Name: closure of a patent foramen ovale (pfo): an intervention sequence
Uploaded: 2022-12-23T12:30:00
Description: Watch this Scientific Journal Video about Closure of a Patent Foramen Ovale PFO: An Intervention Sequence at JoVE.com

协议和视频出版物得到了耶拿大学医院伦理委员会的批准。患者同意出于文章目的发布他的匿名数据。
1. 生理监测
<ol><li>将患者带到手术台后，建立外周静脉通路并连接到 500 cc 的 NaCl。固定患者的胳膊和腿。</li>
	<li>启动心电图、外周血氧饱和度和脉搏测量。使用碘溶液（例如 Betadine 溶液）对右腹股沟进行灭菌。</li>
</ol>2. 无菌设备的准?...

<ol>
	<li>Moore, K. L., Persaud, T. V. N., Torchia, M. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The Developing Human: Clinically Oriented Embryology., 10th Edition. , (2015).</li><li>Hagen, P. T., Scholz, D. G., Edwards, W. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+size+of+patent+foramen+ovale+during+the+first+10+decades+of+life:+An+autopsy+study+of+965+normal+hearts.">Incidence and size of patent foramen ovale during the first 10 decades of life: An autopsy study of 965 normal hearts.</a> Mayo Clinic Proceedings. 59 (1), 17-20 (1984).</li><li>Meissner, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+potential+risk+factors+for+stroke+assessed+by+transesophageal+echocardiography+and+carotid+ultrasonography:+The+SPARC+study.">Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: The SPARC study.</a> Mayo Clinic Proceedings. 74 (9), 862-869 (1999).</li><li>Rodriguez, C. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Race-ethnic+differences+in+patent+foramen+ovale,+atrial+septal+aneurysm,+and+right+atrial+anatomy+among+ischemic+stroke+patients.">Race-ethnic differences in patent foramen ovale, atrial septal aneurysm, and right atrial anatomy among ischemic stroke patients.</a> Stroke. 34 (9), 2097-2102 (2003).</li><li>Hara, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale:+Current+pathology,+pathophysiology,+and+clinical+status.">Patent foramen ovale: Current pathology, pathophysiology, and clinical status.</a> Journal of the American College of Cardiology. 46 (9), 1768-1776 (2005).</li><li>Saver, J. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryptogenic+stroke.">Cryptogenic stroke.</a> New England Journal of Medicine. 374 (21), 2065-2074 (2016).</li><li>Collado, F. M. S., Poulin, M. F., Murphy, J. J., Jneid, H., Kavinsky, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale+closure+for+stroke+prevention+and+other+disorders.">Patent foramen ovale closure for stroke prevention and other disorders.</a> Journal of the American Heart Association. 7 (12), 007146 (2018).</li><li>Choong, C. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Life-threatening+impending+paradoxical+embolus+caught+&amp;#34;red-handed&amp;#34;:+Successful+management+by+multidisciplinary+team+approach.">Life-threatening impending paradoxical embolus caught &amp;#34;red-handed&amp;#34;: Successful management by multidisciplinary team approach.</a> Journal of Thoracic and Cardiovascular Surgery. 136 (2), 527-528 (2008).</li><li>Madani, H., Ransom, P. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Paradoxical+embolus+illustrating+speed+of+action+of+recombinant+tissue+plasminogen+activator+in+massive+pulmonary+embolism.">Paradoxical embolus illustrating speed of action of recombinant tissue plasminogen activator in massive pulmonary embolism.</a> Emergency Medicine Journal. 24 (6), 441 (2007).</li><li>Akagi, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+closure+of+patent+foramen+ovale:+Current+evidence+and+future+perspectives.">Transcatheter closure of patent foramen ovale: Current evidence and future perspectives.</a> Journal of Cardiology. 77 (1), 3-9 (2021).</li><li>Nakayama, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+of+high-risk+patent+foramen+ovale+associated+with+cryptogenic+stroke:+Development+of+a+scoring+system.">Identification of high-risk patent foramen ovale associated with cryptogenic stroke: Development of a scoring system.</a> Journal of the American Society of Echocardiography. 32 (7), 811-816 (2019).</li><li>Kent, D. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+index+to+identify+stroke-related+vs+incidental+patent+foramen+ovale+in+cryptogenic+stroke.">An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke.</a> Neurology. 81 (7), 619-625 (2013).</li><li>Diener, H. -. