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Zhang M, Xiao Q, Wang K, Yin R, Liu G, Zhao H, Li P, Zhu X, Pan X. Embolic stroke of undetermined source: Focusing on atrial cardiopathy and patent foramen ovale. Int J Cardiol 2024; 402:131810. [PMID: 38272131 DOI: 10.1016/j.ijcard.2024.131810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/02/2023] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Atrial cardiopathy(AC) and patent foramen ovale (PFO) are two etiologies of embolic strokes of undetermined source (ESUS). We aimed to explore the relationship between them in ESUS. METHODS A total of 1146 participants were included from January 2019 to June 2022, which included the ESUS group and non-embolic stroke which includes LAA(large arterial atherosclerosis) + SAO(small artery occlusion) group. AC was defined as the presence of at least one of the following: PTFV1(P-wave terminal force in lead V1) > 4000 μV*ms in the electrocardiograms, NT-proBNP(N-terminal probrain natriuretic peptide) > 250 pg/mL in laboratory tests or LAD(left atrial diameter) > 3.8 cm for women and > 4.0 cm for men in cardiac ultrasound. The presence of PFO was assessed by transthoracic echocardiography, transcranial Doppler ultrasound, transesophageal echocardiography or cardiac MRI. PFO was considered pathogenic if the RoPE score was 7 to 10. RESULTS The prevalence of AC and PFO was higher in the ESUS group than the LAA + SAO group. The prevalence of AC was lower in ESUS patients with pathogenic PFO (37.9%) than those without PFO (68.4%) and with incidental PFO (64.0%) (p = 0.006). The prevalence of pathogenic PFO was lower in ESUS patients with AC than those without AC (6.0% vs. 17.8%, p = 0.006). The AUC(area under the curve) of PTFV1 for predicting ESUS was 0.724 [95%CI (0.686-0.762), p < 0.05)], indicating that PTFV1 the most valuable AC biomarker. CONCLUSIONS The prevalence of AC is inversely related to the prevalence of pathogenic PFO in ESUS patients. PTFV1 was the most valuable index to predict ESUS among the AC biomarkers.
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Affiliation(s)
- Meng Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Xiao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kun Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ruihua Yin
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangzhen Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongqin Zhao
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peng Li
- IT Management Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaoyan Zhu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China..
| | - Xudong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China..
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Chinese Society of Cardiology, Chinese Medical Association, Editorial Board of Chinese Journal of Cardiology. [Chinese expert consensus on the standardized diagnosis and treatment of patent foramen ovale]. Zhonghua Xin Xue Guan Bing Za Zhi 2024; 52:369-83. [PMID: 38644252 DOI: 10.3760/cma.j.cn112148-20231030-00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
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Toggweiler S, Moccetti F, Conrad N, Loretz L, Madanchi M, Bossard M, Attiger-Toller A, Cuculi F, Wolfrum M. Amplatzer or Figulla Flex II Occluder: a comparative study of outcomes after transcatheter patent foramen ovale closure. J Invasive Cardiol 2024; 36. [PMID: 38412438 DOI: 10.25270/jic/23.00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Percutaneous closure of a patent foramen ovale (PFO) for the prevention of recurrent paradoxical thromboembolic events has been shown to be safe and effective in randomized controlled trials. However, it remains uncertain if differences in the structure and design of the occluder devices impact the outcomes. The aim of this study was to compare results of percutaneous PFO closure using 2 widely used double-disc occluders. METHODS Consecutive patients who underwent percutaneous PFO closure with the Abbott Amplatzer occluder (APO) or the Occlutech Figulla-Flex-II occluder (OPO) at the Heart Center Lucerne between February 2017 and December 2022 were included in a registry. The primary endpoint was effective closure of the PFO, defined as a residual shunt grade 0 or 1, assessed by contrast echocardiogram at 6-month follow-up. Secondary endpoints included procedural efficacy/safety and major adverse cardiovascular events during the hospital stay and at 6-month follow-up. RESULTS One hundred ninety-three consecutive patients (mean age 51.7 ± 12.5 years; 39% women; Risk of Paradoxical Embolism (RoPE) score = 7, IQR = 6-8) underwent percutaneous PFO closure with the APO (120 patients, 62.2%) or the OPO (73 patients, 37.8%). Main indications for closure were crypotogenic stroke in 168 patients (87.1%) and peripheral embolism in 13 patients (6.7%). At baseline, right-to-left shunt (RLS) greater than or equal to grade 2 was present in 189 patients (97.9%). Immediate procedural success was 99.5%. In 1 patient, an air embolism occurred during positioning of the APO occluder with transient chest pain and electrocardiogram changes, but without further sequelae to the patient. At 6-month follow-up, effective closure was achieved in 185 patients (95.8%; APO: 96.6% vs OPO: 94.5%, P = .30). Rates of atrial fibrillation and recurrent thromboembolic events were 4.2 and 0.5%, respectively. CONCLUSIONS PFO closure is safe and effective when performed with either the self-expanding Abbott Amplatzer or Occlutech Figulla Flex II PFO occluder.
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Affiliation(s)
- Stefan Toggweiler
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Federico Moccetti
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Nina Conrad
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mehdi Madanchi
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Bossard
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Florim Cuculi
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- The Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
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Leaver BA, Cliff ERS, Jefford M, Fogarty S, Zentner D. The paradox of platypnoea-orthodeoxia syndrome. Intern Med J 2024; 54:675-677. [PMID: 38572793 DOI: 10.1111/imj.16365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/11/2023] [Indexed: 04/05/2024]
Abstract
Platypnoea-orthodeoxia is a rare clinical syndrome characterised by dyspnoea and oxygen desaturation in the upright position which improves when supine. It requires two components: a sufficiently sized anatomical vascular defect (typically intra-cardiac or intra-pulmonary) combined with a functional component that promotes positional right-to-left shunting. We describe the rare occurrence of a patient with platypnoea-orthodeoxia syndrome (POS) because of a paradoxical shunt through a patent foramen ovale caused by a large right atrial line-associated thrombus in a male with metastatic oesophageal cancer undergoing chemotherapy. This case is a timely reminder to consider POS amongst differentials for hypoxia as it is often treatable if recognised.
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Affiliation(s)
- Benjamin A Leaver
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Edward R S Cliff
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Samuel Fogarty
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Zou R, Wang S, Liu P, Chen D, Yan J, Cai H, Wang Y, Wang C. The association between patent foramen ovale and unexplained syncope in pediatric patients. Ital J Pediatr 2024; 50:2. [PMID: 38185629 PMCID: PMC10773133 DOI: 10.1186/s13052-023-01572-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is associated with transient ischemia attack (TIA) or stroke, paradoxical embolism, and migraines. PFO closure decreases the recurrent incidence of cerebral ischemic events and reduces the incidence of syncope in adults. However, whether PFO is associated with syncope in pediatric patients has not been investigated. METHODS 1001 pediatric patients (aged 4 to 17 years, mean age 10.31 ± 2.61 years, 519 males) who complained of unexplained syncope, palpitation, headache, dizziness and chest pain and were hospitalized in the Syncope Ward, The Second Xiangya Hospital, Central South University between January 2013 and April 2022 were recruited. Children with definite etiology of syncope, neurological, cardiogenic, psychological and other system diseases were excluded. PFO was measured by transthoracic echocardiography and right-heart contrast echocardiography was performed to identify the presence of right-to-left shunting. The demographic data and medical records were retrospectively reviewed and analyzed. RESULTS 276 cases were included in the simple syncope group, 379 cases in the headache/dizziness group, 265 cases in the chest pain group, and 81 cases in the palpitation group. The incidence of PFO between the four groups was insignificant (4.71%, 4.74%, 4.15%, 6.17%, respectively, P = 0.903). Multivariate Logistic regression demonstrated that PFO is not associated with the increased risk of syncope (P = 0.081). CONCLUSION PFO may not increase the risk of syncope in pediatric patients. Further study may include a large and multicenter sample to investigate the association between PFO and unexplained syncope.
