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Ji S, Dong B, Tang Y, Li H, Lai W, Li Y, Chen Y, Peng A, Chen L. Therapeutic value of patent foramen ovale closure for drug-resistant epilepsy: A case series report. Epilepsia Open 2024. [PMID: 38742825 DOI: 10.1002/epi4.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Closure surgery of patent foramen ovale (PFO) has been found to effectively control cryptogenic stroke and migraine, but it is uncertain whether PFO closure could also alleviate epileptic seizures. This study aims to observe the therapeutic effect of PFO closure on epileptic seizures. METHODS Since July 11th, 2017, in the neurology department of West China Hospital, Sichuan University, Chengdu, we have been regularly monitoring patients with epilepsy who have undergone PFO closure. The patient's clinical information, such as frequency, duration, and severity of seizures, before and after surgery was recorded in detail as well as postoperative safety events. RESULTS Of the 31 epilepsy patients who confirmed PFO observed (27 cases were drug-resistant epilepsy, 87.10%), average age of surgery was 23.74 years, and 12 cases were female (38.71%). After one-year follow-up, 26 patients (83.87%) achieved remission of seizure frequency, and 22 of whom (70.97%) experienced a remission of more than 50%. Additionally, compared to before surgery, 22 cases (70.97%) reported a decrease in the average seizure duration, and 20 cases (64.52%) reported a reduction in seizure severity. In the seizure indicators of frequency, average duration and severity, significant differences were identified between preoperative and postoperative comparisons with all test p values were <0.05. Furthermore, no serious safety events were reported except for one patient who briefly reported chest pain, and all patients expressed effective PFO closure. SIGNIFICANCE The PFO closure has been shown for the first time to result in a significant reduction in the frequency, duration, and severity of seizures. Patients with drug-resistant epilepsy and PFO with a large shunt are ideal candidates for undergoing PFO closure. PLAIN LANGUAGE SUMMARY Since PFO closure was found to have a good therapeutic effect on cryptogenic stroke and migraine, it has become a credible complementary therapy for the treatment of neurological diseases, and drug-resistant epilepsy with PFO is expected to become the next target disease that PFO closure could significantly improve.
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Affiliation(s)
- Shuming Ji
- Department of Clinical Research Management, West China Hospital of Sichuan University, Chengdu, China
| | - Bosi Dong
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
| | - Yusha Tang
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
| | - Hua Li
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
| | - Wanlin Lai
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
| | - Yajiao Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yucheng Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
| | - Lei Chen
- Department of Neurology, West China Hospital, Joint Research Institution of Altitude Health, Sichuan University, Chengdu, China
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Pan Z, Xiao Y, Wang Z, Kong B, Liang Y. The size distribution of the agitated saline microbubbles for contrast transcranial Doppler generated using standard manual methods. Microsc Res Tech 2024; 87:948-956. [PMID: 38174664 DOI: 10.1002/jemt.24481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
Agitated saline microbubbles (MBs) are a common contrast agent for determining right-to-left shunt (RLS) by the contrast transcranial Doppler (c-TCD). The size of the generated bubbles is not standardized in clinical practice. MBs were generated using the recommended manual method by reciprocating motion through two syringes. The bubble size distributions (BSD) were measured using the microscopic shadow imaging technique. The results show that the diameter of MBs is mainly distributed between 10 and 100 μm, the mean bubble size is between 21 and 34 μm, the Sauter mean diameter (D32) is primarily between 50 and 300 μm, and the standard deviation (SD) is between 6 and 17 μm in 80 experiments. It provides a more accurate basis for the recommended manual method instability. The high variance values of the BSD indicate that the manual method has low stability and repeatability. The results of this study can be useful for further improvement of the reliability of c-TCD in detecting RLS. RESEARCH HIGHLIGHTS: This study provided the first detailed descriptions of the MBs size distribution in a flowing contrast agent by the microscopic shadow imaging technique. It reveals significant differences in the bubble size of manual foaming during repeated manipulations for each individual and between individuals.
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Affiliation(s)
- Zhengbin Pan
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology (GTIIT), Shantou, China
| | - Yiting Xiao
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology (GTIIT), Shantou, China
| | - Zhiyue Wang
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology (GTIIT), Shantou, China
| | - Bo Kong
- Department of Chemical Engineering, Guangdong Technion-Israel Institute of Technology (GTIIT), Shantou, China
| | - Yiyi Liang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University Guangzhou, Guangzhou, China
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Li Y, Chen H, Yang X, Peng A, Wang S, Wang H, Jiang Z, Zhang J, Peng Y, Li L, Zhuo L, Li M, Sha L, Peng B, Liu X, Chen L. An Artificial Intelligence-Driven Approach for Automatic Evaluation of Right-to-Left Shunt Grades in Saline-Contrasted Transthoracic Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2024:S0301-5629(24)00152-2. [PMID: 38692941 DOI: 10.1016/j.ultrasmedbio.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Intracardiac or pulmonary right-to-left shunt (RLS) is a common cardiac anomaly associated with an increased risk of neurological disorders, specifically cryptogenic stroke. Saline-contrasted transthoracic echocardiography (scTTE) is often used for RLS diagnosis. However, the identification of saline microbubbles in the left heart can be challenging for novice residents, potentially leading to a delay in diagnosis and treatment. In this study, we proposed an artificial intelligence (AI)-based algorithm designed to automatically detect microbubbles in scTTE images and evaluate right-to-left shunt grades. This tool aims to support residency training and decrease the workload of cardiologists. METHODS A dataset of 23,665 scTTE images obtained from 174 individuals was included in this study. This dataset was partitioned into a training set (n = 20,475) and an internal validation set (n = 3,190) on a patient-level basis. An additional cohort of 33 patients diagnosed with cryptogenic ischemic stroke was enrolled as an external validation set. The proposed algorithm for right-to-left shunt degree classification employed the EfficientNet-b4 model, and the model's performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity, and compared to the performance of residents. RESULTS Our AI model demonstrated robust performance with an accuracy of 0.926, sensitivity of 0.827, and specificity of 0.951 on the internal testing dataset. In the external validation set, our AI model exhibited diagnostic accuracy, sensitivity, and specificity of 0.864, 0.818, and 0.909, respectively. In comparison, residents achieved values of 0.727, 0.636, and 0.818, respectively. CONCLUSION Our AI model provides a swift, precise, and easily deployable methodology for grading the degree of right-to-left shunt in scTTE, carrying substantial implications for routine clinical practice. Residents can benefit from our artificial intelligence-based algorithm, enhancing both the accuracy and efficiency of RLS diagnosis.
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Affiliation(s)
- Yajiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Ximeng Yang
- West China Medical Technology Transfer center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Anjiao Peng
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Hui Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongyuan Jiang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Zhang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yixue Peng
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lijia Zhuo
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mengyu Li
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Leihao Sha
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Peng
- Department of Ultrasonography, Mianzhu City People's Hospital, Mianzhu, China
| | | | - Lei Chen
- Department of Neurology and Joint Research Institution of Altitude Health, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Lin T, Jia H, Li Y, Xu Y, Zhao B, Zheng D, Yan H, Zhao M, Li Y, Xia L, Zhou F, Liu C, Ma K, Mi M, Gu J. Epidemiological Survey of Congenital Heart Disease Among Children Aged from 2 to 18 in Suo County, Nagqu, Tibet. High Alt Med Biol 2024. [PMID: 38511279 DOI: 10.1089/ham.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Lin, Tian, Huaping Jia, Yunming Li, Yongxing Xu, Bei Zhao, Dong Zheng, Hongfeng Yan, Meihui Zhao, Yanlei Li, Liping Xia, Fengxia Zhou, Cuiping Liu, Ke Ma, Ma Mi, and Jianwen Gu. Epidemiological survey of congenital heart disease among children aged from 2 to 18 in Suo County, Nagqu, Tibet. High Alt Med Biol. 00:000-000, 2024. Background: Studies have reported the prevalence of congenital heart disease (CHD) in parts of Tibet, but relative epidemiological surveys are rare. We aimed to explore the prevalence of CHD in children and its relationship with family history in Suo County, Nagqu, Tibet, an altitude of 3,980 meters. Methods: We recruited 4,002 children aged 2-18 years. Subjects underwent a family history investigation, cardiac auscultation, and clinical manifestation examination and then received echocardiographic screening. Results: The prevalence of CHD among children in Suo County was 0.97% (39 cases), much higher than the prevalence at sea level. The most common subtype was atrial septal defect, accounting for 53.9% of CHD, followed by patent ductus arteriosus (33.3%) and ventricular septal defect (12.8%). We also found that children whose mothers had previously borne children with CHD had a higher risk of CHD than those without (p = 0.002); other factors related to CHD during pregnancy, such as smoking, drinking, drug use, and viral infection, showed no statistical differences between children with and without CHD. Conclusions: The prevalence of CHD in children in Suo County is much higher than at low altitude, consisting mostly of simple forms with left-to-right shunt, with rare complex CHD. These results support implementing diagnostic and treatment plans to prevent CHD in Suo County.