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Kryptogener+Schlaganfall+und+offenes+Foramen+ovale,+S2eLeitlinie,+2018.">Kryptogener Schlaganfall und offenes Foramen ovale, S2eLeitlinie, 2018.</a> Deutsche Gesellschaft f&#252;r Neurologie (Hrsg.), Leitlinien f&#252;r Diagnostik und Therapie in der Neurologie. , (2021).</li><li>Zanchetta, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catheter+closure+of+perforated+secundum+atrial+septal+defect+under+intracardiac+echocardiographic+guidance+using+a+single+amplatzer+device:+Feasibility+of+a+new+method.">Catheter closure of perforated secundum atrial septal defect under intracardiac echocardiographic guidance using a single amplatzer device: Feasibility of a new method.</a> Journal of Invasive Cardiology. 17 (5), 262-265 (2005).</li><li>Krizanic, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Occlutech+Figulla+PFO+and+ASD+occluder:+A+new+nitinol+wire+mesh+device+for+closure+of+atrial+septal+defects.">The Occlutech Figulla PFO and ASD occluder: A new nitinol wire mesh device for closure of atrial septal defects.</a> Journal of Invasive Cardiology. 22 (4), 182-187 (2010).</li><li>S&#248;ndergaard, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale+closure+or+antiplatelet+therapy+for+cryptogenic+stroke.">Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke.</a> New England Journal of Medicine. 377 (11), 1033-1042 (2017).</li><li>Saver, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcomes+of+patent+foramen+ovale+closure+or+medical+therapy+after+stroke.">Long-term outcomes of patent foramen ovale closure or medical therapy after stroke.</a> New England Journal of Medicine. 377 (11), 1022-1032 (2017).</li><li>Mas, J. -. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale+closure+or+anticoagulation+vs.+antiplatelets+after+stroke.">Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke.</a> New England Journal of Medicine. 377 (11), 1011-1021 (2017).</li><li>Furlan, A. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Closure+or+medical+therapy+for+cryptogenic+stroke+with+patent+foramen+ovale.">Closure or medical therapy for cryptogenic stroke with patent foramen ovale.</a> New England Journal of Medicine. 366 (11), 991-999 (2012).</li><li>Lee, P. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cryptogenic+stroke+and+high-risk+patent+foramen+ovale:+The+DEFENSE-PFO+trial.">Cryptogenic stroke and high-risk patent foramen ovale: The DEFENSE-PFO trial.</a> Journal of the American College of Cardiology. 71 (20), 2335-2342 (2018).</li><li>Carroll, J. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Closure+of+patent+foramen+ovale+versus+medical+therapy+after+cryptogenic+stroke.">Closure of patent foramen ovale versus medical therapy after cryptogenic stroke.</a> New England Journal of Medicine. 368 (12), 1092-1100 (2013).</li><li>Lock, J. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+umbrella+closure+of+congenital+heart+defects.">Transcatheter umbrella closure of congenital heart defects.</a> Circulation. 75 (3), 593-599 (1987).</li><li>Maloku, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale-When+to+close+and+how.">Patent foramen ovale-When to close and how.</a> Herz. 46 (5), 445-451 (2021).</li><li>Meier, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+closure+of+patent+foramen+ovale+in+cryptogenic+embolism.">Percutaneous closure of patent foramen ovale in cryptogenic embolism.</a> New England Journal of Medicine. 368 (12), 1083-1091 (2013).</li><li>Vanden Branden, B. J., Post, M. C., Plokker, H. W., ten Berg, J. M., Suttorp, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patent+foramen+ovale+closure+using+a+bioabsorbable+closure+device:+Safety+and+efficacy+at+6-month+follow-up.">Patent foramen ovale closure using a bioabsorbable closure device: Safety and efficacy at 6-month follow-up.</a> JACC Cardiovascular Interventions. 3 (9), 968-973 (2010).</li><li>Sievert, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcatheter+closure+of+atrial+septal+defect+and+patent+foramen+ovale+with+Carag+bioresorbable+septal+occluder:+First-in-man+experience+with+24-month+follow-up.">Transcatheter closure of atrial septal defect and patent foramen ovale with Carag bioresorbable septal occluder: First-in-man experience with 24-month follow-up.</a> EuroIntervention. 17 (18), 1536-1537 (2021).</li></ol>

