Study of patent foramen ovale and its shunt direction by transthoracic echocardiography in children
LIN Teng1, ZHANG Zhi-min2, GUO Liang1
1. Department of Ultrasound, the First Affiliated Hospital of Shantou University Medical College, Shantou Guangdong 515041, China; 2. Department of Ultrasound, Minsheng Hospital of Chaonan of Shantou, Shantou Guangdong 515144, China
摘要目的：应用经胸超声心动图（TTE）探讨小儿卵圆孔未闭（PFO）发生情况、声像特点及分流方向。方法：426例小儿分为婴幼儿组（0～3岁）243例和儿童组（4～7岁）183例，再按是否合并先天性心脏病分婴幼儿先心组（A组）93例，婴幼儿正常组（B组）150例，儿童先心组（C组）60例，儿童正常组（D组）123例。TTE观察卵圆孔闭合及分流情况，必要时行右心声学造影。结果：426例小儿共检出PFO 86例，TTE显示卵圆孔瓣与继发隔之间回声分离1.5～5.7mm及细小的斜行分流束，多普勒频谱多呈正向、低速、持续性。婴幼儿组、儿童组PFO大小无明显差别[（2.9±0.7）mm vs （2.6±1.0）mm，P>0.05]。73例PFO为左向右分流，7例为右向左分流，4例为双向分流，2例为潜在分流，右向左及双向分流者均有先心病或肺动脉高压。婴幼儿组、儿童组PFO检出率分别为26.7%及11.5%。A、B、C、D组PFO检出率分别为33.3%，22.7%，18.3%及8.1%。检出率比较：A组高于C组，B组高于D组，C组高于D组（P<0.01或P<0.05）。结论：PFO在婴幼儿期较常见，至儿童期明显减少，部分先心病可能延缓卵圆孔闭合；除外某些先心病及肺动脉高压者，小儿PFO多为左向右分流；TTE对小儿PFO有较高诊断价值，声学造影有助检出PFO潜在分流。
Abstract：Objective: Using transthoracic echocardiography(TTE) to investigate the prevalence, characteristic and shunt direction of patent foramen ovale(PFO). Methods: A total of 426 children were divided into infant group(0～3 year, 243 cases) and child group(4～7 year, 183 cases), then divided into infant associated with congenital heart disease(CHD) group(group A, 93 cases), normal infant group(group B, 150 cases), child with CHD group(group C, 60 cases) and normal child group(group D, 123 cases) according to whether complicating CHD. The characteristic and shunt direction of PFO was observed by TTE. Right-sided contrast echocardiography were performed if necessary. Results: Eighty-six cases were detected to have PFO in all the 426 children. TTE showed echo separating between foramen ovale valve and deuto-atrial septum from 1.5mm to 5.7mm and small oblique shunt at atrium level. Forward direction, low speed and continuous shunt in Doppler frequency was showed in most PFO cases. The size of PFO between infant group and child group without significant difference[(2.9±0.7)mm vs (2.6±1.0)mm, P>0.05]. The left to right shunt in 73 PFO cases, right to left shunt in 7 PFO cases, bidirectional shunt in 4 PFO cases and potential shunt in 2 PFO cases were diagnosed. Patients with right to left shunt or bidirectional shunt were those complicating with certain CHD or pulmonary artery hypertension. The detection rate of PFO in infant group and child group was 26.7% and 11.5% respectively. Simultaneously the detection rate of PFO in group A, group B, group C and group D was 33.3%, 22.7%, 18.3%, 8.1% respectively. Compared the detection rate of PFO in each groups: infant group exceed child group, group A exceed group C, group B exceed group D and group C exceed group D(P<0.01 or P<0.05). Conclusion: The detection rate of PFO in infancy is higher than childhood obviously, some kinds of CHD may delay the closure of PFO. Children with PFO often showed left to right shunt in conditions without certain CHD and pulmonary hypertension. TTE has high value in the diagnosis of PFO in children, contrast echocardiography can help to identify latent shunt of PFO.
林 腾;张志敏;郭 亮. 应用经胸超声心动图诊断小儿卵圆孔未闭及其分流方向的探讨[J]. , 2009, 20(6): 427-430.
LIN Teng;ZHANG Zhi-min;GUO Liang. Study of patent foramen ovale and its shunt direction by transthoracic echocardiography in children. , 2009, 20(6): 427-430.
2009, Vol. 20 