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Affiliation(s)
- Tian Lin
- Department of Neurology, Strategic Support Force Medical Center, Beijing, China
| | - Huaping Jia
- Department of Ultrasound Diagnosis, Strategic Support Force Medical Center, Beijing, China
| | - Yunming Li
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, People's Liberation Army, Chengdu, Sichuan, China
| | - Yongxing Xu
- Department of Nephrology, Strategic Support Force Medical Center, Beijing, China
| | - Bei Zhao
- Department of Cardiology, Strategic Support Force Medical Center, Beijing, China
| | - Dong Zheng
- Department of Radiology, Strategic Support Force Medical Center, Beijing, China
| | - Hongfeng Yan
- Department of General Surgery, Strategic Support Force Medical Center, Beijing, China
| | - Meihui Zhao
- Department of Rehabilitation Medicine, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, General Hospital of People's Liberation Army, Beijing, China
| | - Yanlei Li
- Department of Pharmacy, Strategic Support Force Medical Center, Beijing, China
| | - Liping Xia
- Department of Ophthalmology, Strategic Support Force Medical Center, Beijing, China
| | - Fengxia Zhou
- Department of Ultrasound Diagnosis, Strategic Support Force Medical Center, Beijing, China
| | - Cuiping Liu
- Department of Respiratory Medicine, Strategic Support Force Medical Center, Beijing, China
| | - Ke Ma
- Department of General Medicine, People's Hospital of Suo County, Nagqu, Tibet, China
| | - Ma Mi
- Department of General Medicine, People's Hospital of Suo County, Nagqu, Tibet, China
| | - Jianwen Gu
- Department of Neurosurgery, Strategic Support Force Medical Center, Beijing, China
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Brown C, Stefaniuk-Szmukier M, Decloedt A, Beijerink N, Hamilton NA, Velie BD. Congenital heart defects in Arabian horses and the prospects of genetic testing: A review. Equine Vet J 2024. [PMID: 38272847 DOI: 10.1111/evj.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
Congenital heart defects (CHDs) can have profound and potentially life-threatening consequences on horses' health and performance capability. While CHDs are rare in the general horse population, the Arabian breed is disproportionately overrepresented and thus is widely suspected to be genetically predisposed. This review discusses the most common CHDs in Arabian horses, including ventricular septal defect (VSD), tetralogy of Fallot (TOF), patent duct arteriosus (PDA), tricuspid valve atresia (TVA) and atrial septal defect (ASD). This review also explores how future research into the genetic factors that likely underpin many CHDs can revolutionise the way these disorders are managed in Arabian horses.
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Affiliation(s)
- Caitlin Brown
- Equine Genetics and Genomics Group, School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Monika Stefaniuk-Szmukier
- Department of Animal Molecular Biology, National Research Institute of Animal Production, Balice, Poland
| | - Annelies Decloedt
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Niek Beijerink
- Veterinaire Specialisten Vught, Vught, The Netherlands
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha A Hamilton
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Brandon D Velie
- Equine Genetics and Genomics Group, School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales, Australia
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Tang Y, Ji S, Li H, Dong B, Li Y, Zhu C, Chen L. Association of patent foramen ovale with epilepsy: A hospital-based case-control study. Epilepsia Open 2023; 8:1075-1083. [PMID: 37422851 PMCID: PMC10472407 DOI: 10.1002/epi4.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the proportion of patent foramen ovale (PFO) in people with epilepsy (PWE) compared to controls without epilepsy and to assess whether PWEs with and without PFO exhibit distinctive clinical features. METHODS This is a case-control study conducted in a hospital. Contrast transthoracic echocardiography with a venous microbubble bolus and provocative maneuvers (Valsalva and coughing) were used to identify PFO and its right-to-left shunt (RLS) among 741 PWEs and 800 controls without epilepsy. The risk of having PFO in PWEs was explored using multiple matching methods and logistic regression with adjusted congenital factors that may affect the occurrence of PFO. RESULTS The proportion of PFO in PWEs and controls was 39.00% and 24.25%, respectively. After 1:1 propensity score matching, the risk of suffering PFO in PWEs was 1.71 times (OR, 1.71; 95% CI, 1.24-2.36) higher than that in controls. PWEs also had a higher risk of having a high RLS grade (βepilepsy = 0.390, P < 0.001). Among clinical characteristics of PWEs, migraine, and drug-resistant epilepsy showed significantly different distributions between those without RLS and those with RLS grade I to III. PWEs with PFO had higher risk of suffering from migraine and drug-resistant epilepsy (OR in migraine, 2.54, 95% CI, 1.65-3.95; OR in drug-resistant epilepsy, 1.47, 95% CI, 1.06-2.03). SIGNIFICANCE The proportion of PFO was found to be higher in PWE than in controls without epilepsy, especially in patients with drug-resistant epilepsy, suggesting potential relationship between the two disorders. Large multicentric study will be needed to confirm this finding.
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Affiliation(s)
- Yusha Tang
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Shuming Ji
- Department of Project Design and StatisticsSichuan University West China HospitalChengduChina
| | - Hua Li
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Bosi Dong
- Department of NeurologySichuan University West China HospitalChengduChina
| | - Yajiao Li
- Department of Cardiology, West China HospitalSichuan UniversityChengduChina
| | - Chenxing Zhu
- Department of Clinical Research ManagementSichuan University West China HospitalChengduChina
| | - Lei Chen
- Department of NeurologySichuan University West China HospitalChengduChina
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Dong B, Lu Y, He S, Li B, Li Y, Lai Q, Li W, Ji S, Chen Y, Dai L, Chen L. Multisite and multitimepoint proteomics reveal that patent foramen ovale closure improves migraine and epilepsy by reducing right-to-left shunt-induced hypoxia. MedComm (Beijing) 2023; 4:e334. [PMID: 37576864 PMCID: PMC10422075 DOI: 10.1002/mco2.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 08/15/2023] Open
Abstract
Patent foramen ovale (PFO) is a congenital defect in the partition between two atria, which may cause right-to-left shunt (RLS), leading to neurological chronic diseases with episodic manifestations (NCDEMs), such as migraine and epilepsy. However, whether PFO closure was effective in improving NCDEMs and the mechanism were unclear. Twenty-eight patients with migraine or epilepsy who underwent PFO closure were recruited. Notably, approximately half of patients received 50% or more reduction in seizure or headache attacks. Meanwhile, the postoperative blood oxygen partial pressure and oxygen saturation were elevated after PFO closure. Multisite (peripheral, right, and left atrial) and multitimepoint (before and after surgery) plasma proteomics from patients showed that the levels of free hemoglobin and cell adhesion molecules (CAMs) were significantly increased after PFO closure, which may be related to the relief of the hypoxic state. Furtherly, the omics data from multiple brain regions of mice revealed that a large number of proteins were differentially expressed in the occipital region in response to PFO, including redox molecules and CAMs, suggesting PFO-caused hypoxia may have great impacts on occipital region. Collectively, PFO may cause NCDEMs due to RLS-induced hypoxia, and PFO closure could prevent RLS to improve migraine and epilepsy.
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Affiliation(s)
- Bosi Dong
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Ying Lu
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Siyu He
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Baichuan Li
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yajiao Li
- Department of CardiologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Qi Lai
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Wanling Li
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Shuming Ji
- Department of Clinical Research ManagementWest China HospitalSichuan UniversityChengduSichuanChina
| | - Yucheng Chen
- Department of CardiologyWest China HospitalSichuan UniversityChengduSichuanChina
| | - Lunzhi Dai
- State Key Laboratory of BiotherapyNational Clinical Research Center for Geriatrics and Department of General PracticeWest China HospitalSichuan Universityand Collaborative Innovation Center of BiotherapyChengduSichuanChina
| | - Lei Chen
- Department of NeurologyWest China HospitalSichuan UniversityChengduSichuanChina
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Li Y, Shen Y, Cao Q, Cheng Y, Xu L, Tang Z. Effect of Interventional Therapy Unexplained Dizziness and Relationship Between Dizziness Handicap Inventory and Right-to-Left Shunt Grading. Int J Gen Med 2023; 16:803-811. [PMID: 36883122 PMCID: PMC9985875 DOI: 10.2147/ijgm.s401046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Objective Unexplained dizziness remains a clinical challenge. Our previous studies have shown that unexplained dizziness may be related to patent foramen ovale (PFO). This study aims to explore whether the degree of shunt is correlated with the degree of unexplained dizziness and looking for the possible clinical intervention for patients with unexplained dizziness. Methods This study was a large single-center, prospective, controlled study. From March 2019 to March 2022, patients with unexplained dizziness and explained dizziness and healthy controls were recruited. Contrast-enhanced transcranial Doppler sonography (c-TCD) was performed to detect the existence of right-to-left shunt (RLS) and shunt grading. The dizziness handicap inventory (DHI) was completed to evaluate the dizziness. Unexplained dizziness patients with large amount of PFO were volunteered to receive medication treatment and transcatheter PFO closure and followed up six months. Results A total of 387 patients (132 unexplained, 123 explained and 132 controls) were enrolled. There was a statistical difference in the RLS grading with three groups (p < 0.001). The Spearman correlation coefficient of RLS grading and DHI scores in unexplained dizziness patients (r=0.122, p=0.163) and explained dizziness patients (r=0.067, p=0.460). In the unexplained group, there were 49 cases with massive grading RLS. Of which 25 patients received percutaneous PFO closure treatment and 24 cases received medication treatment. Followed up six months after treatment, the amount of DHI scores change in patients who received the percutaneous PFO closure was significantly higher than that in the medication treatment group (p < 0.001). Conclusion RLS may play an important role in unexplained dizziness. For unexplained dizziness patients, PFO closure may contribute to better outcomes. In the future, large-scale randomized controlled studies are still needed.