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Affiliation(s)
- Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Shuo Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Ping Liu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Donghai Chen
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Jun Yan
- Department of Pediatrics, The First Affiliated Hospital, Hunan University of Medicine, Huaihua, Hunan, 418000, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, No.139 Renmin Middle Road, Changsha, Hunan, 410011, China.
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Mendes E, Vaz Gomes M, Carreira CU, Gon Alves NÍ, Ribeiro AF. Platypnea-orthodeoxia syndrome: an intriguing perioperative hypoxemia case report. Braz J Anesthesiol 2024; 74:744192. [PMID: 34118260 PMCID: PMC10877329 DOI: 10.1016/j.bjane.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 05/10/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare condition of positional hypoxemia and dyspnea. The following is a case of hypoxemia for no obvious reason in the perioperative scenario. A 70-year-old male patient was submitted to a radical prostatectomy. On several occasions after anesthetic induction, peripheral oxygen saturation decreased without any understandable cause. In the postanesthesia care unit, severe hypoxemia occurred in the upright position, oddly correcting with recumbency. An echocardiography showed a right-to-left intracardiac shunt through a patent foramen ovale with no pulmonary hypertension, establishing POS. Achieving this diagnosis required a broad workup with a high degree of suspicion.
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Affiliation(s)
- Eunice Mendes
- Centro Hospitalar e Universit..rio de Coimbra, Servi..o de Anestesiologia, Coimbra, Portugal.
| | - Mariana Vaz Gomes
- Centro Hospitalar e Universit..rio de Coimbra, Servi..o de Anestesiologia, Coimbra, Portugal
| | - Cl Udia Carreira
- Centro Hospitalar e Universit..rio de Coimbra, Servi..o de Anestesiologia, Coimbra, Portugal
| | - N Ídia Gon Alves
- Centro Hospitalar e Universit..rio de Coimbra, Servi..o de Anestesiologia, Coimbra, Portugal
| | - Ana Filipa Ribeiro
- Centro Hospitalar e Universit..rio de Coimbra, Servi..o de Anestesiologia, Coimbra, Portugal
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Luera D, Snarr RL, Posson S, Liras I, Liras G, Filep EM. Transient Ischemic Attack in a 22-Year-Old NCAA Division I Baseball Athlete: A Case Study. J Sport Rehabil 2024; 33:40-44. [PMID: 37917975 DOI: 10.1123/jsr.2023-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/19/2023] [Indexed: 11/04/2023]
Abstract
CONTEXT A healthy, 22-year-old, male NCAA Division I baseball shortstop was experiencing confusion, chest pain, and tightness during an off-season intersquad scrimmage. The patient did not have any significant medical history or mechanism of head injury. After initial evaluation from the athletic trainer, the patient's cognitive status began to quickly decline. The emergency action plan was put in place rapidly and referred the patient to the local emergency clinic. CASE PRESENTATION Upon arrival at the emergency department, an electrocardiogram was performed to rule out myocardial infarction or stroke. The first electrocardiogram results returned negative for any cardiac pathology, but a stroke alert was called. The patient was then transported to a level II trauma center due to continual cognitive decline. The patient was diagnosed with transient ischemic attack (TIA) secondary to an undiagnosed patent foramen ovale (PFO) that would later be diagnosed with further evaluation 2 months after the initial TIA incident. After multiple diagnostic and laboratory tests, the PFO went undetected until a 2D echocardiogram was performed and evaluated by a cardiologist. MANAGEMENT AND OUTCOMES After the confirmation of the congenital defect, surgical intervention was performed to correct the PFO using catheterization. Despite multiple preparticipation examinations, electrocardiograms, and examination of past family history, the PFO went undetected until the patient experienced symptoms of TIA. The discovery of PFO in this 22-year-old athletic individual is unusual because traditional screening techniques (electrocardiogram and preparticipation examinations) failed to detect the congenital defect. CONCLUSIONS Due to the emergent and timely actions of the athletic trainer, the patient has made a full recovery and is able to compete fully in athletic events. This case study amplifies the need for athletic trainers at all sporting events, updated and reviewed emergency action plans, rapid recognition of TIA in athletic individuals, and return-to-play protocol for an athletic individual after TIA.
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Affiliation(s)
- Daisy Luera
- Department of Kinesiology and Military Science, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
| | - Ronald L Snarr
- Department of Kinesiology and Military Science, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
| | - Sara Posson
- Department of Athletics, Texas A&M University-Corpus Christi, Corpus Christi,TX, USA
| | - Ioannis Liras
- Department of Athletics, Texas A&M University-Corpus Christi, Corpus Christi,TX, USA
- CHRISTUS Health, Trinity Clinic, Corpus Christi,TX, USA
| | - George Liras
- Department of Athletics, Texas A&M University-Corpus Christi, Corpus Christi,TX, USA
- CHRISTUS Health, Trinity Clinic, Corpus Christi,TX, USA
| | - Erica M Filep
- Department of Kinesiology and Military Science, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
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Fekri S, Mahmoudimehr P, Jafari Fesharaki M, Hosseinjani E, Abtahi SH, Nouri H. Retinal arterial occlusion and patent foramen ovale: A case study-based review. J Fr Ophtalmol 2024; 47:104021. [PMID: 37951744 DOI: 10.1016/j.jfo.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To identify all reported cases of retinal artery occlusion (RAO) associated with patent foramen ovale (PFO) in the literature and present a similar case of CRAO from our clinic. METHODS PubMed database was searched for studies reporting RAO in individuals with PFO. Relevant data were tabulated and reviewed. We estimated each case's Risk of Paradoxical Embolism (RoPE) score. RESULTS 23 cases of CRAO (n=10; including ours), BRAO (n=10), and CILRAO (n=3) were reviewed. Most cases were under 50 years of age (78.3%). The reported predisposing factors were: hypertension (26.1%), migraine (17.3%), smoking (13.0%), recent immobilization (13.0%), strenuous exertion (8.7%), pregnancy (8.7%), and diabetes (4.3%). A high RoPE score (≥7; suggestive of paradoxical embolism via PFO) was estimated for 71.4% of patients. In most cases, the neurological and cardiovascular examinations, laboratory studies, and imaging were unremarkable, except for the PFO±atrial septal aneurysm (present in 21.7%). In only 28.6% of cases, transthoracic echocardiography (TTE) (± saline contrast) could visualize the PFO; transesophageal echocardiography (TEE) was necessary to detect the PFO in 71.4%. Approximately one-half of the patients underwent percutaneous closure of the PFO; no complications or subsequent acute ischemic events ensued. The visual prognosis was poorer for CRAO than for BRAO or CILRAO. CONCLUSION Timely diagnosis, acute management, and ensuring urgent initiation of stroke workup in cases with RAO or transient monocular vision loss are crucial. Clues to a possible paradoxical embolism as the cause include the absence of known cardiovascular risk factors, young age, migraine, recent immobility, vigorous exercise, and pregnancy.
