肺动静脉瘘所致隐源性卒中病例分析
及初筛方法研究
肺动静脉瘘所致隐源性卒中病例分析及初筛方法研究

摘要/Abstract

摘要：

目的分析肺动静脉瘘（pulmonary a rteriovenous f istula，PAVF）致隐源性卒中患者临床表现，比较各种诊断方法特点，寻找筛查方法。方法 2例PAVF所致隐源性卒中患者详细临床资料，并行经食管超声（transesophageal echocardiography， TEE）、经颅多普勒增强试验（contrast transcranial Doppler，cTCD）。结果 2例患者cTCD结果显示栓子信号具备出现晚、数量多、时间久、持续性（即不受Valsalva动作影响）的特点。TEE结果显示CDFI未见异常，右心声学造影Valsalva动作（valsalva maneuver，VM）后5个心动周期左房内肺静脉开口处见大量微泡。结论缺血性卒中是PAVF最常见的肺外表现，发生与PAVF与供血动脉直径及数量有关。cTCD敏感易操作，结合动脉血气分析可用于该病的初筛，而且适于疗效评价及随访。

文章导读： 经颅多普勒增强试验结合动脉血气分析有利于肺动静脉瘘的初筛。

关键词: 肺动静脉瘘; 隐源性卒中; 经颅多普勒; 动脉血气分析

Abstract:

Objective To analyze the clinical features of the patients with cryptogenic stroke caused by pulmonary arteriovenous fistula (PAVF), and compare the characteristics of different diagnostic methods to find preliminary screening method. Methods Detailed clinical data of 2 patients with cryptogenic stroke were collected. Transesophageal echocardiography (TEE) and contrast transcranial Doppler (cTCD) were performed. Results cTCD in 2 patients showed the following characteristics of microemboli signals: late appearance, large number, long duration, and the number was not influenced by Valsalva maneuver (VM). TEE showed that there were no abnormal CDFI and large number of microbubbles appeared in the left atrium at 5th cardiac cycle after VM. Conclusion Ischemic stroke is the most common extra-pulmonary manifestation of PAVF, influenced by the diameter of feeding artery and quantity of PAVF. cTCD combined with arterial blood gas analysis is useful for preliminary screening, efficacy evaluation and follow-up for PAVM.

Key words: Pulmonary arteriovenous fistula; Cryptogenic stroke; Transcranial Doppler; Arterial blood gas analysis

董培，隗冬梅，白亚秋，黄可飞，胡建科，杨曦晨. 肺动静脉瘘所致隐源性卒中病例分析
及初筛方法研究肺动静脉瘘所致隐源性卒中病例分析及初筛方法研究[J]. 中国卒中杂志, 2016, 11(10): 847-851.

DONG Pei, KUI Dong-Mei, BAI Ya-Qiu, et al.. Case Analysis and Study on Screening Method of the Cryptogenic Stroke Caused by Pulmonary Arteriovenous Fistula[J]. Chinese Journal of Stroke, 2016, 11(10): 847-851.

参考文献

1 Jauss M，Zanette E. Detection of right-to-left shunt

with ultrasound contrast agent and transcranial

Doppler sonography[J]. Cerebravasc Dis，2000，10：

490-496.

2 Hodgson CH，Kaye RL. Pulmonary arteriovenous

fistula and hereditary hemorrhagic telangiectasia：a

review and report of 35 cases of fistula[J]. Dis Chest，

1963，43：449-455.

3 Sands A，Dalzell E，Craig B，et al. Mult iple

intrapulmonary arteriovenous fistulas in childhood[J].

Pediatr Cardiol，2000，21：493-496.

4 Shovlin C，Letar te M. Hereditary hemor rhagic

telangiectasia and pulmonary a r ter iovenous

malformations：issues in clinical management and

review of pathologic mechanisms[J]. Thorax，1999，54：

714-729.

5 White RI Jr，Lynch-Nyhan A，Ter r y P，et a l.

Pulmonary arteriovenous malformations：techniques

and long-term outcome of embolotherapy[J ].

Radiology，1988，169：663-669.

6 Yeung M，Khan KA，Antecol DH，et al. Transcranial

Doppler ult rasonography and t ransesophageal

echocardiography in the investigation of pulmonary

ar ter iovenous malformat ion in a pat ient with

hereditary hemorrhagic telangiectasia presenting with

stroke[J]. Stroke，1995，26：1941-1944.

7 Gossage JR，Kanj G. Pulmonary arteriovenous

malformations. A state of the art review[J]. Am J

Respir Crit Care Med，1998，158：643-661.

8 Moussout tas M，Fayad P，Rosenblat t M，et al.

Pulmonary ateriovenous malformations：cerebral

ischemia and neurologic manifestations[J]. Neurology，

2000，55：959-964.

9 Thenganatt J，Schneiderman J，Hyland RH，et al.

Migraines linked to intrapulmonary right-to-left

shunt[J]. Headache，2006，46：439-443.

10 Ch e s s a M，Dr ago M，Kr a nt u n kov P，e t a l .

Differential diagnosis between patent foramen ovale

and pulmonary arteriovenous fistula in two patients

with previous cryptogenic stroke caused by presumed

paradoxical embolism[J]. J Am Soc Echocardiogr，

2002，15：845-846.

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