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Affiliation(s)
- Yanping Li
- Department of Neuroelectrophysiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yingzhang Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhenyu Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Datta T, Ruggiero N, Peters A, Pender A, Vishnevsky A, Mehrotra P. Three-dimensional Transesophageal Echocardiography for Transcatheter Patent Foramen Ovale Closure: Standardizing Anatomic Nomenclature and Novel Sizing Concepts. CASE (PHILADELPHIA, PA.) 2022; 7:14-20. [PMID: 36704482 PMCID: PMC9871352 DOI: 10.1016/j.case.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Terminology for PFO tunnel sizing remains unstandardized. Device size selection for transcatheter PFO closure is highly variable. Tunnel width measurements may be a better descriptor of PFO size. Wire sizing may be a useful technique for assessment of PFO dimensions. PFO sizing strategies based on tunnel width need to be better studied.
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Affiliation(s)
| | | | | | | | | | - Praveen Mehrotra
- Correspondence: Praveen Mehrotra, MD, Associate Professor of Medicine, Division of Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University, 925 Chestnut Street, Mezzanine Level, Philadelphia, PA 19107
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Willits I, Keltie K, Henderson R, de Belder M, Linker N, Patrick H, Powell H, Berry L, Urwin S, Cole H, Sims AJ. Patent foramen ovale closure: A prospective UK registry linked to hospital episode statistics. PLoS One 2022; 17:e0271117. [PMID: 35834516 PMCID: PMC9282467 DOI: 10.1371/journal.pone.0271117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
Aims PFO closure is a percutaneous intervention, which aims to reduce risk of recurrent stroke by preventing paradoxical embolism. The objective of this study was to measure procedural safety and longer-term effectiveness of PFO closure in a UK setting. Methods and results Prospective registry data from patients with cryptogenic stroke eligible for PFO closure were collected for up to 2 years and linked to routine data sources for additional follow-up. Outcomes of interest included procedural success rate, health related quality of life, and longer-term death and neurological event rates. A total of 973 PFO closure procedures in 971 patients were included in analysis. Successful device implantation was achieved in 99.4 [95% CI 98.6 to 99.8]% of procedures, with one in-hospital death. During median follow-up of 758 (Q1:Q3 527:968) days, 33 patients experienced a subsequent neurological event, 76% of which were ischaemic in origin. Neurological event rate was 2.7 [95%CI 1.6 to 3.9]% at 1-year (n = 751) and 4.1 [95% CI 2.6 to 5.5]% at 2-years (n = 463) using Kaplan-Meier analysis. Improvements in patient quality of life (utility and visual analogue scale) were observed at 6-weeks and 6-months follow-up. Conclusion Our observational study demonstrates that PFO closure for prevention of recurrent stroke is a relatively safe procedure but in routine clinical practice is associated with a slightly higher risk of recurrent neurological events than in randomised trials. We hypothesize that our study enrolled unselected patients with higher baseline risk, who were excluded from randomised trials, but who may benefit from a similar relative reduction in risk from the intervention.
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Affiliation(s)
- Iain Willits
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Medical Physics and Clinical Engineering, Newcastle, United Kingdom
| | - Kim Keltie
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Medical Physics and Clinical Engineering, Newcastle, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Robert Henderson
- Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), Barts Health NHS Trust, London, United Kingdom
| | - Nicholas Linker
- South Tees Hospitals NHS Foundation Trust, Cardiology, Middlesbrough, United Kingdom
| | - Hannah Patrick
- National Institute for Health and Care Excellence, London, United Kingdom
| | - Helen Powell
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Lee Berry
- National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Samuel Urwin
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Medical Physics and Clinical Engineering, Newcastle, United Kingdom
| | - Helen Cole
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Medical Physics and Clinical Engineering, Newcastle, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Andrew J. Sims
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Northern Medical Physics and Clinical Engineering, Newcastle, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
- * E-mail:
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11
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Vernemmen I, Paulussen E, Dauvillier J, Decloedt A, van Loon G. Three‐dimensional and catheter‐based intracardiac echocardiographic characterization of the interatrial septum in 2 horses with suspicion of a patent foramen ovale. J Vet Intern Med 2022; 36:1535-1542. [PMID: 35635303 PMCID: PMC9308446 DOI: 10.1111/jvim.16451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
This case report describes the 2‐dimensional transthoracic (2D‐TTE), 3‐dimensional transthoracic (3D‐TTE) and intracardiac echocardiographic (ICE) characterization of the fossa ovalis region in 2 horses. The first case was presented for poor performance and showed an anechoic zone in the interatrial septum on 2D‐TTE. Based on 3D‐TTE a deepened fossa ovalis could be identified and using ICE the presence of an interatrial shunt could be excluded. The second case was referred for a cardiac murmur and the presence of turbulent flow in and around the interatrial septum on 2D‐TTE color flow Doppler. The complementary use of 2D‐TTE, 3D‐TTE, and ICE allowed detailed characterization of a patent foramen ovale, with evidence of a left‐to‐right shunt in a dorsocranial to ventrocaudal direction with limited hemodynamic implications. These 2 cases underline the feasibility of 3D‐TTE and ICE in horses and especially show the added value of ICE in a clinical setting.
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Affiliation(s)
- Ingrid Vernemmen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Ellen Paulussen
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Julie Dauvillier
- Vet Inside, Equine Internal and Sports Medicine Referral Practice Sainte‐Terre France
| | - Annelies Decloedt
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine Ghent University Ghent Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent University, Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine Ghent University Ghent Belgium
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12
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Liu G, Feng Z, Feng F, Xue C, Liu F, Xie X. The correlation between patent foramen ovale and brain ischemia in plateau residents. BMC Cardiovasc Disord 2021; 21:381. [PMID: 34362308 PMCID: PMC8349053 DOI: 10.1186/s12872-021-02172-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background It has been suggested that patent foramen ovale (PFO) contributes to the majority of cryptogenic stroke cases in young people, however, the direct link is still undetermined. Here we analyzed the correlation between PFO and brain ischemia lesions in a cohort of cases that were long-term residents in the plateau to provide solid evidence to support the causal relation between PFO and brain ischemia lesion or cryptogenic stroke. Methods Long-term residents with young age from Qinghai Plateau were recruited and separated by PFO positivity. Brain MRI was used to image 100 PFO positive cases and 100 healthy controls. The diameter of PFO was measured by echocardiography. The location, number and anterior/posterior circulation of ischemia lesions were also evaluated. The correlation between PFO (including positivity and diameter) and brain ischemia lesion (including positivity and other characteristics) was analyzed by chi-square test. Further, the chi-square test for the trend test was used to analyze the linear correlation between these groups. Results We found a strong correlation between the positivity of PFO and brain ischemia lesion, with 71% of PFO cases showing the presence of brain ischemia lesions, and only 19% for healthy controls (p < 0.001). The diameter of PFO is strongly and linearly correlated with the incidence rate of brain ischemia lesion (RR = 3.737 (95%CI 2.496 to 5.767). Conclusion We found a convincing correlation between the positivity of PFO and brain ischemia lesion in residents of the plateau. Our findings provide another solid evidence of the direct causal relation between PFO and brain ischemia lesion.