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Affiliation(s)
- S Fekri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - P Mahmoudimehr
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Jafari Fesharaki
- Department of Cardiology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - E Hosseinjani
- Department of Cardiology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S-H Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - H Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Pommier T, Lafont A, Didier R, Garnier L, Duloquin G, Meloux A, Sagnard A, Graber M, Dogon G, Laurent G, Vergely C, Béjot Y, Guenancia C. Factors associated with patent foramen ovale-related stroke: SAFAS study. Rev Neurol (Paris) 2024; 180:33-41. [PMID: 37777437 DOI: 10.1016/j.neurol.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Persistent foramen ovale (PFO) contributes to cryptogenic stroke and is associated with stroke recurrence, although the exact mechanism of ischemic events is not fully understood. Several biomarkers have been developed for the prediction of atrial fibrillation after stroke, but there are currently only limited data on their potential value for the diagnosis of PFO-related stroke. METHODS This study was a prospective single-center study that included all patients hospitalized between March 31, 2018, and January 18, 2020, in the stroke department of the Dijon University Hospital for ischemic stroke without obvious cause and without a history of atrial fibrillation. PFO was systematically screened by transthoracic echocardiography and images were reviewed by an independent cardiologist blinded from clinical data. PFO was defined according to the CLOSE trial criteria: PFO associated with interatrial septal aneurysm or significant interatrial shunt (> 30 microbubbles in the left atrium within three cardiac cycles after right atrial opacification). The potential association of PFO-related stroke with biomarkers of cardiac fibrosis and inflammation such as galectin-3, GDF-15, ST-2, osteoprotegerin and NT-proBNP was tested using multivariate backward stepwise logistic regression. RESULTS Of the 240 patients included in the SAFAS study, 229 had complete echocardiographic data, and 23 (10%) had PFO-related stroke. Patients with PFO-related stroke were significantly younger (58±14 vs. 69±14, P<0.001), had less frequent previous arterial hypertension (30 vs. 60%, P=0.008), and more frequent cerebellar territory involvement (26 vs. 9%, P=0.014) compared to the other patients. In addition, they had less frequently left atrial dilatation (left atrial index volume>34mL/m2 [9 vs. 35%, P=0.009]). After ROC curve analysis for definition of thresholds, PFO-related stroke patients more often had galectin-3<9.5ng/mL (59 vs. 27%, P=0.002), ST2<13380pg/ml (23 vs. 50%, P=0.007), GDF-15<1200ng/mL (59 vs. 27%, P=0.002), osteoprotegerin<1133pg/mL (82 vs. 58%, P=0.033) and NT-proBNP<300pg/mL (88 vs. 55%, P=0.009). After multivariate analysis, only galectin-3<9.5ng/mL (OR [95% CI] 3.4 [1.18; 9.8], P=0.024) and osteoprotegerin<1133pg/L (OR [95% CI] 5.0 [1.1; 22.9], P=0.038) were independently associated with PFO-related stroke. CONCLUSION Patients in whom cryptogenic stroke is attributed to a significant PFO have a specific clinical and biological phenotype. Low levels of galectin-3 and osteoprotegerin may help identify patients with PFO-related strokes.
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Affiliation(s)
- T Pommier
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - A Lafont
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - R Didier
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - L Garnier
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - G Duloquin
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - A Meloux
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - A Sagnard
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Graber
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - G Dogon
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - G Laurent
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - C Vergely
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France
| | - Y Béjot
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France; Neurology Department, University Hospital, Dijon, France
| | - C Guenancia
- Cardiology Department, University Hospital, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (EA 7460), Faculty of Health Sciences, université de Bourgogne, université de Bourgogne Franche-Comté, Dijon, France.
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Al Saadi W, Al-Lawati AI, Al Busaidi M, Ahmed S, Alhadhrami Z, Alkindi F. Platypnea-Orthodeoxia Syndrome Caused by Patent Foramen Ovale with Right-To-Left Shunt. Am J Case Rep 2023; 24:e942216. [PMID: 38042984 DOI: 10.12659/ajcr.942216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
BACKGROUND Patent Foramen Ovale (PFO) is an important part of fetal circulation. It allows the oxygenated blood from the umbilical cord to bypass the lungs. PFOs usually close after birth due to the sudden change of the hemodynamics associated with the expansion of the lungs however they are known to persist in about 25% of the total population. One of their rare manifestations is Platypnea-Orthodeoxia Syndrome (POS) that presents as dyspnea upon assuming an upright position, which improves upon recumbency, accompanied by hypoxemia. CASE REPORT We report a case of a 63-year-old man, known to have systemic lupus erythematosus (SLE) and positive anti-phospholipid antibodies but with no prior thrombotic events, admitted with symptoms of SARS-COV2 infection, and developed symptoms of Platypnea-Orthodeoxia Syndrome during his hospitalization, further evaluation by a transthoracic echocardiography revealed he had PFO with a right-to-left shunt which was treated successfully with percutaneous device closure. CONCLUSIONS Platypnea-Orthodeoxia Syndrome (POS) can be associated with various cardiac defects resulting in right-to-left shunts and other non-cardiac pathologies such as pulmonary AV malformations, lung parenchymal diseases and hepatopulmonary syndrome. In cases of cardiac right-to-left shunts Contrast-enhanced Transthoracic Echocardiography (TTE) can effectively diagnose Platypnea-Orthodeoxia Syndrome, and percutaneous closure has shown to be an efficacious treatment option in alleviating the symptoms. This case report highlights the necessity of actively exploring the possibility of PFOs with right-to-left shunts in patients exhibiting POS symptoms, while considering other potential aetiologies.
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Affiliation(s)
- Waleed Al Saadi
- Department of Internal Medicine, Oman Medical Specialty Board, Muscat, Oman
| | - Ali I Al-Lawati
- Department of Nephrology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mujahid Al Busaidi
- Department of Anesthesia and Intensive Care Unit, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sheeraz Ahmed
- Department of Cardiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Zeyana Alhadhrami
- Department of Nephrology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Fahad Alkindi
- Department of Cardiology, Sultan Qaboos University Hospital, Muscat, Oman
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Jin P, Jiao P, Feng J, Shi L, Ma L. The predictive value of abnormal electrocardiogram for patent foramen ovale: A retrospective study. Clin Cardiol 2023; 46:1504-1510. [PMID: 37667505 PMCID: PMC10716327 DOI: 10.1002/clc.24133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS The objective of this study was to identify the characteristics of electrocardiogram (ECG) in adult patients with patent foramen ovale (PFO) and to analyze the predictive value of the characteristics of ECG for PFO in adult patients. METHODS Retrospectively, 267 patients who had undergone ECG, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) with agitated saline contrast echocardiography in our hospital, were recruited continuously from January 2021 to March 2023. Electrocardiographs were analyzed to investigate the presence of right bundle branch block (RBBB) and crochetage R wave. RESULTS The ratio of crochetage R wave in inferior leads in patients with PFO was 45.3% and 21.2% without PFO. There were 17 (6.4%) patients with coexistence of crochetage R wave and RBBB, including 13 (6.5%) patients with PFO and four (6.1%) patients without PFO. The accuracies of TTE, crochetage R wave, and RBBB were 0.637, 0.535, and 0.314, respectively. A combination of crochetage R wave and RBBB demonstrated a sensitivity of 0.507 and a specificity of 0.758. When TTE, crochetage R wave, and RBBB were combined, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 0.712, 0.801, 0.439, 0.813, and 0.420, respectively. Logistic regression analysis revealed a correlation between PFO and the presence of crochetage R wave (odds ratio [OR]: 3.073, 95% confidence interval [CI]: 1.601-5.899, p < 0.001), and also a combination between crochetage R wave and RBBB (OR: 3.220, 95% CI: 1.720-6.028, p < 0.001). CONCLUSIONS Crochetage R wave in ECG was associated with PFO. Crochetage R wave, especially combined with RBBB and TTE, may be helpful in the early detection of patients with PFO.
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Affiliation(s)
- Peng Jin
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Piqi Jiao
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Juan Feng
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Liang Shi
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
| | - Ling Ma
- Department of Cardiovascular Medicinethe 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation ArmyLanzhouChina
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12
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Jurczyk D, Macherey-Meyer S, Rawish E, Stiermaier T, Eitel I, Frerker C, Schmidt T. New-onset atrial fibrillation after percutaneous patent foramen ovale closure: a meta-analysis. Clin Res Cardiol 2023; 112:1824-1834. [PMID: 37515604 PMCID: PMC10697880 DOI: 10.1007/s00392-023-02263-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/29/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The exact incidence and predictors of new-onset atrial fibrillation (AF) after percutaneous closure of patent foramen ovale (PFO) are unknown. OBJECTIVE We sought to find post-procedural AF incidence rates and differences due to different screening strategies and devices. METHODS A systematic search was conducted in Cochrane, MEDLINE and EMBASE. Controlled trials fulfilling the inclusion criteria were included into this meta-analysis. The incidence of new-onset AF was the primary outcome. Further parameters were surveillance strategy, device type, AF treatment and neurological events. New AF was determined as early onset within one month after implantation and late thereafter. RESULTS 8 controlled trials and 16 cohort studies were eligible for quantitative analysis. 7643 patients received percutaneous PFO closure after cryptogenic stroke or transient ischaemic attack, 117 with other indications, whereas 1792 patients formed the control group. Meta-analysis of controlled trials showed an AF incidence of 5.1% in the interventional and 1.6% in the conservative arm, respectively (OR 3.17, 95% CI 1.46-6.86, P = 0.03, I2 = 55%). 4.7% received high-quality surveillance strategy with Holter-ECG or Loop recorder whereby AF incidence was overall higher compared to the low-quality group with 12-lead ECG only (3.3-15% vs. 0.2-4.3%). Heterogeneous results on time of AF onset were found, limited by different follow-up strategies. CardioSEAL and Starflex seemed to have higher AF incidences in early and late onset with 4.5% and 4.2%, respectively. CONCLUSION Percutaneous PFO closure led to higher AF post-procedural incidence compared to the conservative strategy. Heterogeneity in surveillance and follow-up strategy limited the generalizability. TRIAL REGISTRATION Registered on PROSPERO (CRD42022359945).
