【Explain Medicine by Case】
It is difficult to solve many years of headache
Maybe there is another mystery?
During his lifetime, Cao Cao had a frequent headache.
Regarding the truth about Cao Cao suffering from migraine, there are divergent opinions.Among them, there is a saying: Cao Cao may have a "small hole" in the heart, that is, the oval hole is not closed.In fact, the oval holes are not closed. One of the four people has an oval hole that is not closed, but it is strange that there are very few people who know that this hole will be diseased.Maybe it’s you, maybe me, maybe someone around us, because the egg round hole is not closed, it has been troubled by headaches.
"I have a headache as soon as I stay up late."
"As soon as I blow the cold wind, I have a headache when I quarrel and tired."
"For more than ten years of headache, the bags of their peers have been cosmetics, and my bags are all equipped with painkillers."
Zhang Yan, who had learned excellent, did not expect to dream that he was also troubled by this inexplicable headache …
Zhang Yan, a Shanxi patient, is 27 years old, young and beautiful, smart and wise.Now that he is a college teacher, life is also happy.
Recalling the headache, "I was only 12 years old when I had a headache for the first time. I was in junior high school. Usually, a quiet little girl suddenly had a headache to hit the wall. Later, I felt that I couldn’t breathe.I’m about to spit out the bile. "
She frowned and said, "At that time, my parents looked at my headache and were very distressed. The family was not rich at the time. My parents took me to many hospitals for neurology.Non -nuclear magnetic resonance and cervical spondylum magnetic resonance can not find out problems. "
The painful memories of the previous trap, Zhang Yan’s face was full of sadness, "Doctors believe that it may be a headache for teenagers. The cause is related to factors such as genetic, endocrine, diet, and spirit.Tablets and other painkillers will let me go home. "
Due to the heavy studies in middle school, sometimes he had dizziness once a week, and Zhang Yan would take painkillers such as ibuprofen and Losorofen sodium tablets to relieve pain.My parents often comforted her: "My daughter is too smart. God needs to let you stop shutdown for a while.The age of the highest occurrence! Thank you for your smart brain for your own self -protection mechanism. "She said with a smile.
Kung Fu is worthy of care, Zhang Yan has been admitted to a college in Beijing through her own efforts.During college, she had anti -drug resistance to ibuprofen, and did not respond after eating. She still had headaches.During the winter and summer vacations, she often moved to many hospitals in Beijing (endocrine, neurology, pain, and traditional Chinese medicine department). The symptoms have not been reduced, but they are getting worse.distressed.
After graduating from college, Zhang Yan was willing to find the other half and taught in a university in Xi’an.She thought: I am still so young, I must find the cause as soon as possible, give birth to a child, and live a "normal person" life as soon as possible.
Since then, she has read a large number of medical books in the library and listened to medical lectures.One day, she had no intention of turning to the book "The Estallar is not closed with cardiovascular and cerebrovascular diseases". She recognized the theory of "holes in the heart, illness in the brain", and doubting whether her disease was related to the oval hole was not closed?
With such doubts, she came to the Department of Cardiovascular and Cerebal Vascular, a military hospital in Xi’an, Dr. Zhao Zhao. "Dr. Zhao, I read all Chinese and Western medicine, and the inspections should be done.I have an oval hole that is not closed? "" Do you check it! "
Then Dr. Zhao gave her a right -hearted sound, and the results were as follows:
"You may have an oval hole that is not closed. This may be related to headaches." Dr. Zhao read the checklist and told Zhang Yan.
"Do I need surgery?"
"Let’s do the gallery ultrasound heart -hearted picture first! Look at the results."
After finishing the meridian ultrasound, the results are as follows:
Sweep the caoped ultrasound multi -cut surface scan:
1. The size of the left heart is normal, and the measured size is 17 × 22mm. There is no abnormal echo attachment in the left room and the left heart.
2. The first and second room intervals are "wrong". After VALSALVA movements, the separation of the right room is 3.8mm, the left room is separated by 2.1mm, and the length is about 4.2mm.Diversion left to right.
