[Analysis of contrast echocardiography for detecting right to left shunt in adults with patent foramen ovale].

Objective: To analyze the contrast echocardiography for detecting right to left shunt in adults with patent foramen ovale(PFO), and study the relationship between PFO and cryptogenic stroke. Methods: Clinical data of forty-six adults patients with PFO diagnosed by transesophageal echocardiography(TEE)from March, 2012 to March, 2017 were retrospectively collected, and the patients were divided to 3 groups according to the direction and brightness of the color Doppler shunts: obvious left-to-right shunt (OLRS, group A), weak left-to-right shunt(WLRS, group B), bi-directional shunt(BDS, group C). A right-to-left shunt (RLS) scale was calculated using the method of 10 ml hand-operated saline for contrast echocardiography. Results: There were seventeen cases in group A, four cases (23.5%) showed RLS at level 1, and thirteen cases (76.5%) showed no RLS; there were twenty cases in group B, and all cases (100%) showed RLS, with five cases (25%) at level 1 and fifteen cases (75%) at level 2-3; there were nine cases in group C, and all cases (100%) showed RLS, with two cases (22.2%) at level 1 and seven cases (77.8%) at level 2-3. Anteroposterior diameter of left atrium of patients with no RLS (4.8 cm±0.6 cm) was significantly larger than that of patients with RLS in contrast echocardiography (3.6 cm±0.5 cm)(P=0.000). Conclusions: OLRS of adults with patent foramen ovale and with larger left atrium have less RLS than WLRS and DLRS with normal left atrium in contrast echocardiography.The possibility of paradoxical embolism in WLRS and DLRS is higher than that in OLRS, which should be taken seriously in clinical practice.目的： 通过对成人卵圆孔未闭患者右心声学造影进行分析，了解卵圆孔未闭与隐源性卒中的关系。 方法： 回顾性收集2012年3月至2017年3月解放军第三七一医院经食管超声诊断成人卵圆孔未闭46例患者的临床资料，根据彩色多普勒分流束的方向及色彩明亮程度，分为明显左向右分流组(A组)，微弱左向右分流组(B组)和双向分流组(C组)3组。采用10 ml手振生理盐水方法行右心声学造影，计算右向左分流(RLS)的分级。 结果： A组17例，右心声学造影4例 (23.5%)出现右向左分流，均为1级分流，13例(76.5%)无右向左分流；B组20例，全部(100%)出现右向左分流，其中5例(25%)1级分流，15例(75%)2～3级分流；C组9例，全部(100%)出现右向左分流，其中2例(22.2%)1级分流，7例(77.8%)2～3级分流。右心声学造影无右向左分流患者左心房前后径[(4.8±0.6) cm]比有右向左分流患者左心房[(3.6±0.5) cm]明显增大(P＝0.000)。 结论： 成人卵圆孔未闭患者，彩色多普勒左向右分流明显、左心房增大者，声学造影右向左分流少；微弱左向右分流及双向分流、左心房不大者往往右向左分流较多，容易在一定条件下发生矛盾性栓塞，临床上更应该予以重视。.