与介入心脏病学中的其他程序相比，PFO的介入闭合相对简单。重要的是在没有并发症的情况下进行手术，因为患者大多是年轻人，并且由于其预防性质而没有从手术中获得短期益处，与急性心肌梗死期间可能挽救生命的疗法相比。
从我们的角度来看，手术 的关键步骤 是安全穿刺腹股沟以避免出血并发症，充分冲洗所有导管和设备以避免空气栓塞，以及选择合适?...

卵圆孔是胚胎心脏发育的残余物，通常在出生后几年内关闭1。此前，在一项针对 965 例正常心脏2 的尸检研究中，有 27.3% 的病例发现了卵圆孔未闭 （PFO），在经食管超声心动图 （TEE） 研究中，581 名受试者中有 25.6% 发现了卵圆孔未闭 （PFO）3。在性别或种族/民族方面没有显着差异2,3,4，尸检数据显示，成人PFO直径从1毫米到19毫米不等（平均：4.9毫米），并随着5岁而增加。
在所有缺血性卒中病例中，尽管进行了广泛的血管、血清学和心脏评估，但病因不能归因于明确的因素，例如大血管动脉粥样硬化、小动脉疾病或心脏栓塞，因此被称为“隐源性卒中”6,7。静脉血栓通过PFO迁移到动脉循环，已经在几项研究中被证明是卒中的可能原因，并且通过对运输过程中的血栓成像也显示8,9。当心脏左心房充满右心房后或 Valsalva 动作终止后的 3 个心跳周期内出现造影剂时，可通过经胸造影超声心动图诊断 PFO。在这里，可以使用左心房中出现的气泡数量对分流进行分级：1 级（少于 5 个气泡）、2 级（6-25 个气泡）、3 级（25 个或更多气泡）和 4 级（整个心室气泡的可视化）10。此外，经食管超声心动图（TEE）对于评估特定的PFO形态是必要的（见图1）。某些发现与较高的血栓栓塞事件发生率相关。这些高危 PFO 可能体积较大、存在心房动脉瘤（定义为房间隔组织从房间隔平面向右心房或左心房偏移超过 10 mm）、大咽鼓瓣、自发性左向右分流以及 Valsalva 操作期间鼻中隔过度活动11。已经建立了许多评分，例如RoPE评分12，以确定发现的PFO具有致病性的概率。最后，现行指南建议 16 岁至60 岁 13 岁的隐源性卒中患者使用 PFO 封堵术。该手术的进一步适应症是耐药性偏头痛。
经食管超声心动图被视为诊断 PFO 的金标准，用于 PFO 封堵的程序规划。该手术在标准心导管实验室中以微创方式经皮进行，使用透视、TEE 引导和生理监测。有经验的操作人员可以考虑将心内超声心动图（ICE）作为TEE的替代方法14。
我们描述了在TEE和透视引导下使用由镍钛诺（镍钛）金属丝网（即PFO阻隔器）制成的双盘装置的PFO闭合程序15，如图 2所示。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>50 ml syringe- Perfusor syringe Luer-Lock 50 cc</td>
			<td>B. Braun</td>
			<td>8728844F</td>
			<td>Flush syringe</td>
		</tr>
		<tr>
			<td>Amplatz Super stiff Guide wire 260 cm</td>
			<td>Boston Scientific</td>
			<td>M001465021</td>
			<td>exchange wire</td>
		</tr>
		<tr>
			<td>Amplatzer Sizing ballon II 24 mm</td>
			<td>Abbott&#160;</td>
			<td>9-SB-024</td>
			<td>sizing</td>
		</tr>
		<tr>
			<td>catheter set- Angiodyn Set Uni Jena</td>
			<td>B. Braun</td>
			<td>6010111-0</td>
			<td>cover set</td>
		</tr>
		<tr>
			<td>Figulla Flex II PFO Occluder Procedure Pack</td>
			<td>Occlutech</td>
			<td>19PFO25DP</td>
			<td>various sizes available</td>
		</tr>
		<tr>
			<td>Mullins Sheat 7-11 fr.- Check Flow Performer Introducer- 9F 75 cm&#160;</td>
			<td>Cook Medical</td>
			<td>RCFW-9.0-38-75-RB-MTS</td>
			<td>delivery sheath</td>
		</tr>
		<tr>
			<td>Multi purpose catheter 5 F - Impulse MPA 1</td>
			<td>Boston scientific</td>
			<td>H749163911171</td>
			<td>atrial septal passage</td>
		</tr>
		<tr>
			<td>Sheath 4 F- Radiofocus Introducer II 4 Fr. 10 cm</td>
			<td>Terumo</td>
			<td>RS*B40K10MR</td>
			<td>arterial blood pressure measurement</td>
		</tr>
		<tr>
			<td>Sheath 7-11 Fr- Radiofucus Introducer II 9 F 10 cm</td>
			<td>Terumo</td>
			<td>RS*B90N10MRD</td>
			<td>Device Loading</td>
		</tr>
	</tbody>
</table>