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Affiliation(s)
- Dominik Jurczyk
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Sascha Macherey-Meyer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Elias Rawish
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Frerker
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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13
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Hong H, Glassman D, Westin SN. Ischemic bowel associated with newly diagnosed patent foramen ovale. Int J Gynecol Cancer 2023; 33:1833-1834. [PMID: 37666526 DOI: 10.1136/ijgc-2023-004527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Hannah Hong
- Department of Obstetrics and Gynecology, Orlando Health Winnie Palmer Hospital for Women & Babies, Orlando, Florida, USA
| | - Deanna Glassman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon Neville Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Raavi L, Garg P, Alomari M, Ali M, Wadiwala I, El-Sayed Ahmed MM. Patent Foramen Ovale-Related Hypoxemia After Bilateral Lung Transplant. Tex Heart Inst J 2023; 50:e238229. [PMID: 37872694 PMCID: PMC10658146 DOI: 10.14503/thij-23-8229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
A 64-year-old man with interstitial pulmonary fibrosis and a small patent foramen ovale with right-to-left shunting underwent bilateral lung transplant without closure of the patent foramen ovale. Postoperatively, the patient remained persistently hypoxemic with partial response to high-flow oxygen. Investigations revealed the presence of a large patent foramen ovale with right-to-left shunting on echocardiography and a shunt fraction of 21% on cardiac catheterization. Two months after the lung transplantation, primary surgical repair of the patent foramen ovale was performed with immediate improvement in oxygenation. Three years postoperatively, the patient remained oxygen independent.
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Affiliation(s)
- Lekhya Raavi
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mohammad Alomari
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mostafa Ali
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Ishaq Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Magdy M. El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
- Department of Surgery, Zagazig University Faculty of Medicine, Zagazig, Egypt
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15
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Kamel M, Malik A, Sarkar K, Narine B, Garcia-Bengochea Y, Makaryus JN, Singh A. Orthodeoxia Platypnea Syndrome in the Setting of Cholangiocarcinoma: A Case Report. Am J Cardiol 2023; 204:64-69. [PMID: 37536206 DOI: 10.1016/j.amjcard.2023.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Platypnea-orthodeoxia syndrome is a rare cause of positional hypoxemia and dyspnea. We present the case of a 54-year-old man with right-to-left shunting through a patent foramen ovale in the setting of metastatic cholangiocarcinoma resulting in platypnea-orthodeoxia syndrome. The shunt was originally not visualized on cardiac magnetic resonance imaging but later detected with transesophageal echocardiography. This case highlights the importance of complimentary multimodality cardiac imaging in the diagnosis of both common and uncommon disorders.
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Affiliation(s)
- Maikel Kamel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York.
| | - Aysha Malik
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Kumar Sarkar
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Badewattie Narine
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Youssef Garcia-Bengochea
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - John N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Avneet Singh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
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16
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Bezgin T, Celik AI, Baytugan NZ, Karakoyun S, Cagdas M. An unusual approach for platypnea-orthodeoxia syndrome due to isolated pulmonary arteriovenous malformations. J Invasive Cardiol 2023; 35. [PMID: 37984329 DOI: 10.25270/jic/23.00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
A 27-year-old man presented to the emergency department with complaints of syncope, dyspnea, and fatigue. Physical examination revealed left-sided mild hemiparesis, platypnea, and continuous murmur on right middle lobe lung auscultation.
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Affiliation(s)
- Tahir Bezgin
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Aziz Inan Celik
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey.
| | - Nart Zafer Baytugan
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
| | - Suleyman Karakoyun
- Department of Cardiology, Akademi Hospital, Kocaeli, Turkey; Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
| | - Metin Cagdas
- Department of Cardiology, Gebze Fatih State Hospital, Heart Center, Kocaeli, Turkey
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17
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Skibsted CV, Korsholm K, Pedersen L, Bonnesen K, Nielsen-Kudsk JE, Schmidt M. Long-term risk of atrial fibrillation or flutter after transcatheter patent foramen ovale closure: a nationwide Danish study. Eur Heart J 2023; 44:3469-3477. [PMID: 37279491 DOI: 10.1093/eurheartj/ehad305] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/20/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
AIMS Transcatheter closure of patent foramen ovale (PFO) is the recommended stroke prevention treatment in patients ≤60 years with cryptogenic ischemic stroke and PFO. Atrial fibrillation or flutter (AF) is a known potential procedure-related complication, but long-term risk of developing AF remains unknown. This paper studied the long-term risk of developing AF following PFO closure. METHODS AND RESULTS A Danish nationwide cohort study was conducted. During 2008-2020, this study identified a PFO closure cohort, a PFO diagnosis cohort without PFO closure, and a general population comparison cohort matched 10:1 to the PFO closure cohort on age and sex. The outcome was first-time AF diagnosis. Risk of AF and multivariable-adjusted hazard ratio (HR) of the association between PFO closure or PFO diagnosis and AF were calculated. A total of 817 patients with PFO closure, 1224 with PFO diagnosis, and 8170 matched individuals were identified. The 5 year risk of AF was 7.8% [95% confidence interval (CI): 5.5-10] in the PFO closure cohort, 3.1% (95% CI: 2.0-4.2) in the PFO diagnosis cohort, and 1.2% (95% CI: 0.8-1.6) in the matched cohort. The HR of AF comparing PFO closure with PFO diagnosis was 2.3 (95% CI: 1.3-4.0) within the first 3 months and 0.7 (95% CI: 0.3-1.7) thereafter. The HR of AF comparing PFO closure with the matched cohort was 51 (95% CI: 21-125) within the first 3 months and 2.5 (95% CI: 1.2-5.0) thereafter. CONCLUSION Patent foramen ovale closure was not associated with any substantial increased long-term risk of developing AF beyond the well-known procedure-related short-term risk.
