其德. 基于内镜筛查发现的自身免疫性胃炎的临床特征分析[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(04): 233-237.
[15] 王宇, 张泽锴, 吴明胜, 王高祥, 孙效辉, 王君, 徐美青, 李田, 徐世斌, 解明然. 术后病理诊断为良性肺结节323例患者临床特征分析[J/OL]. 中华胸部外科电子杂志, 2024, 11(03): 167-174.
阅读次数
全文


摘要