Analysis Of The Efficacy Of Interventional Closure With Patent Foramen Ovale

Objective:By comparing the improvement of clinical symptoms of 40 patients diagnosed with patent foramen ovale in the first hospital of shanxi medical university and before and after receiving interventional blocking treatment,the safety and near and intermediate clinical efficacy of interventional blocking treatment with patent foramen ovale were evaluated.Methods:Retrospective analysis was performed on the case data of 40 patients who were admitted to the first hospital of shanxi medical university from January 2017 to January2019 with the chief complaint of migraine or stroke,and who were diagnosed with patent foramina ovale and received interventional blocking treatment in our hospital,and their relevant medical history,auxiliary examination and treatment process were collected.Patients were followed up 1 month,3 months and 6 months postoperatively in a variety of ways to improve the relevant assessment and examination,and to observe the remission of migraine symptoms and the recurrence of stroke.At the same time,the headache impact score(hit-6)was determined before,1 month after,3 months after and 6months after the operation of migraine patients,and statistical analysis was conducted.Results:1.General information: a total of 40 patients aged between 16 and 63 years(44.41±13.32)were included in this study,including 18 males(45.0%)and 22 females(55.0%).2.Clinical manifestations and related scores: there were 28 patients with migraine as the main symptom,including 12 males(42.8%)and 16 females(57.2%).The preoperative hit-6 score was(72.69±9.85).There were 12 patients with implicit stroke(CS)as the main symptom,including 4 males(33.3%)and 8 females(66.7%).Among them,there were 3 patients with more than 2 strokes and 7 young patients with stroke,accounting for 58.33% of CS.3.Auxiliary examination: preoperative echocardiography(TTE,TEE)and right echocardiography(c-TTE,c-TEE,c-TCD)were completed in all patients,and PFO was confirmed.The diameters of PFO in TTE and TEE were(2.9±0.6)mm and(3.2±0.8)mm,respectively.Thirty-one patients were positive for c-TTE foaming test,with a positive rate of 77.5%(31/40),and 25 patients with moderate to large amount of RLS.Thirty-nine patients were positive for c-TEE foaming test,with a positive rate of 97.5%(39/40),and37 patients with moderate to large amount of RLS.Twenty-nine patients were positive in the c-TCD test,with a positive rate of 72.5%(29/40),and a moderate-large number of RLS in 20 patients.12 patients with implicit cerebral apoplexy underwent cranial CT or cranial MRI before surgery and had definite neurological events,including 11 cases(91.67%)with unilateral cerebral infarction and 1 case(8.33%)with bilateral cerebral infarction.4.Treatment and prognosis: 38 cases were successfully interventional,2 cases were abandoned due to the failure of the catheter guide wire through the ovale hole,with a success rate of 95.0%(38/40).All the 38 patients completed the operation successfully,and no obvious abnormality was found in the chest X-ray and transthoracic echocardiography 24 hours after the operation,and the patients were discharged successfully 3 days after the operation.The migraine symptoms of all 26 patients were relieved after occlusion,and 5 patients completely disappeared.Compared with those before the operation,the scores of hit-6 were all decreased one month after the operation,three months after the operation and six months after the operation(P < 0.01).The hit-6score at 6 months after the operation was still lower than that at 3 months after the operation,and the difference was statistically significant(P < 0.05).Twelve patients withcerebral apoplexy were followed up for 6 months,and no new infarction lesions were found by head CT.No serious complications such as severe arrhythmia,pericardial effusion,and loss of occluder occurred in all patients during hospital and follow-up.Conclusion:Patent foramen ovale is closely related to neurological diseases(migraine,stroke).Interventional occlusion was used to treat patients with incomplete foramen ovale and migraine and cerebral apoplexy,with high surgical safety,high success rate,significant improvement of migraine symptoms,and good effect in preventing recurrence of cerebral apoplexy.Therefore,PFO intervention should be actively considered for patients with incomplete foramen ovale and refractory migraine,incomplete foramen ovale and cerebral apoplexy,if the surgical indications are clear.