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Affiliation(s)
- Gang Liu
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China.
| | - Zhao Feng
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China
| | - Fan Feng
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China
| | - Changju Xue
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China
| | - Fei Liu
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China
| | - Xiaoting Xie
- Department of Radiological Interventionalradiology, Qinghai Red Cross Hospital, Xining, 810100, Qinghai, China
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Eskandari S, Jalali P. Relationship between patent foramen ovale and COVID-19 in patients admitted to an intensive care unit. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:725-726. [PMID: 34030947 PMCID: PMC8096169 DOI: 10.1016/j.rec.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Saber Eskandari
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooya Jalali
- Department of Medicine, Islamic Azad University Tabriz Branch, Tabriz, Iran.
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Eskandari S, Jalali P. [Relationship between patent foramen ovale and COVID-19 in patients admitted to an intensive care unit]. Rev Esp Cardiol 2021; 74:725-726. [PMID: 34092897 PMCID: PMC8166536 DOI: 10.1016/j.recesp.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Saber Eskandari
- Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Teherán, Irán
| | - Pooya Jalali
- Department of Medicine, Islamic Azad University Tabriz Branch, Teherán, Irán
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Van der Giessen H, Wilson LC, Coffey S, Whalley GA. Review: Detection of patient foramen ovale using transcranial Doppler or standard echocardiography. Australas J Ultrasound Med 2020; 23:210-219. [PMID: 34765407 PMCID: PMC8411673 DOI: 10.1002/ajum.12232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/07/2022] Open
Abstract
A patent foramen ovale (PFO) is a common remnant of fetal circulation present in up to 25% of the worldwide adult population. Paradoxical embolism occurs when venous blood crosses the PFO into the arterial system, bypassing the pulmonary circulation. This allows for the direct passage of microemboli into cerebral blood vessels, increasing the risk of cryptogenic stroke. This review investigates the current diagnostic procedures used to detect and grade a PFO, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and transcranial Doppler (TCD). Only a few studies have directly compared the use of TTE with TCD for PFO detection but several have compared TTE and TCD independently against the clinical gold standard TOE. Known pitfalls of TTE and TCD are also discussed, including the difficulty of differentiating between intracardiac shunts and intrapulmonary shunts. This review also discusses methods to optimise imaging, such as performing an adequate Valsalva manoeuvre, the role of abdominal compression and the choice of the injection site for the contrast agent and how these may increase the diagnostic success of detecting a right-to-left shunt when prompted by a clinician.
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Affiliation(s)
- Hanna Van der Giessen
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Luke C Wilson
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Sean Coffey
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Gillian A Whalley
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
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Samiei N, Akiash N, Djafari Naeini S, Nikpajouh A, Pazoki M. The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect. J Tehran Heart Cent 2020; 15:98-104. [PMID: 33552204 PMCID: PMC7827115 DOI: 10.18502/jthc.v15i3.4218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.
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Affiliation(s)
- Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nehzat Akiash
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sepideh Djafari Naeini
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akbar Nikpajouh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Pazoki
- Rasul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Felix A, Alcantara MLD. To Close or not to Close PFOs in Cryptogenic Stroke, an Evolving Question. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Hong CS, Politzer C, Ryan SP, Wellman SS, Jiranek WA, Bolognesi MP, Seyler TM. Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management. Orthopedics 2020; 43:e151-e158. [PMID: 32077965 DOI: 10.3928/01477447-20200213-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/25/2019] [Indexed: 02/03/2023]
Abstract
Venous thromboembolism and ischemic stroke are major complications following total knee arthroplasty (TKA) and potentially are associated with a patent foramen ovale (PFO). Although this association has been shown in other surgical disciplines, it has not been demonstrated in patients undergoing TKA. This study was undertaken to determine whether patients with a PFO would have a significantly increased risk of cerebrovascular accident (CVA) following TKA. The Humana national database was used to identify TKA patients who were stratified by the presence of a PFO from 2007 to 2016. Ninety-day follow-up was used for the primary outcome of CVA. Potential confounding comorbidities also were investigated, including age, sex, anticoagulation, insurance type, arrhythmia, valvular disease, peripheral vascular disease, chronic kidney disease, and diabetes mellitus. Of 153,245 TKAs, a total of 2272 patients had strokes; 479 of these patients had a PFO. On multivariable analysis, PFO remained an independent predictor of CVA postoperatively (odds ratio, 3.824; 95% confidence interval, 2.614-5.406; P<.0001). Other significant comorbidities associated with CVA included arrhythmia, chronic kidney disease, diabetes mellitus, peripheral vascular disease, and coronary valve disease. Importantly, low-molecular weight heparin or factor Xa inhibitor administration postoperatively had a negative correlation with stroke (odds ratio, 0.762; 95% confidence interval, 0.663-0.871; P=.0001 and odds ratio, 0.749; 95% confidence interval, 0.628-0.885; P=.0009, respectively). The findings of the multivariable analysis indicate PFO is associated with early postoperative CVA within 90 days following TKA. If known preoperatively, appropriate referral should be made to a cardiologist for PFO management and anticoagulation to reduce the overall risk of stroke. [Orthopedics. 2020;43(3):e151-e158.].
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Koutroulou I, Tsivgoulis G, Tsalikakis D, Karacostas D, Grigoriadis N, Karapanayiotides T. Epidemiology of Patent Foramen Ovale in General Population and in Stroke Patients: A Narrative Review. Front Neurol 2020; 11:281. [PMID: 32411074 PMCID: PMC7198765 DOI: 10.3389/fneur.2020.00281] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/25/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction: Percutaneous closure of patent foramen ovale (PFO) in selected patients with cryptogenic cerebrovascular ischemic events (CEs) decreases the risk of recurrent stroke; however, optimal patient selection criteria are still under investigation. Candidates for PFO closure are usually selected from the pool of CE patients with a high risk of Paradoxical Embolism (RoPE) score. The RoPE score calculates the probability that PFO is causally related to stroke, based on PFO prevalence in patients with CE compared with that in healthy subjects. The latter has been set at 25% based on the average of autopsy and transesophageal echocardiography (TEE) studies. Methods: We conducted a comprehensive review of studies investigating PFO prevalence in general population and in patients with CE and non-CE using autopsy, TEE, transcranial Doppler (TCD) or transthoracic echocardiography (TTE). Studies were excluded if they (1) reported data from referred subjects with underlying cerebrovascular disease or (2) did not specify etiologically the events. Results: In healthy/control subjects, PFO prevalence was 24.2% (1,872/7,747) in autopsy studies, 23.7% (325/1,369) in TEE, 31.3% (111/355) in TCD, and 14.7% (186/1,267) in TTE studies. All diagnostic modalities included PFO prevalence was higher in CE compared with healthy/control population [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 2.5–3.8] and compared with non-CE (OR = 2.3, 95% CI = 2.0–2.6). In patients with CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (48.9 vs. 27.3%, p < 0.0001, OR = 2.6 with 95% CI = 2.0–3.3) or TCD (58.1 vs. 41%, OR = 1.9, 95% CI = 1.6–2.5), but not TTE (53.3 vs. 37.5%, p = 0.16). Regarding non-CE, PFO prevalence in the young compared to the old was higher when the diagnostic modality was TEE (20 vs. 12.9%, OR = 1.7, 95% CI = 1.0–2.8) but not TTE (10.4 vs. 7.8%, p = 0.75) or TCD (22.8 vs. 20.1%, p = 0.56). Conclusions: Given the limitations of autopsy and TEE studies, there is good reason not to take a fixed 25% PFO prevalence for granted. The estimation of degree of causality may be underestimated or overestimated in populations with PFO prevalence significantly lower or higher than the established. Given the high sensitivity, non-invasive nature, low cost, and repeatability of TCD, future large-scale TCD-based studies should investigate potential heterogeneity in PFO prevalence in different healthy racial/ethnic populations.
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Affiliation(s)
- Ioanna Koutroulou
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitris Karacostas
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
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Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
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21
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Ozel A, Dedeoglu R, Davutoglu EA, Madazli R, Oztunc F. Outcome of Aneurysmal Septum Primum with Non-restrictive Foramen Ovale in Fetuses with Structurally Normal Hearts: A Tertiary Center Experience. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Darmoch F, Al-Khadra Y, Bacha HM, Soud M, Alraies MC. Closing the gap on patent foramen ovale and cryptogenic stroke. Expert Rev Cardiovasc Ther 2019; 17:389-394. [PMID: 31184225 DOI: 10.1080/14779072.2019.1627875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: The treatment options for prevention of recurrent of cryptogenic stroke in patients with patent foramen ovale (PFO) have been intensely debated in the recent decades. The suggested options were percutaneous closure of PFO versus medical therapy. However, up to these date there is a controversy regarding the indication of percutaneous closure. Multiple meta-analysis and recent randomized control trials showed the benefit of PFO closure when compared with medical therapy alone. Areas covered: The article reviews the prevalence, physiology, diagnosis and treatment options of PFO after cryptogenic stroke. Furthermore, it will discuss the results of randomized control trials that compared the PFO closure to medical therapy. Expert opinion: The association between PFO and unexplained cryptogenic stroke has been well established in the multiple studies. The diagnosis and management of PFO might be challenging in some cases. Although multiple studies showed that PFO closure is associated with lower rates of recurrent stroke in patients presenting with cryptogenic stroke, the indication and patient selection for this intervention are not well established yet in the guidelines.
