medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-012medsovet-8290Research ArticleТРОМБОЭМБОЛИЯ ЛЕГОЧНОЙ АРТЕРИИPULMONARY EMBOLISMКлиническая значимость открытого овального окна у пациентов с тромбоэмболией легочной артерииClinical significance of a patent foramen ovale in patients with pulmonary embolismhttps://orcid.org/0000-0001-6151-6412ПавловаA. В.PavlovaA. V.

Павлова Анастасия Васильевна, врач-кардиолог

614002, Пермь, ул. Сибирская, д. 84

Anastasiya V. Pavlova, Cardiologist

84, Sibirskaya St., Perm, 614002

anastasiya_pavlova_96@inbox.ruКлинический кардиологический диспансерРоссияClinical Cardiology DispensaryRussian Federation20242005202406212216Copyright © Павлова A.В., 20242024Павлова A.В.Pavlova A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8290

Феномен открытого овального окна у пациентов с тромбоэмболией легочной артерии (ТЭЛА) увеличивает риск развития ишемического инсульта. Клиническую значимость данного явления следует учитывать для определения диагностического алгоритма, тактики ведения и выбора вторичной профилактики, поскольку прогноз пациента с ТЭЛА не только зависит от вероятности развития рецидива ТЭЛА, формирования хронической легочной гипертензии, но и связан с повышенным риском ишемического инсульта по механизму парадоксальной эмболии в связи с наличием открытого овального окна, через которое происходит миграция венозного тромба в результате работы внутрисердечного право-левого шунта. Цель научного обзора – повысить осведомленность о проблеме ишемического инсульта у пациентов с ТЭЛА. Представлены результаты исследований и регистров, в которых отражено, что наличие открытого овального окна повышает риск развития ишемического инсульта у пациентов с ТЭЛА. Ишемический инсульт может произойти в течение 2–22 дней после развития клиники ТЭЛА, также его риск сохраняется в течение года. Неинвазивная транскраниальная доплерография рекомендована для диагностики на первом этапе по идентификации право-левого шунта и является высокочувствительным методом (95–98%). Чреспищеводную эхокардиографию следует рассматривать как второй этап диагностики. Проведение тромболитической терапии или хирургической тромбэкстракции улучшает прогноз для данной категории пациентов. Учитывая возможность проведения тромболитической терапии в период до 14 дней для пациентов с ТЭЛА, ее применение при развитии ишемического инсульта становится возможной опцией для улучшения прогноза. Стратегия выбора проведения вторичной профилактики важна, поскольку пациенты имеют повышенный риск развития рецидива.

The phenomenon of a patent foramen ovale in patients with pulmonary embolism increases the risk of ischemic stroke. The clinical significance of this phenomenon should be taken into account to determine the diagnostic algorithm, management tactics and choice of secondary prevention. The prognosis of a patient with pulmonary embolism depends not only on the likelihood of recurrent pulmonary embolism, the formation of chronic pulmonary hypertension, but is also associated with an increased risk of ischemic stroke through the mechanism of paradoxical embolism due to the presence of a patent foramen ovale. A venous thrombus migrates through the patent foramen ovale as a result of the operation of an intracardiac right-left shunt. The purpose of the scientific review is to raise awareness of the problem of ischemic stroke in patients with pulmonary embolism. The results of studies and registries are presented, which reflect that the presence of patent foramen ovale increases the risk of developing ischemic stroke in patients with pulmonary embolism. Ischemic stroke can occur within 2–22 days after the onset of a pulmonary embolism clinic, and the risk of ischemic stroke remains within a year. Non-invasive transcranial dopplerography is recommended for diagnosis at the first stage of identification of the right-to-left shunt and is highly sensitive method (95–98%). Transesophageal echocardiography should be considered for the second stage of diagnosis. Thrombolytic therapy or surgical thrombectomy improves the prognosis for this category of patients. Тhrombolytic therapy may be given for up to 14 days in patients with pulmonary embolism. The use of thrombolytic therapy in the development of ischemic stroke becomes a possible option to improve the prognosis patients. The choice strategy for secondary prevention is important because patients have an increased risk of relapse.

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The authors declare that there are no conflicts of interest present.