Analysis of the influence of tunnel characteristics of patent foramen ovale on interventional closure

doi:10.3877/cma.j.issn.2095-5782.2023.04.010

Abstract

Abstract:

Objective

To investigate the influence of tunnel characteristics of patent foramen ovale (PFO) by transesophageal echocardiography (TEE) on interventional closure.

Methods

124 patients with PFO closure in the Fifth Affiliated Hospital of Sun Yat-sen University from August 2020 to April 2022 were selected. Preprocedural TEE was performed to evaluate the tunnel characteristics of PFO. All patients were divided into simple operation group with 92 cases and complex operation group with 32 cases according to the operation time and the difficulty of the J-shaped guidewire crossing the interatrial septum. The operation time, the success rate of the J-shaped guidewire crossing the interatrial septum and the X-ray exposure time were recorded during the operation and compared. The independent influencing factors of interventional closure were screened by Logistic regression analysis, and the influence of different PFO tunnel characteristics on the operation was analyzed.

Results

The PFO tunnel characteristics of 124 cases were described as four types: the channel type without fatty adhesion in the tunnel (55/124, 44.35%), the channel type with fatty adhesion in the tunnel (21/124, 16.94%), the right funnel type (23/124, 18.55%) and the left funnel type (25/124, 20.16%). The right atrial diameter of PFO (OR = 0.078, 95%CI: 0.018-0.339), the secondary septum thickness (OR = 3.070, 95%CI: 1.591~5.925) and fatty adhesion in the tunnel (OR = 12.081, 95%CI: 1.312~111.206) were the independent influencing factors of interventional closure by binary Logistic regression analysis. The channel type with fatty adhesion in the tunnel PFO could lead to longest operation time and X-ray exposure time (P < 0.05), and the success rate of the J-shaped guidewire crossing the interatrial septum was lowest(P < 0.05). Compared with the channel type without fatty adhesion in the tunnel and the right funnel type PFO, the left funnel type PFO had longer operation time and X-ray exposure time (P < 0.05), and a lower success rate of the J-shaped guidewire crossing the interatrial septum (P < 0.05).

Conclusion

The characteristics of PFO tunnel are diverse. The definite classification of PFO by TEE before surgery is helpful to formulate a more reasonable occlusion plan, select an appropriate type of occluder, shorten the operation time, reduce the related complications, and improve the success rate of occlusion.

Key words: Patent foramen ovale, Tunnel, Transesophageal echocardiography, Interventional closure, Success rate

Jiali Tian, Xiaobo Chen. Analysis of the influence of tunnel characteristics of patent foramen ovale on interventional closure[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(04): 346-351.

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Figures/Tables 6

References 17

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观察指标	总计（124例）	简单手术组（92例）	复杂手术组（32例）	t/c²	P值
年龄（岁，±s）	49.38 ± 13.32	50.11 ± 13.17	47.28 ± 13.73	1.035	0.303
男性[例（%）]	58（46.77）	44（47.83）	14（43.75）	0.158	0.691
心血管病危险因素[例（%）]
高血压	36（29.03）	28（30.43）	8（25.00）	0.340	0.560
糖尿病	10（8.06）	9（9.78）	1（3.13）	1.419	0.234
高脂血症	33（26.61）	26（28.26）	7（21.88）	0.496	0.481
吸烟	21（16.94）	18（19.57）	3（9.38）	1.753	0.186
脑部缺血灶[例（%）]	76（61.29）	62（67.39）	14（43.75）	5.593	0.018
PFO右房侧内径（mm，±s）	1.96 ± 0.91	2.25 ± 0.82	1.13 ± 0.59	7.077	< 0.001
PFO左房侧内径（mm，±s）	2.03 ± 0.95	2.06 ± 0.88	1.96 ± 1.15	0.513	0.609
PFO隧道长度（mm，±s）	9.52 ± 2.08	9.34 ± 2.12	10.03 ± 1.92	-1.639	0.104
原发隔厚度（mm，±s）	1.00 ± 0.09	0.99 ± 0.08	1.03 ± 0.11	-2.242	0.027
继发隔厚度（mm，±s）	5.39 ± 1.73	4.82 ± 1.37	7.01 ± 1.65	-7.373	< 0.001
PFO隧道内脂肪粘连[例（%）]	21（16.94）	11（11.96）	10（31.25）	6.282	0.012

观察指标	总计（124例）	简单手术组（92例）	复杂手术组（32例）	t/c²	P值
年龄（岁，±s）	49.38 ± 13.32	50.11 ± 13.17	47.28 ± 13.73	1.035	0.303
男性[例（%）]	58（46.77）	44（47.83）	14（43.75）	0.158	0.691
心血管病危险因素[例（%）]
高血压	36（29.03）	28（30.43）	8（25.00）	0.340	0.560
糖尿病	10（8.06）	9（9.78）	1（3.13）	1.419	0.234
高脂血症	33（26.61）	26（28.26）	7（21.88）	0.496	0.481
吸烟	21（16.94）	18（19.57）	3（9.38）	1.753	0.186
脑部缺血灶[例（%）]	76（61.29）	62（67.39）	14（43.75）	5.593	0.018
PFO右房侧内径（mm，±s）	1.96 ± 0.91	2.25 ± 0.82	1.13 ± 0.59	7.077	< 0.001
PFO左房侧内径（mm，±s）	2.03 ± 0.95	2.06 ± 0.88	1.96 ± 1.15	0.513	0.609
PFO隧道长度（mm，±s）	9.52 ± 2.08	9.34 ± 2.12	10.03 ± 1.92	-1.639	0.104
原发隔厚度（mm，±s）	1.00 ± 0.09	0.99 ± 0.08	1.03 ± 0.11	-2.242	0.027
继发隔厚度（mm，±s）	5.39 ± 1.73	4.82 ± 1.37	7.01 ± 1.65	-7.373	< 0.001
PFO隧道内脂肪粘连[例（%）]	21（16.94）	11（11.96）	10（31.25）	6.282	0.012

变量	OR	95%CI	P值
脑部缺血灶	2.954	0.826~10.558	0.096
PFO右房侧内径	0.078	0.018~0.339	0.001
原发隔厚度	0.226	0.000~784.496	0.721
继发隔厚度	3.070	1.591~5.925	0.001
PFO隧道内脂肪粘连	12.081	1.312~111.206	0.028

变量	OR	95%CI	P值
脑部缺血灶	2.954	0.826~10.558	0.096
PFO右房侧内径	0.078	0.018~0.339	0.001
原发隔厚度	0.226	0.000~784.496	0.721
继发隔厚度	3.070	1.591~5.925	0.001
PFO隧道内脂肪粘连	12.081	1.312~111.206	0.028

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