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Affiliation(s)
- Fahed Darmoch
- a Beth Israel Deaconess Medical Center/Harvard School of Medicine , Boston , MA , USA
| | | | | | - Mohammad Soud
- c MedStar Washington Hospital Center , Washington, D.C. , USA
| | - M Chadi Alraies
- d Wayne State University, Detroit Medical Center , Detroit Heart Hospital , Detroit , MI , USA
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Genomic Observations of a Rare/Pathogenic SMAD3 Variant in Loeys⁻Dietz Syndrome 3 Confirmed by Protein Informatics and Structural Investigations. ACTA ACUST UNITED AC 2019; 55:medicina55050137. [PMID: 31096651 PMCID: PMC6571799 DOI: 10.3390/medicina55050137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/29/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022]
Abstract
Background and objectives: Loeys–Dietz syndrome 3, also known as aneurysms-–osteoarthritis syndrome, is an autosomal dominant genetic connective tissue disease caused by pathogenic variants in SMAD3, a transcription factor involved in TGF-β signaling. This disorder is characterized by early-onset osteoarthritis and arterial aneurysms. Common features include scoliosis, uvula abnormalities, striae, and velvety skin. Materials and Methods: The pathogenicity of a variant of uncertain significance in the SMAD3 gene was evaluated (variant c.220C > T) through personalized protein informatics and molecular studies. Results: The case of a 44-year-old male, who was originally presumed to have Marfan syndrome, is presented. An expanded gene panel determined the probable cause to be a variant in SMAD3, c.220C > T (p.R74W). His case was complicated by a history of stroke, but his phenotype was otherwise characteristic for Loeys–Dietz syndrome 3. Conclusion: This case emphasizes the importance of comprehensive genetic testing to evaluate patients for connective tissue disorders, as well as the potential benefit of utilizing a protein informatics platform for the assessment of variant pathogenicity.
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Deana C, Conangla L, Vetrugno L, Saltarini M, Buttera S, Bove T, Bassi F, De Monte A. Persistent hypoxemia after an asthma attack. Ultrasound J 2019; 11:6. [PMID: 31359291 PMCID: PMC6638612 DOI: 10.1186/s13089-019-0121-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
The presence of an unknown intracardiac shunt due to a patent foramen ovale may be an unusual cause of hypoxemia. We report the case of a patient who presented persistent hypoxemia after an adequate treatment for a severe asthma attack requiring intensive care unit admission. The patient underwent a transthoracic microbubbles contrast echocardiography that showed a massive patent foramen ovale. The favorable clinical course and the absence of major signs and symptoms related to patent foramen ovale allowed a conservative approach with a follow-up program. Patent foramen ovale should be suspected in case of persistent hypoxemia after a severe asthma attack had resolved.
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Affiliation(s)
- Cristian Deana
- Anesthesiology and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata-Udine, P.le S.Maria Della Misericordia n. 15, 33100, Udine, Italy.
| | - Laura Conangla
- Primary Care Service Barcelonès Nord i Maresme, Catalan Health Institute, Barcelona, Spain
| | - Luigi Vetrugno
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria Della Misericordia n.15, 33100, Udine, Italy
| | - Massimiliano Saltarini
- Anesthesiology and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata-Udine, P.le S.Maria Della Misericordia n. 15, 33100, Udine, Italy
| | - Stefania Buttera
- Anesthesiology and Intensive Care 2, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata-Udine, P.le S.Maria Della Misericordia n. 15, 33100, Udine, Italy
| | - Tiziana Bove
- Anesthesiology and Intensive Care Clinic, Department of Medicine, University of Udine, P.le S. Maria Della Misericordia n.15, 33100, Udine, Italy
| | - Flavio Bassi
- Anesthesiology and Intensive Care 2, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata-Udine, P.le S.Maria Della Misericordia n. 15, 33100, Udine, Italy
| | - Amato De Monte
- Anesthesiology and Intensive Care 1, Department of Anesthesia and Intensive Care, Azienda Sanitaria Universitaria Integrata-Udine, P.le S.Maria Della Misericordia n. 15, 33100, Udine, Italy
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Giacoppo D, Caronna N, Frangieh AH, Michel J, Andò G, Tarantini G, Kasel AM, Capodanno D, Byrne RA. Long-term effectiveness and safety of transcatheter closure of patent foramen ovale compared with antithrombotic therapy alone: a meta-analysis of six randomised clinical trials and 3,560 patients with reconstructed time-to-event data. EUROINTERVENTION 2018; 14:857-867. [DOI: 10.4244/eij-d-18-00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Li JJ, Liu Y, Xie SY, Zhao GD, Dai T, Chen H, Mu LF, Qi HY, Li J. Newborn screening for congenital heart disease using echocardiography and follow-up at high altitude in China. Int J Cardiol 2018; 274:106-112. [PMID: 30195837 DOI: 10.1016/j.ijcard.2018.08.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 06/26/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pulse oximetry screening for critical congenital heart disease (CHD) is inapplicable to high altitude due to the variedly decreased arterial saturations and rare complex CHD. We examined the incidence and spectrum of CHD in newborns using echocardiography at high altitude and followed up their outcomes. METHODS A total of 1337 babies were studied. Echocardiography was performed in 1002 asymptomatic newborns (3-5 days). In the same period, retrospectively studied 394 newborns (≤2 days) admitted to the NICU where echocardiograph was performed in 335. In both groups, follow-up was made at 1-3, 6 and 12-18 months. RESULTS The incidence of CHD in asymptomatic newborns was 27.8%, consisting secundum atrial septal defect (ASD) [175 (62.7%)], patent ductus arteriosus (PDA) [61 (21.9%)], ventricular septal defect (VSD) [8 (2.9%)] and multiple defects [35 (12.6%)]. And 19.4% in NICU patients with similar spectrum, except for 2 with complex CHD who died before discharge. By 12-18 months of follow-up, 30% of CHD remained open. Thirteen patients developed mild to severe pulmonary arterial hypertension (PAH), and 2 of them died of heart failure. CONCLUSIONS The incidence of CHD in newborns at high altitude is about 20 times higher than that at low altitude, consisting mostly of simple forms with left to right shunt, with rare complex CHD. By 12-18 months, the incidence of CHD is still about 10 times higher than that at low altitude. About 8% patients developed PAH or death. Follow-up must be reinforced in order to provide early intervention and prevent from PAH or death.
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Affiliation(s)
- Jing-Jing Li
- Clinical Pathophysiology Laboratory, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, China
| | - Yuan Liu
- Department of Echocardiography, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Si-Yuan Xie
- Clinical Pathophysiology Laboratory, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, China
| | - Guo-Dong Zhao
- Department of Echocardiography, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Ting Dai
- Department of Echocardiography, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Hong Chen
- Department of Echocardiography, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Lan-Fang Mu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China
| | - Hai-Ying Qi
- Department of Echocardiography, Women and Children's Hospital of Qinghai Province, Xining, Qinghai 810000, China.
| | - Jia Li
- Clinical Pathophysiology Laboratory, Capital Institute of Pediatrics, Peking University Teaching Hospital, Beijing 100020, China.
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Aggeli C, Verveniotis A, Andrikopoulou E, Vavuranakis E, Toutouzas K, Tousoulis D. Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle. Int J Cardiovasc Imaging 2018; 34:1849-1861. [PMID: 29956022 DOI: 10.1007/s10554-018-1406-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/22/2018] [Indexed: 01/11/2023]
Abstract
Patent foramen ovale (PFO) is a residual, oblique, slit or tunnel like communication in the atrial septum that persists into adulthood. It is usually an incidental finding with no clinical repercussions. Nevertheless, recent evidence supports the association between the presence of a PFO and a number of clinical conditions, most notably cryptogenic stroke (CS). There is enough evidence that paradoxical embolism is a mechanism which can explain this association. Patient characteristics and certain echocardiography-derived anatomical and hemodynamic features of PFO provide great assistance in estimating the probability of paradoxical embolism. In this review, we initially describe PFO embryology and anatomy. We extensively present the available data on clinical, anatomical and hemodynamic features of PFOs which have been correlated with increased likelihood of paradoxical embolism and recent evidence of therapeutic management.