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Affiliation(s)
- Christian Valdemar Skibsted
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kasper Korsholm
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus University Hospital A1001, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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18
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Küçükseymen S, Ciardetti N, Stolcova M, Mario CD, Meucci F. Platypnea-Orthodeoxia Syndrome Following Transcatheter Aortic Valve Replacement. Anatol J Cardiol 2023; 27:549-551. [PMID: 37551749 PMCID: PMC10510414 DOI: 10.14744/anatoljcardiol.2023.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- Selçuk Küçükseymen
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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Rigatelli G, Zuin M, Bilato C. Atrial septal aneurysm contribution to the risk of cryptogenic stroke in patients with patent foramen ovale: A brief updated systematic review and meta-analysis. Trends Cardiovasc Med 2023; 33:329-333. [PMID: 35181471 DOI: 10.1016/j.tcm.2022.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
Atrial septal aneurysms (ASA) play an important role in cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) but its contribution remains still not fully clarified in current literature. We sought to evaluate the contribution of ASA to the risk of CS in PFO patients based on studies published so far by means of a systematic review and metanalysis. A literature search, based on PubMed, Google Scholar and EMBASE databases, was performed to locate articles, published English language between 2000 and 2021, analysing the relationship between ASA and CS. The final research was conducted in September 2021. A total of 577 articles were retrieved after excluding duplicates. The initial screening excluded 215 articles because they did not meet inclusion criteria, leaving 362 articles to assess for eligibility. Subsequently, after evaluation of the full-text articles, 354 were excluded and 8 investigations met the inclusion criteria. Overall, 822 patients (mean age 48.3 years) were enrolled in the reviewed manuscripts with a prevalence of males of 48.7% and a normal distribution of the classical cardiovascular risk factors. ASA was present in 25.3% (208 subjects) of the patients enrolled, while the association of PFO+ASA was observed in 24.3% (200 subjects) of patients enrolled. PFO Patients with ASA were at higher risk of CS compared to those without (odd ratio: 3.38, 95% CI: 2.72-5.51, p<0.001, I2=4.3%,). The relative funnel plot did not show any evident asymmetry, confirming absence of publication bias. Our updated metanalysis enhances the importance of ASA contribution to stroke in patients with patent foramen ovale, being present in a third of patients with symptomatic PFO to whom it confers an additional odd ratio of 3.38.
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Affiliation(s)
- Gianluca Rigatelli
- Division of Cardiology, Department of Specialistic Medicine, Rovigo General Hospital, Rovigo, Italy.
| | - Marco Zuin
- Department of Morphology, Surgery & Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Claudio Bilato
- Division of Cardiology, Ospedale dell'Ovest Vicentino, Arzignano, Vicenza, Italia
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20
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Ueno Y. Editorial commentary: Atrial septal aneurysm as a risk factor for ischemic stroke with patent foramen ovale. Trends Cardiovasc Med 2023; 33:334-335. [PMID: 35568264 DOI: 10.1016/j.tcm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan.
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21
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He S, Zhang L, Liu XY, Ji XJ, Tang SL, Wu XY, Lu TW. Cerebral Infarction from Sick Sinus Syndrome (Based on SCN5A) via Patent Foramen Ovale. Indian J Pediatr 2023; 90:836. [PMID: 37145349 DOI: 10.1007/s12098-023-04645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Shuang He
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lei Zhang
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiao-Yan Liu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiao-Juan Ji
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shi-Long Tang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yun Wu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Chongqing, 400014, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Tie-Wei Lu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, 136 Second Zhongshan Road, Chongqing, 400014, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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Goldschmied A, Geisler T. [Thromboembolic diseases from a cardiological point of view]. Dtsch Med Wochenschr 2023; 148:908-914. [PMID: 37493952 DOI: 10.1055/a-1825-7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Thromboembolic disease is associated with a high mortality. It can be divided into two groups: embolism from a venous and embolism from an arterial side. This article gives an overview on thromboembolic disease (with a focus on pulmonary embolism and ischemic stroke) from a cardiologist's perspective.The therapeutic options for acute pulmonary embolism range from anticoagulation to fibrinolysis to interventional recanalization and surgery. The deciding factor for choice of therapy is the risk of early death. Besides clinical parameters, laboratory markers like cardiac troponin and right ventricular function on echocardiography or CTPA (computed tomography pulmonary angiography) are used to determine the early mortality risk. In hemodynamically instable patients, immediate thrombolysis is required, whereas patients with intermediate and low risk can be treated with anticoagulation. Interventional recanalization is currently being studied in patients at risk for development of CTEPH (chronic thromboembolic pulmonary hypertension) or an intermediate risk of early mortality.In ischemic stroke, early interdisciplinary workup involving a cardiologist is paramount. Post stroke screening should include monitoring for arrythmias (especially atrial fibrillation) and transthoracic echocardiography as well as sonography of extra- and intracranial arteries. If no embolic source can be detected (embolic stroke of undetermined source), transesophageal echo can be helpful to detect intracardiac shunts like patent foramen ovale (PFO) or intracardiac tumors. Post stroke care includes secondary prevention measures like risk factor modification and lipid lowering therapy as well as anticoagulation. In high risk for paradoxical embolization, interventional PFO closure can be performed. Interventional closure of the left atrial appendage (LAA) can be discussed in patients with both high thromboembolic and bleeding risk.
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Sposato LA, Martins S, Scheitz JF, Aspberg S, Gurol ME, Abdalla M, Arauz A, Cano-Nigenda V, Fiorilli P, Israel C, Kusano K, Mansour O, Messé SR, Pille A, Secchi T, Polanczyk CA, Biolo A, Ramadan I, Sallam A, Schäbitz W, Toyoda K, Valencia S, Wang S, Xiong Y, Zaki A, Saposnik G, Fisher M, Bahit MC. World Stroke Organization Brain & hEart globAl iniTiative Program. Cerebrovasc Dis 2023; 53:115-124. [PMID: 37276846 DOI: 10.1159/000530471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The World Stroke Organization (WSO) Brain & Heart Task Force developed the Brain & hEart globAl iniTiative (BEAT), a pilot feasibility implementation program to establish clinical collaborations between cardiologists and stroke physicians who work at large healthcare facilities. METHODS The WSO BEAT pilot project focused on atrial fibrillation (AF) and patent foramen ovale (PFO) detection and management, and poststroke cardiovascular complications known as the stroke-heart syndrome. The program included 10 sites from 8 countries: Brazil, China, Egypt, Germany, Japan, Mexico, Romania, and the USA The primary composite feasibility outcome was the achievement of the following 3 implementation metrics (1) developing site-specific clinical pathways for the diagnosis and management of AF, PFO, and the stroke-heart syndrome; (2) establishing regular Neurocardiology rounds (e.g., monthly); and (3) incorporating a cardiologist to the stroke team. The secondary objectives were (1) to identify implementation challenges to guide a larger program and (2) to describe qualitative improvements. RESULTS The WSO BEAT pilot feasibility program achieved the prespecified primary composite outcome in 9 of 10 (90%) sites. The most common challenges were the limited access to specific medications (e.g., direct oral anticoagulants) and diagnostic (e.g., prolonged cardiac monitoring) or therapeutic (e.g., PFO closure devices) technologies. The most relevant qualitative improvement was the achievement of a more homogeneous diagnostic and therapeutic approach. CONCLUSION The WSO BEAT pilot program suggests that developing neurocardiology collaborations is feasible. The long-term sustainability of the WSO BEAT program and its impact on quality of stroke care and clinical outcomes needs to be tested in a larger and longer duration program.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Heart and Brain Laboratory, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Sheila Martins
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | - Jan F Scheitz
- Klinik für Neurologie mit Experimenteller Neurologie and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sara Aspberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohamed Abdalla
- Neurology Department, Armed Forces Medical Institute in Alexandria, Alexandria, Egypt
| | - Antonio Arauz
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Vanessa Cano-Nigenda
- Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Paul Fiorilli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carsten Israel
- Department of Cardiology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ossama Mansour
- Stroke and Neurointerventional Center, Alexandria University School of Medicine, Alexandria, Egypt
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania., Philadelphia, Pennsylvania, USA
| | - Arthur Pille
- Brazilian Stroke Network, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Thaís Secchi
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Brazilian Stroke Network, Porto Alegre, Brazil
| | | | - Andreia Biolo
- Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ismail Ramadan
- Neurology Department, Alexandria University School of Medicine, Alexandria, Egypt
| | - Ashraf Sallam
- Cardiology and Angiology Department, Armed Forces Medical Institute, Alexandria, Egypt
| | - Wolf Schäbitz
- Department of Neurology, Evangelisches Klinikum Bethel, University Hospital OWL, University Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sharon Valencia
- Cardiology and Echocardiography Department, Instituto Nacional de Neurología y Neurocirugia Manuel Velasco Suárez, Mexico City, Mexico
| | - Shang Wang
- Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Amr Zaki
- Cardiology Department, Alexandria University School of Medicine, Alexandria, Egypt
| | - Gustavo Saposnik
- Department of Medicine (Neurology), Stroke Outcomes & Decision Neuroscience Research Unit, University of Toronto, Toronto, Canada
| | - Marc Fisher
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - M Cecilia Bahit
- Department of Cardiology, INECO Neurociencias Rosario, Rosario, Argentina
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Salam A, Mandal S, Fathima S, Rasthapuram S, Radhakrishnan K. Platypnoea orthodeoxia syndrome and its association with cryptogenic ischaemic stroke. J R Coll Physicians Edinb 2023; 53:109-110. [PMID: 36869700 DOI: 10.1177/14782715231159470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Platypnoea orthodeoxia syndrome is a rare condition, which can be present in patients with patent foramen ovale (PFO). In this case, a 72-year-old lady presented to the emergency department with a cryptogenic stroke associated with right thalamic infarct. While in hospital, it was noticed that the patient had desaturations in the upright position, and these improved in the recumbent position, consistent with platypnoea orthodeoxia syndrome. The patient was found to have a PFO, which was then closed, and her saturations returned to normal. This case highlights the importance of patients who present with cryptogenic stroke and features of platypnoea orthodeoxia syndrome need to be considered for underlying PFO or other septal defect.