Check the esophageal ultrasound cardiac inspection:
The oval hole is not closed;
The size of the left heart is normal, and there is no clear thrombosis formation in the left room and the left heart;
The left room contraction function is normal;
Color blood flow: Dives left to the right.
It is clear that Zhang Yan has an ovarian hole that is not closed. The hospital organizes cardiology and neurology consultation. In view of the poor effect of taking the medicine, the ovaries are large and the diversion is large.In order to ensure the smooth and safe operation, the doctor intervened in the ultrasound with the ultrasound doctor before surgery. The result is as follows:
1. The room interval between the first and second parts of the room changes.
2. Call of the two -pointed closer point dislocation.
3. Color blood flow: No obvious diversion is seen in the level of house.Eliphloral return flow (a small amount); three valve return flow (a small amount).
4. The interval between the room is thin and thin, and the measured range is about 25mm, which is slightly swinging;
The next day, Dr. Zhao performed an egg rounded hole without closing surgery for Zhang Yan.The operation is smooth.One day after surgery, the hospital conducted an ultrasonic heart dynamic diagram check. The report showed that the location and echo were normal.In this way, the condition was temporarily stable, and the hospital prescribed the medicine and asked Zhang Yan to go home.
However, one month after the operation, Zhang Yan still had a headache and dizzy, and her mother was very anxious. "The cause was found and the surgery was done. Why is the daughter’s illness good yet? Is the cause of the disease not right?" The family was puzzled., Cantile again into anxiety again, "Otherwise, let’s observe first, it may take some time after blocking."
Waiting until 6 months after the operation, after the review, "the blocking has not grown well."The family’s concerns were getting bigger and bigger, and they went to the neurology department of the Second Affiliated Hospital of Xi’an Jiaotong University. The doctor gave her a TCD foam test and found that there were still a lot of micro -bubbles.The doctor finally recommended her to find Professor Zhang Yushun, the First Academy of Xi’an Jiaotong University.
"Yes, the baby’s headache of our next door is also promising by Professor Zhang Yushun, the First Affiliated Courtyard of Jiaotong University. Children, let’s try it." Zhang Yan’s mother seemed to grab the "life -saving straw".
Zhang Yan and her mother came to the First Hospital of Jiaotong University. Professor Zhang Yushun read Zhang Yan’s complete information and wondered why the effect was not good after surgery.
"From the results of your first foam test, I suspect that there is a small pulmonary intravenous fistula. Let me do a simple test first, take the right heart acoustic angiography, eliminate it, okay?"
"Okay! You say you can check everything."
After finishing the chest ultrasound, the right heart sound, the results are as follows:
Figure 2 After the chest ultrasound, right heart sound learning angiography
In the static state, a small amount of micro-foam (7-10/frames) can be seen in the seventh heart dynamic cycle, and a large number of micro-bubbles are visible in the left heart (the whole heart is turbid) in the left heart after acting.
After watching the results of the inspection, Professor Zhang Yushun gave Zhang Yan’s mother and daughter analysis:
1. From the inspection, the diversion comes from the atrium, which can exclude the small pulmonary intravenous fistula;
2. The reasons may be: ① too slower after surgery, incomplete endothelium, this need, etc., may be 1 year or even 2 years;The house is short, a hole is blocked, and a hole is left.
3. The next step can be: wait until 1 year or 2 years to observe whether it can grow well.Or do the esophagus ultrasound again to see what is the reason?It is a little painful to do the esophageal ultrasound.
"We are not afraid of pain, let’s do the esophagus ultrasound! Give us clear."
After finishing the esophagus ultrasound, the results are as follows:
1. Multi -cut surface show: The blocking device can be seen in the middle of the interval, and the shape and position of the block can be seen in the middle of the interval.The opening of the room is 1.5mm and the length is 3.9mm; there is no significant change after the Valsalva movement: 3.0mm in the right room, 1.9mm in the left room, and 3.9mm in length;
2. Check the shape and position of the vessel ultrasound: the blocking device is normal; the color blood dish shows that the housing horizontal ovaries are diverted to the left to the right.