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MESH Headings
- Echocardiography, Doppler, Color
- Echocardiography, Three-Dimensional
- Echocardiography, Transesophageal
- Embolism, Paradoxical/diagnostic imaging
- Embolism, Paradoxical/etiology
- Embolism, Paradoxical/physiopathology
- Embolism, Paradoxical/prevention & control
- Foramen Ovale/diagnostic imaging
- Foramen Ovale/embryology
- Foramen Ovale/physiopathology
- Foramen Ovale, Patent/complications
- Foramen Ovale, Patent/diagnostic imaging
- Foramen Ovale, Patent/physiopathology
- Foramen Ovale, Patent/therapy
- Hemodynamics
- Humans
- Incidental Findings
- Predictive Value of Tests
- Prognosis
- Risk Factors
- Stroke/etiology
- Stroke/physiopathology
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Affiliation(s)
- Constantina Aggeli
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece.
| | - Athanasios Verveniotis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece
| | - Efstathia Andrikopoulou
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Emmanouil Vavuranakis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece
| | - Konstadinos Toutouzas
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, 114 Vas. Sofias, 11527, Athens, Greece
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Zoltowska DM, Agrawal Y, Kalavakunta JK. Serpentine thrombus in the heart: a rare case of trapped thrombus in patent foramen ovale. BMJ Case Rep 2018; 2018:bcr-2017-223469. [PMID: 29563129 DOI: 10.1136/bcr-2017-223469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 77-year-old Caucasian woman with recent abdominal surgery was diagnosed with multiple paradoxical systemic emboli in the mesenteric and renal circulation. Diagnosis was made by direct visualisation of a serpentine thrombus traversing both atria through patent foramen ovale (PFO) by transesophageal echocardiogram (TEE). Concomitantly, the patient was found to have deep venous thrombosis and pulmonary embolism. A decision was made to pursue cardiothoracic surgery preceded by inferior vena cava filter placement. She was started on intravenous anticoagulation. Repeat TEE was negative for thrombus and the patient did not present any new clinical signs of embolisation by this time. Consequently, the treatment plan was modified and the patient received oral systemic anticoagulation followed by PFO closure with the use of St. Jude Amplatzer Cribriform septal occluder device. During the outpatient follow-up the patient was asymptomatic and there was no significant flow through the device on transthoracic echocardiogram.
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Affiliation(s)
- Dominika M Zoltowska
- Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
| | - Yashwant Agrawal
- Western Michigan University Homer Stryker School of Medicine, Kalamazoo, Michigan, USA
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29
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Risk of stroke in patients with right-sided congenital heart disease and interatrial communication. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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30
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Stecco A, Quagliozzi M, Soligo E, Naldi A, Cassarà A, Coppo L, Rosso R, Bongo AS, Amatuzzo P, Buemi F, Guenzi E, Carriero A. Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study. Radiol Med 2017; 122:412-418. [PMID: 28224399 DOI: 10.1007/s11547-017-0738-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 02/06/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this retrospective study was to map the specific ischemic lesion patterns of distribution in patent foramen ovale-related stroke (PFO-stroke) and atrial fibrillation-related stroke (AF-stroke) in patients with idiopatic ischemic stroke. MATERIALS AND METHODS 750 ischaemic strokes were screened on basis of diagnostic imaging and tests: patients with known causes were excluded. 171 patients with unknown cause were selected and divided in two groups: AF-stroke (43 patients) and PFO-stroke (128 patients). Vascular territories of ischemic involvement were divided into four classes in each group: the anterior cerebral artery, the middle cerebral artery, the vertebro-cerebral artery (including the posterior cerebral artery) and multisite (MS) involvement. RESULTS Infarcts in vertebro-basilar territory and multisite represented each one about 32% of infarcts in PFO-stroke group and their involvement are more frequent than AF-stroke group (p = 0.03). Ischemic lesions in PFO-group were predominantly cortical (34.3%), and in AF-group cortical-subcortical (60.4%). Multisite pattern of ischemic lesion was more frequent in patients with severe degree of right to left shunts (37.5%). CONCLUSION In clinical practice, PFO may be considered a cause of cortical stroke on the basis of radiological findings, when VB vascular territory or MS brain involvement is present in younger patients (<50 age).
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Affiliation(s)
- Alessandro Stecco
- Neuroradiology Unit, Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy.
| | - Martina Quagliozzi
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Soligo
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Andrea Naldi
- Neurology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessia Cassarà
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Lorenzo Coppo
- Neurology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Roberta Rosso
- Cardiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Angelo Sante Bongo
- Cardiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Paola Amatuzzo
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Francesco Buemi
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Elena Guenzi
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Carriero
- Radiology Department, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Corso Mazzini 18, 28100, Novara, Italy
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Saric M, Armour AC, Arnaout MS, Chaudhry FA, Grimm RA, Kronzon I, Landeck BF, Maganti K, Michelena HI, Tolstrup K. Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism. J Am Soc Echocardiogr 2016; 29:1-42. [PMID: 26765302 DOI: 10.1016/j.echo.2015.09.011] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism. It describes general mechanisms of stroke and systemic embolism; the specific role of cardiac and aortic sources in stroke, and systemic and pulmonary embolism; the role of echocardiography in evaluation, diagnosis, and management of cardiac and aortic sources of emboli including the incremental value of contrast and 3D echocardiography; and a brief description of alternative imaging techniques and their role in the evaluation of cardiac sources of emboli. Specific guidelines are provided for each category of embolic sources including the left atrium and left atrial appendage, left ventricle, heart valves, cardiac tumors, and thoracic aorta. In addition, there are recommendation regarding pulmonary embolism, and embolism related to cardiovascular surgery and percutaneous procedures. The guidelines also include a dedicated section on cardiac sources of embolism in pediatric populations.
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Affiliation(s)
- Muhamed Saric
- New York University Langone Medical Center, New York, New York
| | | | - M Samir Arnaout
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Farooq A Chaudhry
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Richard A Grimm
- Learner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Kirsten Tolstrup
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Larrosa D, Ramón C, Alvarez R, Martínez-Camblor P, Cernuda E, Pascual J. No Relationship Between Patent Foramen Ovale and Migraine Frequency. Headache 2016; 56:1466-1473. [PMID: 27634435 DOI: 10.1111/head.12945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Pathophysiology of migraine is not fully known. A link has been proposed between migraine and patent foramen ovale (PFO). However, there are conflicting data regarding the causal relationship between PFO and migraine. OBJECTIVE To test a potential association between migraine frequency and PFO by way of an observational, single-center, case-controlled study. METHODS We studied a total of 130 chronic migraine (CM) and 53 episodic migraine (EM) patients. Transcranial Doppler with agitated saline injection was used to evaluate the presence and degree of PFO. PFO was judged to be present if any signal was detected. The degree of PFO during rest and Valsalva was quantified as follows: small (1-10 microbubbles [MB]), medium (10-25 MB), or large (>25 MB with shower or curtain pattern). PFO detected at rest were considered permanent, while those detected during Valsalva maneuver were classified as latent. RESULTS The prevalence of PFO was similar in CM and EM patients (53.1% [44.1-62.2] vs 54.7% [40.3-69.1], P = .871). PFO size was significantly larger in the EM group compared to the CM group (35.8% vs 20.3%, P = .037). The presence of permanent PFO was also significantly higher in EM compared to CM (37.7% vs 22.7%, P = .044). No differences were found according to the presence of aura. CONCLUSION This study indicates that PFO is not more common or larger in CM than in EM patients. These findings do not support a relationship between PFO and migraine frequency.
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Affiliation(s)
- Davinia Larrosa
- Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain.
| | - César Ramón
- Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain
| | - Rocío Alvarez
- Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain
| | - Pablo Martínez-Camblor
- Geisel School of Medicine at Darmouth, Hanover, NH, USA.,Autonomous University of Chile, Santiago, Chile
| | - Eva Cernuda
- Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain.,Geisel School of Medicine at Darmouth, Hanover, NH, USA
| | - Julio Pascual
- Service of Neurology, University Hospital "Central de Asturias" and INEUROPA, Oviedo, Spain.,University Hospital "Marqués de Valdecilla" and IDIVAL, Santander, España
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García Peña ÁA, Rodríguez JA. ¿Estamos cerrando muchos forámenes ovales permeables en Colombia? Foramen ovale permeable, aneurisma del septum interauricular y riesgo de ataque cerebrovascular criptogénico recurrente. Revisión sistemática de la literatura. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Savino K, Maiello M, Pelliccia F, Ambrosio G, Palmiero P. Patent foramen ovale and cryptogenic stroke: from studies to clinical practice: Position paper of the Italian Chapter, International Society Cardiovascular Ultrasound. Int J Clin Pract 2016; 70:641-8. [PMID: 27384340 DOI: 10.1111/ijcp.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right-to-left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists. AIMS This review aims to evaluate the role of PFO in cryptogenic stroke, the diagnostic accuracy of transcranial Doppler, contrast transthoracic and transesophageal echocardiography in the diagnosis of left-fright shunt and PFO; and discuss the indications to medical treatment and percutaneous closure of PFO. METHODS All studies published in the literature on PFO and cryptogenic stroke are considered and discussed. RESULTS We define an appropriate diagnostic and clinical management of PFO patients with cryptogenic stroke. CONCLUSION After many years of interest on PFO and many concluded studies, there are still no definitive data. However, we are on good track for an appropriate management of PFO patients and cryptogenic stroke.