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Nakayama R, Takaya Y, Akagi T, Yokohama F, Miki T, Ito H. Patent foramen ovale with sail-like Eustachian valve causing recurrent strokes. Cardiovasc Interv Ther 2023; 38:264-265. [PMID: 36152129 DOI: 10.1007/s12928-022-00887-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Fumi Yokohama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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26
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Meschia JF. Diagnostic Evaluation of Stroke Etiology. Continuum (Minneap Minn) 2023; 29:412-424. [PMID: 37039402 DOI: 10.1212/con.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Precise therapies require precise diagnoses. This article provides an evidence-based approach to confirming the diagnosis of ischemic stroke, characterizing comorbidities that provide insights into the pathophysiologic mechanisms of stroke, and identifying targets for treatment to optimize the prevention of recurrent stroke. LATEST DEVELOPMENTS Identifying the presence of patent foramen ovale, intermittent atrial fibrillation, and unstable plaque is now routinely included in an increasingly nuanced workup in patients with stroke, even as ongoing trials seek to clarify the best approaches for treating these and other comorbidities. Multicenter trials have demonstrated the therapeutic utility of patent foramen ovale closure in select patients younger than age 60 years. Insertable cardiac monitors detect atrial fibrillation lasting more than 30 seconds in about one in ten patients monitored for 12 months following a stroke. MRI of carotid plaque can detect unstable plaque at risk of being a source of cerebral embolism. ESSENTIAL POINTS To optimize the prevention of recurrent stroke, it is important to consider pathologies of intracranial and extracranial blood vessels and of cardiac structure and rhythm as well as other inherited or systemic causes of stroke. Some aspects of the stroke workup should be done routinely, while other components will depend on the clinical circumstances and preliminary testing results.
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Zhang Y, Zhu R, Yu Z, Hou S, Niu J. Patent foramen ovale-associated stroke repeatedly misdiagnosed as cerebral small vessel disease: A case report. Medicine (Baltimore) 2023; 102:e32996. [PMID: 36930123 PMCID: PMC10019218 DOI: 10.1097/md.0000000000032996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) is the most commonly used screening method for cardiac structural abnormalities. However, it may lead to a missed diagnosis of partial patent foramen ovale (PFO)-associated stroke. CASE PRESENTATION A 60-year-old male was admitted to the hospital for recurrent left limb weakness with or without slurred speech for 14 months. No stroke-related cardiac structural abnormality was detected during repeated TTE, and the patient was diagnosed with cerebral small vessel disease. Finally, right-to-left shunt was detected by contrast-enhanced transcranial Doppler. Subsequently, the patient was diagnosed with PFO-associated stroke by transesophageal echocardiography and contrast transesophageal echocardiography. CONCLUSIONS TTE has a low detection rate of PFO, such that it is easily missed. Contrast-enhanced transcranial Doppler is easy to operate and should be promoted as a supplementary measure to stroke etiological investigation and primary PFO screening.
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Affiliation(s)
- Yiwen Zhang
- Neurology Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ruihan Zhu
- Neurology Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Zhenzhen Yu
- Neurology Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Songqi Hou
- Imaging Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Jianping Niu
- Neurology Department, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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28
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Komarov AL, Krivosheeva EN, Makeev MI, Merkulov EV, Tripoten MI, Panchenko EP. [Patent foramen ovale as the cause of recurrent embolic strokes. Case report]. TERAPEVT ARKH 2022; 94:1109-1114. [PMID: 36286763 DOI: 10.26442/00403660.2022.09.201842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.
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Affiliation(s)
- A L Komarov
- Chazov National Medical Research Center of Cardiology
| | | | - M I Makeev
- Chazov National Medical Research Center of Cardiology
| | - E V Merkulov
- Chazov National Medical Research Center of Cardiology
| | - M I Tripoten
- Chazov National Medical Research Center of Cardiology
| | - E P Panchenko
- Chazov National Medical Research Center of Cardiology
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29
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Farjat-Pasos JI, Guedeney P, Houde C, Alperi A, Mesnier J, Côté M, Montalescot G, Rodés-Cabau J. Transcatheter Closure of Patent Foramen Ovale in Patients With Peripheral (Noncerebrovascular) Embolism. J Invasive Cardiol 2022; 34:E720-E725. [PMID: 36166362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Scarce data exist on noncerebrovascular peripheral embolism (NCPE) patients undergoing transcatheter patent foramen ovale (PFO) closure. The objectives of this study were to determine the clinical and procedural characteristics, and long-term outcomes of patients with NCPE undergoing transcatheter PFO closure. METHODS This was a multicenter study including 1136 consecutive patients who underwent PFO closure after a thromboembolic event. Patients were divided into 2 groups according to the type of event leading to PFO closure, ie, cerebrovascular event (CVE, n = 1099 [96.7%]) and NCPE (n = 37 [3.3%]). The median follow-up was 3 years (interquartile range, 1-8), with follow-up complete in 98%. RESULTS Patients in the NCPE group exhibited higher rates of prior or concomitant pulmonary embolism (29.7% vs 3.4%; P<.001), and prior myocardial infarction (24.3% vs 1.8%; P<.001). Most NCPE events were located in the limbs (41%), followed by coronary (27%) and renal/splenic/mesenteric arteries (12%). PFO closure was successful in all patients, with a low complication rate (<1%) in both groups. NCPE patients were more frequently treated with anticoagulation following PFO closure (63% vs 13%; P<.001). There were no differences between NCPE and CVE groups in death (0 per 100 patient years vs 0.4 per 100 patient-years; P=.53) or cerebrovascular events (1.3 per 100 patient-years vs 0.4 per 100 patient-years; P=.15) at follow-up. CONCLUSIONS Patients with NCPE events undergoing PFO closure exhibited differential baseline characteristics compared with patients with CVEs; limbs and coronary arteries were the most frequent NCPE location. PFO closure results and long-term outcomes were similar to their CVE counterparts, with a very low rate of recurrent thromboembolic events. Further studies are needed in this population.
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Affiliation(s)
| | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, 2725 Chemin Ste-Foy, G1V 4G5, Quebec City, Quebec, Canada.
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Chiang M, Wang DD, O'Neill WW, Villablanca PA. Bilateral Transbrachial Intracardiac Echocardiography-Guided Patent Foramen Ovale Closure in Patient With Bilateral Deep Vein Thrombosis. J Invasive Cardiol 2022; 34:E643-E644. [PMID: 35920736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patent foramen ovale (PFO) closure is a very common procedure, and unfavorable femoral venous access is not uncommonly encountered. The ability to treat this common condition in a minimally invasive manner via a different access is important in our daily practice. The transjugular venous approach has been successfully reported, with 1 main difficulty when faced with the angulation of the PFO septum primum during the crossing, as well as less operator-friendly in terms of positioning. Hence, we adopted the bilateral transbrachial approach in this patient. We consider this to be the first reported case of intracardiac echocardiography-guided PFO closure via bilateral transbrachial approach. The authors believe their experience serves an important role in the following: (1) steps and equipment needed for bilateral transbrachial PFO closure; (2) tips and tricks for a successful procedure; and (3) safety and feasibility of bilateral transbrachial approach as an alternative approach for minimally invasive PFO closure.
