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2010 | 37 | 2 | 181-204
Article title

Charakterystyka kliniczna i echokardiograficzna chorych z przetrwałym otworem owalnym oraz ryzyko zatorowania systemowego w tej grupie chorych. Ocena retrospektywna 1920 echokardiograficznych badań przezprzełykowych

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EN
Clinical and echocardiographic characteristics of patients with Patent Foramen Ovale and the risk of systemic embolisation in this group of patients. Retrospective analysis of 1920 transoesophageal echocardiographic examinations
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PL
Abstracts
EN
Patent foramen ovale (PFO) represents the most common persistent abnormality of fetal origin. The aim of the study was to analyze the incidence and characteristics of PFO and to assess PFO as the risk factor of paradoxical embolism. 1920 consecutive transesophageal echocardiograms (TEE) in pts examined at the period 1998-2010 (902 F and 1018 M aged 13 – 86, mean 52.95± 12.21 years) in whom flow through PFO was detected in basal conditions (color-Doppler) and/or during provocation (Valsalva/cough maneuver) with contrast were retrospectively analyzed. 377 pts had a history of systemic embolism (SE) or transient ischemic attack (TIA) – Group I, 1543 pts had negative history of SE/TIA – Group II. Two subgroups of pts were distinguished: pts with no abnormalities on transthoracic echocardiography (TTE) and no history of cardiovascular disease (CVD) – Group I-A + II-A and pts with abnormalities on TTE or positive history of CVD – Group I-B + II-B. PFO was diagnosed (PFO/+/) in 157 pts (8.2%) - 60F, 97M mean age 52.65 ±12.55 years. In 1763 pts PFO was excluded [PFO(-)]. Aneurismal formation of interatrial septum was detected in 42 pts, and in 13 pts it coexisted with PFO. The intensity of shunt was significantly higher in I-B + II-B group than in I-A + II-A group. In 10 pts permanent shunt through PFO at the basal stage was observed. Percentage of pts with the history of SE/TIA was significantly higher in group PFO(+) I-A than in PFO(-) I-A (p < 0.01). Conclusions: 1. In pts with no abnormalities on TTE and no history of CVD PFO is a possible risk factor of SE/TIA 2. Flow through PFO is generally minimal, but in case of coexisting heart pathology PFO may provoke significant right-to-left or even left-to-right shunt.
PL
Przetrwały otwór owalny (PFO) jest najczęstszą wrodzoną nieprawidłowością anatomiczną serca u dorosłych. Celem pracy była analiza częstości występowania i charakterystyka PFO, a takŜe ocena PFO jako czynnika ryzyka zatoru systemowego. Retrospektywnej analizie poddano 1920 kolejnych echokardiogramów przezprzełykowych (TEE) z lat 1998-2010 (K-902, M-1018, wiek od 13 do 86 lat, śr. 52,95±12,21), podczas których oceniono przepływ przez PFO w warunkach podstawowych (Doppler kolorowy) i/lub podczas prowokacji (próba Valsalvy i kaszlowa) z uŜyciem kontrastu (sól fizjologiczna). 377 chorych (ch.) przebyło zator systemowy (ZS) lub przemijający epizod niedokrwienny mózgu (TIA) – Grupa I. Pozostałych 1543 ch. bez wywiadu ZS lub TIA stanowiło Grupę II. Wyodrębniono podgrupy ch. z prawidłowym echokardiogramem przezklatkowym (TTE) i bez wywiadu chorób sercowo-naczyniowych (CHSN), I-A i II-A oraz z nieprawidłowym TTE lub wywiadem CHSN, I-B, II-B. PFO rozpoznano [PFO(+)] u 157 ch. (8,2% badanych, K-60, M-97, wiek śr. 52,65±12,55 lat). U 1763 ch. wykluczono PFO [PFO(-)]. Tętniak przegrody międzyprzedsionkowej uwidoczniono u 42 ch., w tym PFO(+) u 13 ch. U ch. PFO(+) stopień przecieku w podgrupie I-B + II-B był znamiennie wyŜszy niŜ w podgrupie I-A + II-A. U 10 ch. uwidoczniono przeciek w warunkach podstawowych (7 ch. z istotnymi niedomykalnościami zastawek przedsionkowo komorowych, 3 ch. ze zwęŜeniem prawego ujścia Ŝylnego lub tętniczego). Stwierdzono znamiennie wyŜszy udział ch. z wywiadem ZS/TIA w podgrupie I-A PFO(+) w stosunku do podgrupy I-A PFO(-), p < 0,01. Wnioski: 1. U chorych bez wywiadu CHSN i z prawidłowym TTE PFO jest czynnikiem ryzyka ZS/TIA. 2. Przepływ przez PFO u tych chorych jest najczęściej niewielki. 3. Przy współistnieniu cięŜkich patologii serca, PFO moŜe być powodem istotnego prawo-lewego lub lewo-prawego przecieku.
Discipline
Year
Volume
37
Issue
2
Pages
181-204
Physical description
References
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paper
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bwmeta1.element.psjd-f5bed6b5-7846-4726-9a24-135c2162e432
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