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Affiliation(s)
- K Savino
- Division of Cardiology - S. Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - M Maiello
- ASL Brindisi, District Cardiology Equipe, Brindisi, Italy
| | - F Pelliccia
- Department Heart and Great Vessels "Attilio Reale", University "La Sapienza" Rome, Rome, Italy
| | - G Ambrosio
- Division of Cardiology - S. Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - P Palmiero
- ASL Brindisi, District Cardiology Equipe, Brindisi, Italy
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Wessler BS, Kent DM, Thaler DE, Ruthazer R, Lutz JS, Serena J. The RoPE Score and Right-to-Left Shunt Severity by Transcranial Doppler in the CODICIA Study. Cerebrovasc Dis 2015; 40:52-8. [PMID: 26184495 DOI: 10.1159/000430998] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/27/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND For patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), it is unknown whether the magnitude of right-to-left shunt (RLSh) measured by contrast transcranial Doppler (c-TCD) is correlated with the likelihood an identified PFO is related to CS as determined by the Risk of Paradoxical Embolism (RoPE) score. Additionally, for patients with CS, it is unknown whether PFO assessment by c-TCD is more sensitive for identifying RLSh compared with transesophageal echocardiography (TEE). Our aim was to determine the significance of RLSh grade by c-TCD in patients with PFO and CS. METHODS We evaluated patients with CS who had RLSh quantified by c-TCD in the Multicenter Study into RLSh in Cryptogenic Stroke (CODICIA) to determine whether there is an association between c-TCD shunt grade and the RoPE Score. For patients who underwent c-TCD and TEE, we determined whether there is agreement in identifying and grading RLSh between these two modalities. RESULTS The RoPE score predicted the presence versus the absence of RLSh documented by c-TCD (c-statistic = 0.66). For patients with documented RLSh by c-TCD, shunt severity was correlated with increasing RoPE score (rank correlation (r) = 0.15, p = 0.01). Among 293 patients who had both c-TCD and TEE performed, c-TCD was more sensitive (98.7%) for detecting RLSh. Of the 97 patients with no PFO identified on TEE, 28 (29%) had a large amount of RLSh seen on c-TCD. CONCLUSIONS For patients with CS, severity of RLSh by c-TCD is positively correlated with the RoPE score, indicating that this technique for shunt grading identifies patients more likely to have pathogenic rather than incidental PFOs. c-TCD is also more sensitive in detecting RLSh than TEE. These findings suggest an important role for c-TCD in the evaluation of PFO in the setting of CS.
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Affiliation(s)
- Arjun K Ghosh
- Specialty Registrar in Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Ajay Jain
- Consultant Cardiologist at Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London
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Bayar N, Arslan Ş, Çağırcı G, Erkal Z, Üreyen ÇM, Çay S, Köklü E, Yüksel İÖ, Küçükseymen S. Assessment of Morphology of Patent Foramen Ovale with Transesophageal Echocardiography in Symptomatic and Asymptomatic Patients. J Stroke Cerebrovasc Dis 2015; 24:1282-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.01.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/18/2015] [Accepted: 01/30/2015] [Indexed: 11/25/2022] Open
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38
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De Vry DJ, Ferron DR, Kersten JR, Rashid ZA, Pagel PS. How Can a Large Left Atrial Myxoma Cause a Selective Mid-Diastolic Right-to-Left Atrial Shunt? J Cardiothorac Vasc Anesth 2015; 29:820-3. [DOI: 10.1053/j.jvca.2014.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/11/2022]
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Abstract
Patent foramen ovale (PFO) is common and only rarely related to stroke. The high PFO prevalence in healthy individuals makes for difficult decision making when a PFO is found in the setting of a cryptogenic stroke, because the PFO may be an incidental finding. Recent clinical trials of device-based PFO closure have had negative overall summary results; these trials have been limited by low recurrence rates. The optimal antithrombotic strategy for these patients is also unknown. Recent work has identified a risk score that estimates PFO-attributable fractions based on individual patient characteristics, although whether this score can help direct therapy is unclear.
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Affiliation(s)
- Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 63, Boston, MA 02111, USA; Division of Cardiology, Tufts Medical Center, 800 Washington Street, Box 63, Boston, MA 02111, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Box 63, Boston, MA 02111, USA.
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Abstract
OPINION STATEMENT Cardioembolic (CE) stroke mechanisms account for a significant number of ischemic strokes; however, the true burden is likely underestimated. It is critically important to identify patients with CE strokes because these individuals have high recurrence rates and represent a subgroup of patients who may benefit from targeted therapy in the form of anticoagulation or device based treatments. Current guidelines offer recommendations for diagnosis and treatment of these patients; however, important questions remain. First, appropriate cardiac testing in the setting of CE must be individualized and the optimal duration of electrocardiographic monitoring to rule out atrial fibrillation (AF) is unclear. Second, risk stratification tools for AF remain understudied, and there is controversy about which anticoagulant agents are most appropriate. Lastly, important potential CE sources of stroke such as patent foramen ovale have garnered significant attention recently, and debate regarding how to manage these patients persists. In this review, we discuss some of the important controversies in diagnosing and treating patients with possible CE stroke, pointing to areas where future research might be particularly valuable.
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Affiliation(s)
- Benjamin S. Wessler
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston
- Division of Cardiology, Tufts Medical Center, Boston
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston
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Ramakrishna H, Patel PA, Gutsche JT, Kohl BA, Savino JS, Augoustides JG. Incidental Patent Foramen Ovale in Adult Cardiac Surgery: Recent Evidence and Management Options for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2014; 28:1691-5. [DOI: 10.1053/j.jvca.2014.04.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Indexed: 11/11/2022]
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42
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Sadahiro H, Nomura S, Inamura A, Yamane A, Sugimoto K, Fujiyama Y, Suzuki M. Brain abscess associated with patent foramen ovale. Acta Neurochir (Wien) 2014; 156:1971-6; discussion 1976. [PMID: 24975278 DOI: 10.1007/s00701-014-2170-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Brain abscesses can develop with Tetralogy of Fallot and pulmonary anterior venous fistula with large right-to-left shunt. However, some patients exhibit cryptogenic brain abscess (CBA) in the absence of any such congenital disease or other infections. Patent foramen ovale (PFO) is a very common disease that exhibits right-to-left shunt. This study reports the potential for concern between CBA and PFO. METHODS We enrolled patients with CBA in our hospital between January 2003 and January 2013. Patients underwent transesophageal echocardiography (TEE) with contrast medium to investigate the presence of PFO. RESULTS Seven patients were included. Four were females, and the mean age was 67.7 ± 9.2 years. In all patients, TEE failed to reveal any new findings, however, six patients had PFO, and another patient had pulmonary arteriovenous shunt. Four patients had odontopathy. CONCLUSION In this study, all CBA patients exhibited right-to-left shunt. CBA might be caused by paradoxical embolization of a bacterial mass via PFO. Thus, more patients with CBA need to undergo TEE to detect PFO.
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Mean platelet volume, an indicator of platelet reactivity, is increased in patients with patent foramen ovale. Blood Coagul Fibrinolysis 2014; 24:605-7. [PMID: 23511902 DOI: 10.1097/mbc.0b013e32836029ee] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Numerous studies have shown an association between patent foramen ovale (PFO) and cryptogenic stroke suggesting that paradoxical emboli may be an important cause of stroke. In addition, some authors have proposed that platelet activation is present in PFO patients and this might be the cause of the stroke. The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation and/or reactivity in patients with PFO. The study group consisted of 77 patients with PFO. An age, sex, BMI-matched control group was composed of 43 healthy volunteers. We measured serum MPV values in patients and controls. MPV was significantly higher among PFO patients when compared with control group (9.0±0.8 vs. 8.3±0.9 fl, respectively; P<0.001). We have shown that MPV was significantly elevated in patients with PFO compared with controls.