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Affiliation(s)
- Michael Chiang
- Henry Ford Hospital, Center for Structural Heart Disease, CFP 4th floor, 2799 W Grand Blvd, Detroit, MI 48202 USA.
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Walker-Jacobs A, Mota B, Hajjar K, Abdul-Samad O, Sankaran P. Platypnoea-orthodeoxia syndrome and hemidiaphragm paralysis. BMJ Case Rep 2022; 15:e248502. [PMID: 35383098 PMCID: PMC8984005 DOI: 10.1136/bcr-2021-248502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 70s was admitted to hospital with worsening shortness of breath and no prior respiratory history of note. This patient's shortness of breath was posture-dependent; symptoms were markedly worse and oxygen saturations were lower on sitting upright than in recumbency. Her shortness of breath had started several weeks prior to admission and had slowly worsened. Chest X-ray revealed a raised right hemidiaphragm. Further investigation revealed a patent foramen ovale, which was managed with percutaneous closure. This is one of several cases that demonstrate right-to-left shunting through a septal defect secondary to right hemidiaphragmatic paralysis. However, previous reports have not provided a clear guide for management of these cases. We suggest where patients are admitted with new onset breathlessness and platypnoea-orthodeoxia, a septal defect should be suspected. In this report, we have suggested a flowchart for the investigation and management of platypnoea-orthodeoxia syndrome.
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Affiliation(s)
| | - Bruno Mota
- Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Karine Hajjar
- Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Omar Abdul-Samad
- Cardiology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Prasanna Sankaran
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Respiratory Medicine Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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Abstract
Patent foramen ovale (PFO) describes a valve in the interatrial septum that permits shunting of blood or thrombotic material between the atria. PFOs are present in approximately 25% of the healthy population and are not associated with any pathology in the vast majority of cases. However, comparisons between patients with stroke and healthy controls suggest that PFOs may be causative of stroke in certain patients whose stroke is otherwise cryptogenic. Options for the diagnosis of PFO include transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler ultrasonography. PFOs associated with an interatrial septal aneurysm seem to be more strongly linked to risk of recurrent stroke. Therapeutic options for secondary stroke prevention in the setting of a PFO include antiplatelet therapy, anticoagulation, and percutaneous device closure. Recent randomized clinical trials suggest that percutaneous closure reduces the subsequent risk of stroke in appropriately selected patients, with a large relative benefit but small absolute benefit. Referral for percutaneous PFO closure should therefore be considered in certain patients after a multidisciplinary, patient centered discussion. Areas for future study include structural biomarkers to aid in determining the role of PFO closure in older people with possible PFO associated stroke, the role of direct oral anticoagulants, and very long term outcomes after device closure.
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Affiliation(s)
- Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - E Magnus Ohman
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Ying Xian
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Michael E Reznik
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Takase KI, Maeda N, Kawakami S, Inoue S. Paradoxical Cerebellar Embolism Associated with Platypnea-orthodeoxia Syndrome. Intern Med 2021; 60:3987-3990. [PMID: 34176830 PMCID: PMC8758454 DOI: 10.2169/internalmedicine.7024-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Platypnea-orthodeoxia syndrome is a rare clinical entity characterized by dyspnea and arterial blood deoxygenation in a sitting position. An 89-year-old woman was diagnosed with subacute cerebellar infarction. Her blood oxygen saturation decreased to 88% in a sitting position, resulting in dyspnea. Cardiological thoracic computed tomography revealed an unruptured aortic aneurysm, an enlarged ascending aorta, right atrial compression, and counterclockwise rotation of the heart. An anatomical distortion of the atrial septum induced by these abnormalities directed the atrial venous inflow such that the right-left shunt flow was exacerbated in a sitting position.
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Affiliation(s)
| | - Norihisa Maeda
- Department of Neurology, National Hospital Organization Beppu Medical Center, Japan
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34
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May JE. Unexplained arterial thrombosis: approach to diagnosis and treatment. Hematology Am Soc Hematol Educ Program 2021; 2021:76-84. [PMID: 34889390 PMCID: PMC8791102 DOI: 10.1182/hematology.2021000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Arterial thrombotic events in younger patients without a readily apparent etiology present significant diagnostic and management challenges. We present a structured approach to diagnosis with consideration of common causes, including atherosclerosis and embolism, as well as uncommon causes, including medications and substances, vascular and anatomic abnormalities, systemic disorders, and thrombophilias. We highlight areas of management that have evolved within the past 5 years, including the use of dual-pathway inhibition in atherosclerotic disease, antithrombotic therapy selection in embolic stroke of undetermined source and left ventricular thrombus, the role of closure of patent foramen ovale for secondary stroke prevention, and the thrombotic potential of coronavirus disease 2019 infection and vaccination. We conclude with a representative case to illustrate the application of the diagnostic framework and discuss the importance of consideration of bleeding risk and patient preference in determining the appropriate management plan.
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Affiliation(s)
- Jori E. May
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
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35
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Hayek A, Rioufol G, Bochaton T, Rossi R, Mewton N, Paccalet A, Bonnefoy-Cudraz E, Thibault H, Derimay F. Prognosis After Percutaneous Foramen Ovale Closure Among Patients With Platypnea-Orthodeoxia Syndrome. J Am Coll Cardiol 2021; 78:1844-1846. [PMID: 34711343 DOI: 10.1016/j.jacc.2021.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
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Frankfurter C, Muthuppalaniappan AM, Gorocica-Romero R, Abrahamyan L, Olesovsky C, Ma J, Benson L, Osten M, Horlick EM. Coronary Artery Disease in Adults Undergoing Percutaneous Patent Foramen Ovale Closure Following Cryptogenic Stroke. J Invasive Cardiol 2021; 33:E870-E876. [PMID: 34653956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND A patent foramen ovale (PFO) is found in nearly half of patients with cryptogenic stroke. Little guidance on the use or necessity of coronary angiography at the time of percutaneous PFO closure exists. We aimed to characterize the presence of coronary artery disease (CAD) in patients undergoing PFO closure following a cryptogenic stroke. METHODS A retrospective analysis of consecutive patients who underwent concurrent percutaneous PFO closure and coronary angiography was performed. Patients were ≥40 years of age and had a preceding diagnosis of cryptogenic stroke with no known CAD. Visual analysis of coronary angiograms was performed. RESULTS Of 180 patients, 8 (4%) had severe CAD, 15 (8%) had moderate CAD, 32 (18%) had mild CAD, and 12 (7%) had luminal irregularities. Of those with moderate-to-severe CAD, 9 (5%) had proximal disease and 9 (5%) had multivessel disease. Of those with moderate-to-severe CAD, 8 (35%) underwent further risk stratification with stress testing, 4 (17%) were medically managed, and 1 (4%) underwent concurrent angioplasty. CONCLUSIONS Coronary angiography identified a low prevalence of CAD in patients with cryptogenic stroke undergoing PFO closure, suggesting that coronary angiography is not routinely indicated in patients undergoing PFO closure.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eric M Horlick
- Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4.