closure of a patent foramen ovale (pfo): an intervention sequence

卵圆孔未闭（PFO）在约四分之一的人中持续存在，并且是高达25%的缺血性卒中的来源，尤其是年轻人的中风。PFO 可通过经胸造影剂和/或经食管超声心动图轻松诊断。通过股静脉 介入 性闭合 PFO 是一种常用的心脏学操作，因为多项试验已证明，对于经历过缺血性、心脏栓塞性或隐源性卒中的 PFO 患者，PFO 封堵术优于标准药物治疗。当前的论文和视频逐步展示了PFO封堵的过程。

在这项研究中，成功进行了PFO的闭合。实时回声能够显示房间隔的闭合，而没有使用所用设备的残余分流（见 材料表）。控制设备左右椎间盘之间的房间隔位置对于保证设备的稳定性很重要，并且在释放设备之前由TEE在几个平面上进行检查。该装置平稳地放置在房间隔上，而不会接触心房顶部。由于设备结构光滑，有时观察到的设备在主动脉根部周围的扩散是可以接受的。在接下来?...

Watch this Scientific Journal Video about Closure of a Patent Foramen Ovale PFO: An Intervention Sequence at JoVE.com

Closure of a Patent Foramen Ovale PFO: An Intervention Sequence

卵圆孔未闭 （PFO） 是一种基于导管的干预措施，用于预防 PFO 相关卒中。PFO 闭塞装置通过股静脉推进，并使用经食管超声心动图 （TEE） 和透视引导部署在房间隔上。以下协议提供了使用双盘装置进行PFO闭合干预的分步指南。

闭合卵形孔（PFO）：干预序列

A patent foramen ovale (PFO) persists in about one-quarter of people and is the source of up to 25% of all ischemic strokes, especially strokes in young ...