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Rhone E, Chung N, Clapp B. Current evidence for closure of a patent foramen ovale for cryptogenic stroke prevention. Int J Clin Pract 2014; 68:551-6. [PMID: 24373020 DOI: 10.1111/ijcp.12312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A patent foramen ovale (PFO) has long been implicated as a potential mechanism for cryptogenic stroke (CS), which accounts for up to 40% of all cases of ischaemic stroke. Although there is a strong association between a PFO and CS, there is less evidence that percutaneous closure of the defect, as opposed to medical therapy with antithrombotics or anticoagulants, is the most effective form of secondary prevention. The aim of this review is to examine the evidence comparing percutaneous closure with medical therapy, with a particular focus on three recently published randomised controlled trials.
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Affiliation(s)
- E Rhone
- Kings College London Medical School, London, UK
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Gate-Martinet A, Da Costa A, Romeyer-Bouchard C, Bisch L, Levallois M, Isaaz K. Does a patent foramen ovale matter when using a remote-controlled magnetic system for pulmonary vein isolation? Arch Cardiovasc Dis 2014; 107:88-95. [PMID: 24556188 DOI: 10.1016/j.acvd.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/21/2013] [Accepted: 01/07/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) takes longer when using a patent foramen ovale (PFO) compared with a transseptal puncture in paroxysmal atrial fibrillation (AF) with manual catheter ablation. To our knowledge, no data exist concerning the impact of a PFO on AF ablation procedure variables when using a remote magnetic navigation (RMN) system. AIM To assess the impact of a PFO when using an RMN system in patients requiring AF ablation. METHODS Between December 2011 and December 2012, catheter ablation was performed remotely using the CARTO(®) 3 system in 167 consecutive patients who underwent PVI for symptomatic drug-refractory AF. The radiofrequency generator was set to a fixed power ≤ 35 W. The primary endpoint was wide-area circumferential PVI confirmed by spiral catheter recording during ablation for all patients and including additional lesion lines (left atrial roof) or complex fractionated atrial electrograms for persistent AF. Secondary endpoints included procedural data. RESULTS Mean age 58±10 years; 18% women; 107 (64%) patients with symptomatic paroxysmal AF; 60 (36%) with persistent AF; CHA2DS2-VASc score 1.2 ± 1. The PFO presence was evidenced in 49/167 (29.3%) patients during the procedure but in only 26/167 (16%) by transoesophageal echocardiography. Median procedure time 2.5 ± 1 hours; median total X-ray exposure time 14 ± 7 minutes; transseptal puncture and catheter positioning time 7.5 ± 5 minutes; left atrium electroanatomical reconstruction time 3 ± 2.3 minutes; catheter ablation time 3 ± 3 minutes. No procedure time or X-ray exposure differences were observed between patients with or without a PFO during magnetic navigation catheter ablation. X-ray exposure time was significantly reduced using a PFO compared with double transseptal puncture access. CONCLUSIONS A PFO does not affect magnetic navigation during AF ablation; procedure times and X-ray exposure were similar. Septal catheter probing is mandatory to limit X-ray exposure and prevent potential complications.
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Affiliation(s)
| | - Antoine Da Costa
- Division of Cardiology, Jean-Monnet University, Saint-Étienne, France.
| | | | - Laurence Bisch
- Division of Cardiology, Jean-Monnet University, Saint-Étienne, France
| | - Marie Levallois
- Division of Cardiology, Jean-Monnet University, Saint-Étienne, France
| | - Karl Isaaz
- Division of Cardiology, Jean-Monnet University, Saint-Étienne, France
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Kar S. Cardiovascular implications of obstructive sleep apnea associated with the presence of a patent foramen ovale. Sleep Med Rev 2014; 18:399-404. [PMID: 24703203 DOI: 10.1016/j.smrv.2014.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 01/29/2014] [Accepted: 02/05/2014] [Indexed: 11/30/2022]
Abstract
Patent foramen ovale (PFO) is a common congenital cardiac abnormality of the atrial septum which occurs in 25% of the population. It allows communication between the right and left atrium enabling right to left shunting of deoxygenated blood (after birth) which may be linked to strokes or transient ischemic attacks. PFO may also have an association with obstructive sleep apnea (OSA). OSA is a common medical condition occurring in 9% of adult males and 4% of adult females. It may increase the risk of cardiovascular disease. OSA causes intermittent hypoxia from episodes of apnea and hypopnea during sleep. Consequently, hypoxic pulmonary vasoconstriction ensues which produces an increased right atrial pressure which may generate a right to left shunt during apneic episodes promoting the occurrence of thromboembolic events. The existence of a PFO may be higher in patients with OSA. The presence of a PFO and OSA may increase the risk of stroke. In this review, the association of PFO and OSA is described along with their implications for cardiovascular disease. The relevant literature and treatment options are discussed to elaborate on the significance of the associated pathology.
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Affiliation(s)
- Subrata Kar
- Division of Cardiovascular Medicine, University of Missouri-Columbia School of Medicine, 5 Hospital Drive, Columbia, MO 65212, USA.
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Migliore A, Jefferson T, Cerbo M, Abraha I, Montedori A. Implantable devices for the closure of patent foramen ovale in adults: an Italian rapid health technology assessment. Expert Rev Med Devices 2014; 11:151-61. [PMID: 24506299 DOI: 10.1586/17434440.2014.882229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous closure of patent foramen ovale (PFO) is offered to patients suffering from cryptogenic stroke, transient ischemic attack or persistent migraine. Several PFO closure devices are CE marked but none have yet been approved by the FDA. On the Italian market 11 different PFO closure devices are available and more than 2500 PFO procedures were reported in 2012. We report findings of a systematic review and meta-analysis of studies in which patients with PFO and transient ischemic attacks, cryptogenic stroke or persistent migraine who underwent PFO closure were compared to patients treated by usual care. We included five controlled clinical trials and one randomized controlled trial. Included studies had poor methodological quality and heterogeneity. In the included randomized controlled trial, 4.7% of procedure-related serious adverse events were observed. Large multicenter, sufficiently powered, and properly randomized trials need to be conducted in Europe with particular attention to patient selection.
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Affiliation(s)
- Antonio Migliore
- Agenas, Agenzia nazionale per i servizi sanitari regionali, Sez. ISS - Innovazione, Sperimentazione e Sviluppo, via Puglie, 23 - 00187 Rome, Italy
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Capodanno D, Milazzo G, Vitale L, Di Stefano D, Di Salvo M, Grasso C, Tamburino C. Updating the evidence on patent foramen ovale closure versus medical therapy in patients with cryptogenic stroke: a systematic review and comprehensive meta-analysis of 2,303 patients from three randomised trials and 2,231 patients from 11 observational studies. EUROINTERVENTION 2014; 9:1342-9. [DOI: 10.4244/eijv9i11a225] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C. How to Understand Patent Foramen Ovale Clinical Significance: Part I. J Cardiovasc Echogr 2014; 24:114-121. [PMID: 28465918 PMCID: PMC5353567 DOI: 10.4103/2211-4122.147202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Patent foramen ovale (PFO) is a remnant of fetal circulation commonly found in healthy population. However, a large number of clinical conditions have been linked to PFO, the most important being ischemic strokes of undetermined cause (cryptogenic strokes) and migraine, especially migraine with aura. Coexistent atrial septal aneurysm, size of PFO, degree of the shunt, shunt at rest, pelvic deep vein thrombosis, and prothrombotic states (G20210A prothrombin gene mutation, Factor V Leiden mutation, MTHFR: C677T, basal homocystine, recent surgery, trauma, or use of contraceptives) could enhance stroke risk in subjects with PFO. Owing to the complexity of this issue, for any individual presenting with a PFO, particularly in the setting of cryptogenic stroke, it is not clear whether the PFO is pathogenically related to the neurological event or an incidental finding. Thus, a heart-brain team, which individually plans the best strategy, in accordance with neuroimaging findings and anatomical characteristics of PFO, is strongly recommended. In the first part of this review, we discuss the embryologic and anatomic features of PFO, the diagnostic techniques for its identification and evaluation, and the relationship between PFO and neurological syndromes. A special attention is made to provide some key points, useful in a daily clinical practice, which summarize how better we understand PFO clinical significance
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Affiliation(s)
- Gabriella Falanga
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Giuseppe Oreto
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Messina, Italy
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Mojadidi MK, Bogush N, Caceres JD, Msaouel P, Tobis JM. Diagnostic Accuracy of Transesophageal Echocardiogram for the Detection of Patent Foramen Ovale: A Meta-Analysis. Echocardiography 2013; 31:752-8. [DOI: 10.1111/echo.12462] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Mohammad Khalid Mojadidi
- Department of Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; Bronx New York
| | - Nikolay Bogush
- Department of Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; Bronx New York
| | - Jose Diego Caceres
- Department of Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; Bronx New York
| | - Pavlos Msaouel
- Department of Medicine; Albert Einstein College of Medicine; Jacobi Medical Center; Bronx New York
| | - Jonathan M. Tobis
- Program in Interventional Cardiology; David Geffen School of Medicine; University of California; Los Angeles California
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