关键词:

卵圆孔未闭, 右心声学造影, 经食管超声心动图, 分型诊断, 隐匿性, 右-左分流

Abstract:

Objective　To explore the application value of right heart acoustic cardiography (RHAC) combined with transesophageal echocardiography (TEE) in the diagnosis of the classification of occult patent foramen ovale (PFO). Methods　A retrospective study was conducted on 98 suspected PFO patients at Tongchuan People's Hospital from June 2021 to June 2024, who presented with unexplained stroke, migraine, transient ischemic attack, or unexplained syncope and underwent RHAC and TEE examinations. Among them, there were 42 males and 56 females, with an age range of 21 to 68 (43.7±12.5) years old. RHAC used the modified Valsalva maneuver to enhance the visualization of right to left shunt, while TEE confirmed the anatomical structure and shunt characteristics of PFO. PFO was classified into three types based on the degree of shunt and anatomical features: type I (minimal shunt), type II (moderate shunt), and type III (significant shunt). The gold standard was clinical follow-up combined with surgical verification. The study analyzed the differences in the detection rate and classification accuracy between the two methods and the advantages of their combined use. Statistical analysis was conducted using the χ² test, McNemar test, Pearson correlation analysis, enter method multiple linear regression analysis, and receiver operating characteristic curve (ROC). Results　Of the 98 suspected PFO patients, 73 (74.49%) were ultimately diagnosed with PFO. RHAC detected 67 cases of PFO with a sensitivity of 91.78% and a specificity of 100.00%. TEE detected 59 cases of PFO with a sensitivity of 80.82% and a specificity of 100.00%. Combined diagnosis (positive in either method) detected 73 cases, with a sensitivity of 100.00% and a specificity of 100.00%. In the classification diagnosis, the combined determination achieved a accuracy rate of 100.00% for the diagnosis of type I, type II, and type III PFO. Among the patients with occult PFO, there were 25 cases with atrial septal aneurysm and 16 cases with Chiari's network. The detection rates of atrial septal aneurysm by RHAC and TEE were 80.00% (20/25) and 100.00% (25/25), respectively, and the detection rates of Chiari's network were 56.25% (9/16) and 100.00% (16/16), respectively; there were statistically significant differences in the detection rates of atrial septal aneurysm and Chiari's network between the two examination methods (χ²=5.56, P=0.018; χ²=9.14, P=0.003). The number of RHAC microbubbles was positively correlated with the size of the PFO opening measured by TEE (r=0.785, P<0.001). The predictive model established by combining the two parameters of microbubble quantity and opening size had a macro-average AUC (area under the curve) of 0.899 (95%CI: 0.848 - 0.951) for PFO classification. Conclusion　RHAC combined with TEE examination provides a more comprehensive evaluation method for the classification diagnosis of occult PFO, improving diagnostic accuracy and providing important evidences for clinical intervention decisions.

Key words:

Patent foramen ovale, Right heart acoustic cardiography, Transesophageal echocardiography, Classification diagnosis, Occult, Right to left shunt