该协议有助于了解PFO介入闭合标准化程序的所有步骤。我们展示了一种安全可行的标准化技术，可以关闭几乎所有PFO。首先，建立外周静脉通路并连接到 500 CC 氯化钠，然后固定患者的手臂和腿部。启动心电图、外周血氧饱和度和脉搏测量。使用碘基溶液对右腹股沟进行灭菌。使用导管助理或护士所需的材料准备无菌设备。用透明箔石膏覆盖灭菌的股骨通路部位。在口咽区域进行局部麻醉 5 到 10 次，然后应用咬伤保护。在无菌条件下准备超声引导。通过触诊、透视或超声引导进入右股静脉。提供皮下麻醉。进行腹股沟静脉穿刺。然后将带有 J-Tip 的标准导线和五法式多用途导管引入上腔静脉。对股动脉进行动脉穿刺，并引入四个法式鞘进行压力监测。许多介入心脏病专家可能会发现非侵入性血压监测在稳定患者中可靠或使用径向通路。一旦建立动脉血压测量，如文本手稿中所述，开始用咪达唑仑和丙泊酚对患者进行清醒镇静。测量右心房的压力。CVP 应在大约 6 到 12 毫米汞柱的正常范围内。如果主要CVP较低，请输注氯化钠，直到CVP达到至少6毫米汞柱，以避免在手术过程中出现空气栓塞。引入 TEE 探头，在四腔视图中评估可能存在的心包积液，并将双腔位设置为包括 PFO。将 J-Tip 标准导线和多用途导管推进到左心房，方法是将导线稍微向前推，并在透视和 TEE 引导下将其放置在左上肺静脉中。通过从 30 度扫描到 110 度来获得最佳 TEE 成像。获取 45 度左前斜位，因为这可能会有所帮助。将导管引入左心房后，推注每公斤体重 100 IU 肝素，以达到约 250 秒的活化凝血时间。活化凝血时间应在大约五分钟后由即时 ACT 分析仪控制。通过多用途导管测量左心房压力。如果低于 5 毫米汞柱，则静脉输液以达到 5 至 10 毫米汞柱的平均左心房压力。将一根坚硬的长导丝与软尖端沿导管推进到左心房，瞄准上肺静脉。然后在患者外部用四分之一至四分之二的造影剂和盐水混合物小心地为球囊脱气。将多用途导管更换为 24 毫米尺寸的球囊。将球囊放在PFO上，并在造影剂溶液中以三比一的比例用0.9%氯化钠充气。使用两个垂直的 TEE 投影进行 PFO 测量。通过血管造影图像确认尺寸。在这两种情况下，测量最小的气球尾部都是至关重要的。使用尺寸表选择PFO封堵装置的尺寸和类型，使用TEE或TTE根据制造商的说明评估的PFO尺寸和隔膜总长度。按照文本手稿中的描述准备一个足够大小的闭合装置。并正确冲洗以消除气泡。放气球并将其换成交付鞘。通过刚性导丝引入输送护套。然后取下介绍器和电线。抽吸血液后，确保鞘和PFO闭合装置之间的湿对湿连接，以确保装置无气泡推进。通过湿到湿的连接将闭合装置引入鞘，方法是通过侧端口冲洗盐水并确保鞘中回流。然后将设备向前推入护套。一旦设备在护套内可见，观察设备前面是否有气泡。然后将设备向后拉约两厘米，以确认设备已连接到传送电缆。将设备向前推入左心房，并以推拉运动和超声心动图引导小心地将鞘缩回左心房中，使左侧椎间盘展开。在这里，TEE 引导（而不是血管造影）就足够了，建议减少辐射剂量。我们将左侧椎间盘拉向房间隔，直到感觉到细微的阻力，并且通过TEE在隔膜上看到左侧椎间盘。在谨慎的张力下，将护套拉回右心房，扩大右侧椎间盘。将设备轻轻推到心房隔上，直到椎间盘连接。通过TEE和血管造影评估闭合装置的正确位置。对于后者，吃豆人符号表示正确的设备放置。彻底检查设备的边缘，是否有任何关于主动脉或左心房顶部的错位，这可能导致局部压缩损伤。推拉拖船测试可以帮助显示设备的稳定性。设备位置正确后，断开输送电缆并卸下护套。使用皮下组织材料的八字形缝合线或血管闭合装置用吸收缝合线关闭股静脉。使用紧贴压力绷带以防止局部出血。取下动脉血压监测装置后，对股总动脉进行手动加压或使用闭合装置，然后使用紧密的绷带。继续无创监测血压和心率 24 小时。按照文本手稿中的说明提供肝素 24 小时。在 65 岁以下的年轻患者中，与仅药物治疗相比，介入性 PFO 封堵后复发性卒中和死亡的风险较低。PFO封堵术的围介入并发症很少见。心包填塞在RESPECT和REDUCE试验中很少发生，发生率分别为0.4%和0.2%。心脏穿孔是一种严重的并发症，在CLOSURE-I试验中为0.25%，在RESPECT试验中为0.2%。至关重要的是，设备打开和定位必须在TEE控制下完成，以获得最佳结果。如果TEE不可用，也可以通过注射造影剂来检查设备位置。

