Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JPIC 3(1): 18-23 (2018)

原著Original Article

卵円孔を介した全身性塞栓の頻度,発症形態,治療についてSystemic embolic event caused by patent foramen ovale: incidence, embolic destinations, treatment

徳島赤十字病院循環器内科Division of Cardiology, Tokushima Red Cross Hospital

受付日:2018年5月31日Received: May 31, 2018
受理日:2018年6月1日Accepted: June 1, 2018
発行日:2018年7月31日Published: July 31, 2018



方法:2006年5月から2017年10月までに当院で施行された,心エコー15万7310例のうち,経食道エコー(TEE)が2200例に施行された.TEEの結果,305例がPFOと診断された.塞栓源精査は157例あり今回の対象とした.内訳は脳梗塞148例,全身性塞栓9例,急性心筋梗塞症1例であった.心房細動と4 mm以上の可動性大動脈プラークを有する例は除外した.記録からバブルテストがgrade1 以上をPFO(grade 0: 左房内バブルが1視野に0, 1–5個:grade 1, grade 2: 6–20個,grade 3: 20個以上)と定義した.



Background: The incidence of systemic embolic events (SEE) in atrial fibrillation (Af; 0.24%/100 person-years) was lower than that of cerebral embolism (1.92%/100 person-years). Stroke and SEE were also primary symptom of paradoxical embolism. There are few reports described SEE caused by paradoxical embolism of patent foramen ovale (PFO).

Objective: To evaluate the incidence, primary symptom and treatment of SEE caused by paradoxical embolism of PFO.

Methods and Results: From May 2006 to October, 305 patients were diagnosed with PFO by transesophageal echocardiogram (TEE) with bubble test. 157 patients (103 women, mean age 64.6±11.2 yeas) were examined in a search for source of embolism (148 stroke, 9 SEE. 1 acute MI). TEE was conducted with bubble test and Valsalva maneuver under local anesthesia: shunt grading (grade 0=none, grade 1=1 to 5 bubbles, grade 2=6 to 20 bubbles, grade 3=>20 bubbles). Primary symptom of SEE was 9 acute ischemia of lower–extremity. 3 patients of acute ischemia of lower–extremity and one acute myocardial infarction were diagnosed paradoxical embolism caused by PFO. Incidence of paradoxical SEE in the 305 patients with PFO was 1.3%. On the other hand, that in the 157 patients with stroke and SEE was 2.5%. Two patients were treated percutaneous PFO closure without any complication.

Conclusions: Incidence of paradoxical SEE in patients with PFO was few, but more frequent than that caused by Af. Patients with SEE without atrial fibrillation should be examined for source of embolism.

Key words: paradoxical embolism; patent foramen ovale; systemic embolic events

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