Merid -esophageal ultrasonic right heart acoustics:
① In the static state, the micro -bubbles of micro -bubbles originated from the ovarian hole in the left room.
② In the static state, a small amount of micro -foam bubbles can be seen in the left pulmonary vein after the valsalva movement, and no micro -bubbles are seen in the right pulmonary vein.
From the results, the original lack of small houses was missed before surgery, and when the surgery of the obtained round hole was blocked, it happened to pass the house deficiency.Not blocked.
In order to accurately complete the blocking, the structural cardiac doctor doctor was discussed extensively.Due to the large diversion, the ultrasound and most doctors agree that the operation is simple and can be done according to the conventional method.However, Professor Zhang believes that the conventional method is very difficult, and it is recommended to do under the guidance of the esophageal ultrasound or ICE (intraocular ultrasound).Professor Zhang looked at everyone’s strange expression, analyzed the ultrasound image carefully, and drawn a picture: "Look, if you simply block the egg round holes, it is estimated that it will be completed in a few minutes. Now there is one under the oval hole.The blocking device, the cross -sealing device is passing through the surgery. It is estimated that the operation is difficult. It is necessary to prepare ultrasound so that it can be accurately blocked. "
Because the surgery left Zhang Yan’s psychological shadow, when she heard it, she had to perform surgery, and the fear and anxiety bothered Zhang Yan again.Professor Zhang watched her worried and explained patiently: "You don’t have to worry. We will block it under ultrasound guidance this time. Just like driving GPS, we can accurately locate …" Zhang Yan suddenly opened up after hearing.
Finally, under the guidance of ICE, the ovarian hole was accurately closed.At this point, Zhang Yan and his family finally let go of the "heart" disease that has plagued for more than ten years.
Half a year later, Zhang Yan called and said grateful:
"Professor Zhang, thank you! My headache is much better. I only took one after the operation. Now I feel very good every day. In addition, I am pregnant, can I stop the medicine?"
"Yes, take care, bless you!"
It is just the beginning to block a hole, and the far -reaching impact it brings is unbearable in three or two sentences.
【Settings】 Migraphy and PFO
Headache is one of the most common complaints in daily diagnosis and treatment. The literature reports that about 46%of adults around the world have had a seizure of headache, and there are about 600 million patients with headaches worldwide every year.Nearly 1/4 people in my country are troubled by headache.The 2001 World Health Report released by the World Health Organization (WHO) will arranges common diseases to be lost in the year of health life (YLD).Chronic diseases are similar to dementia, limb paralysis, and severe mental illness.
In recent years, many studies have paid attention to the relationship between the ovarian hole and the migraine.According to reports, the prevalence of migraines in PFO patients is 2 to 3 times that of ordinary people.People generally accept that PFO is related to some migraine, but its mechanism needs to be further studied.Whether the blocking PFO is valid for migraine, and its research results are very different.
In 2020, the Massachusetts General Hospital published an article with long -term effects of migraine after blocking PFO, and found that the symptoms of aura type and unparalleled migraine were significantly improved; threatened migraine was easy to completely relieve; after surgery, residual diversion would affect the partial partial partial partiality.Headache symptoms improve.(J am Coll Cardiol Intv 2020; 13: 293, Effect of Residual InterativeRial Shunt On Migraine Burden after Transcatheter Closure of Patient Forale)
The lack of long -term follow -up results in China, the follow -up of the first affiliated hospital of Xi’an Jiaotong University showed that after the blocking PFO, the complete relief rate of patients with migraine in 2 years was 62.7%, and the effective rate was 92.2%.Patients who have a static diversion of right heart acoustic angiography before surgery have a relatively low migraine relief rate, which may be related to the high postoperative residual diversion of these patients (China is involved in cardiac magazines, to be published).
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