Research

JoVE Journal

Medicine

Closure of a Patent Foramen Ovale (PFO): An Intervention Sequence

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

守望的左心耳封闭装置心房颤动

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting an estimated 6 million people in the United States 1. Since AF affects primarily ...

科研

医学

Using Quantitative Real-time PCR to Determine Donor Cell Engraftment in a Competitive Murine Bone Marrow Transplantation Model

采用实时定量PCR检测供体细胞植入一个具有竞争力的小鼠骨髓移植模型

Murine bone marrow transplantation models provide an important tool in measuring hematopoietic stem cell (HSC) functions and determining genes/molecules ...

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

多囊肾一种可能的斑马鱼型号：击倒<em&gt; Wnt5a的</em&gt;原因在斑马鱼肾囊肿

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

A Case Series of Successful Abdominal Closure Utilizing a Novel Technique Combining a Mechanical Closure System with a Biologic Xenograft that Accelerates Wound Healing

利用一种新技术,将机械闭合系统与可加速伤口愈合的生物异种移植相结合的成功腹部闭合案例系列

In the acute setting, once intra-abdominal injuries have been addressed, the next great hurdle is restoring a functional and intact abdominal compartment. ...

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

经导管闭合前心房通路的超声心动图评估

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...

Preparation of a Non-Cardiomyocyte Cell Suspension for Single-Cell RNA Sequencing from a Post-Myocardial Infarction Adult Mouse Heart

制备用于心肌梗死后成年小鼠心脏单细胞RNA测序的非心肌细胞悬液

Myocardial infarction (MI) is one of the most common cardiovascular diseases, with increasing mortality worldwide. Non-cardiomyocytes account for more ...

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

In Vitro Application of a Wireless Sensor in Flexion-Extension Gap Balance of Unicompartmental Knee Arthroplasty

体外 无线传感器在单间室膝关节置换术屈伸间隙平衡中的应用

Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage anteromedial osteoarthritis (AMOA). The key to UKA is the ...

Quantitative Analysis of Liver Stiffness Distribution

A Three-Dimensional Digital Model for Early Diagnosis of Hepatic Fibrosis Based on Magnetic Resonance Elastography

Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI (Video) | JoVE

基于磁共振弹性成像的肝纤维化早期诊断三维数字模型

Hepatic fibrosis is an early stage of liver cirrhosis, and there are no better non-invasive and convenient methods for the detection and evaluation of the ...

Treating Knee Osteoarthritis with Tuina in a Rabbit Model

Tuina Intervention in Rabbit Model of Knee Osteoarthritis

Using a Rabbit Model to Explore the Efficacy of Tuina in Treating Knee Osteoarthritis (Video) | JoVE

推拿干预膝骨关节炎兔模型

Knee osteoarthritis (KOA) is mainly characterized by degenerative changes in the knee joint's cartilage and surrounding soft tissues. The efficacy of ...