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Musto C, Cifarelli A, Dipasquale F, Chin D, Nazzaro MS, Stio RE, Pennacchi M, De Felice F. A Comparison Between Gore Cardioform and Amplatzer Septal Occluder for Percutaneous Closure of Patent Foramen Ovale Associated With Atrial Septal Aneurysm: Clinical and Echocardiographic Outcomes. J Invasive Cardiol 2021; 33:E857-E862. [PMID: 34653958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the short- and long-term clinical and echocardiographic outcomes of the percutaneous closure of the patent foramen ovale (PFO) with an atrial septal aneurysm (ASA) using 2 different devices. METHODS We enrolled 100 patients with PFO and ASA. Fifty consecutive patients had transcatheter closure of the PFO with the Gore Cardioform septal occluder (GSO) (Gore Medical) and a second group of 50 consecutive patients with the Amplatzer PFO occluder (APO) (Abbott). A clinical and transthoracic echocardiographic follow-up was performed at 1, 3, 6, and 12 months after the implant procedure. The primary endpoint was the incidence of moderate-to-severe residual right-to-left shunting (rRLS) at the 6-month follow-up. The procedural results and the recurrence of embolic events at 1 year were also investigated. RESULTS The procedure was successful in all patients. The immediate postprocedural moderate-to-severe rRLS incidence was similar between the 2 groups (GSO 14% vs APO 12%; P=NS) as well as the incidence of moderate-to-severe rRLS at the 6-month follow-up (GSO 4% vs APO 4%; P=non-significant). In only 1 patient of the GSO group, there was a persistent moderate rRLS at the 1-year follow-up. The 6-month and 1-year complete occlusion rate for all subjects was 93% and 96%, respectively. No devices embolized and no death or recurrent embolic events were observed during hospitalization through the 1-year follow-up. CONCLUSIONS GSO and APO devices appear to be safe and effective devices for the percutaneous closure of a PFO with ASA, showing similar results for the presence of rRLS at the 6-month follow-up, complete occlusion rate, and clinical embolic recurrences.
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Affiliation(s)
- Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital, Via Circonvallazione Gianicolense n. 87, 00152 Rome, Italy.
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Houtzager T, Berg I, Urlings T, Grauss R. Concomitant pulmonary embolism and upper limb ischaemia as a first presentation of a patent foramen ovale. BMJ Case Rep 2021; 14:e242351. [PMID: 34598956 PMCID: PMC8488715 DOI: 10.1136/bcr-2021-242351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old female patient presented to the emergency department with syncope and dyspnoea. The left arm appeared to be cold and radial pulse was not palpable. A CT scan of the chest and left arm with intravenous contrast displayed bilateral central pulmonary embolisms in combination with a left subclavian artery embolism and an atrial septal aneurysm. Transthoracic echocardiography identified a patent foramen ovale with right-to-left shunting confirming the diagnosis of paradoxical embolism. The patient was treated with anticoagulants. In a patient presenting with a combination of a pulmonary embolism and a peripheral arterial embolism, the clinician should consider a right-to-left shunt with paradoxical embolism. In line with this, when diagnosing a peripheral arterial embolism, a central venous origin should be considered. Furthermore, when diagnosing a pulmonary embolism or other forms of venous thromboembolism, the clinician should be aware of signs of a peripheral arterial embolism.
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Affiliation(s)
- Tessa Houtzager
- Emergency Medicine, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Ingvar Berg
- Emergency Medicine, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Thijs Urlings
- Radiology, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Robert Grauss
- Cardiology, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
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39
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Saunders H, Melody M, Chirila R. 23-Year-Old Female With Right-Sided Weakness and Aphasia. Mayo Clin Proc 2021; 96:1634-1638. [PMID: 34088421 DOI: 10.1016/j.mayocp.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Hollie Saunders
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Megan Melody
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Razvan Chirila
- Advisor to residents and Consultant in Internal Medicine, Mayo Clinic, Jacksonville, FL.
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40
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Burgdorf C, Januszewski M, Pusch C, Remppis BA. "Brass Knuckle"-Like Right Coronary Artery. J Invasive Cardiol 2021; 33:E484. [PMID: 34089310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 60-year-old asymptomatic woman was admitted to hospital for an invasive evaluation of a patent foramen ovale and a suspected formation within the right atrium. Transthoracic and transesophageal echocardiography excluded both, but instead unveiled a huge "brass knuckle"-like ectasia of the right coronary artery meandering down the lateral wall of the right atrium. Coronary anomalies are common and mostly discovered incidentally. Thus, diagnostic and therapeutic approaches should be guided by the clinical scenario of the patient.
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Affiliation(s)
- Christof Burgdorf
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Bevensen, Römstedter Straße 25, 29549 Bad Bevensen, Germany.
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41
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Reeder GS, Taggart NW, Ammash NM. Management of the Patient With Patent Foramen Ovale in 2021: A Spectrum of Cases. Mayo Clin Proc 2021; 96:1356-1362. [PMID: 33958063 DOI: 10.1016/j.mayocp.2020.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/01/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
Patients with patent foramen ovale can manifest in a variety of ways. These presentations and their resolution are discussed in this article.
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Affiliation(s)
- Guy S Reeder
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
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Matsuzawa M, Ideno S, Suga K, Osaka Y, Morita Y. Platypnea-orthodeoxia syndrome due to undiagnosed patent foramen ovale: A case report. J Clin Anesth 2021; 71:110237. [PMID: 33756447 DOI: 10.1016/j.jclinane.2021.110237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mana Matsuzawa
- Department of Anesthesiology, Kawasaki Municipal Hospital, 12-1 Shinkawa Street, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan; Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Satoshi Ideno
- Department of Anesthesiology, Kawasaki Municipal Hospital, 12-1 Shinkawa Street, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan.
| | - Kikuko Suga
- Department of Anesthesiology, Kawasaki Municipal Hospital, 12-1 Shinkawa Street, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan
| | - Yoshimune Osaka
- Department of Anesthesiology, Kawasaki Municipal Hospital, 12-1 Shinkawa Street, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan
| | - Yoshihisa Morita
- Department of Anesthesiology, Kawasaki Municipal Hospital, 12-1 Shinkawa Street, Kawasaki-ku, Kawasaki City, Kanagawa 210-0013, Japan
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43
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Djokic B, Girod G, Tapponnier M, Alexe R, Sierro C. [Heart and thromboembolic events: situation in 2021]. Rev Med Suisse 2021; 17:449-453. [PMID: 33656298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In daily practice, ischemia of embolic origin is frequent. The clinical spectrum can range from minor ischemia to stroke or myocardial infarction. This article summarizes the common etiologies of a cardioembolic event, such as atrial fibrillation or atrial flutter, presence of a patent foramen ovale or intracardiac masses (endocarditis, thrombi or tumors). This paper aims to serve as a short repository of information to guide every physician might need to initiate the diagnostic investigations and therapy according to recent recommendations.
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Affiliation(s)
- Bojan Djokic
- Service de cardiologie, Hôpital du Valais, 1950 Sion
| | | | | | - Raluca Alexe
- Service de cardiologie, Hôpital du Valais, 1950 Sion
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44
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Aktaş Ş, Mirasoğlu B. Comment on "Concomitant fat embolism syndrome and pulmonary embolism in a patient with patent foramen ovale". Acta Orthop Traumatol Turc 2021; 55:189-190. [PMID: 33847585 DOI: 10.5152/j.aott.2021.20328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Şamil Aktaş
- Department of Underwater and Hyperbaric Medicine, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Bengusu Mirasoğlu
- Department of Underwater and Hyperbaric Medicine, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
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45
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Auer J, Primus C. Stroke During Hip Surgery. J Invasive Cardiol 2021; 33:E143-E144. [PMID: 33531447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During hip replacement, acetabular and femur bone preparation may cause bone marrow extravasation. Paradoxical fat embolism occurs when emboli pass from the pulmonary to the systemic circulation by either a patent foramen ovale or pulmonary capillaries. Impaired consciousness in the immediate postoperative period of orthopedic surgery frequently results from hypovolemia, anemia, or residual anesthesia. A high index of suspicion is required to consider the possibility of paradoxical fat embolism.
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Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, "St Josef" Hospital, Braunau, Austria.
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46
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D'Onofrio Y, Céspedes Harnes O, Manigot D, Caminiti N. [Platypnea-orthodeoxia syndrome. A simple and useful diagnosis for COVID evolution]. Medicina (B Aires) 2021; 81:878-879. [PMID: 34633974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Affiliation(s)
- Yanina D'Onofrio
- Hospital Bicentenario, Esteban Echeverría, González Catán, Buenos Aires, Argentina. E-mail:
| | - Oscar Céspedes Harnes
- Hospital Zonal General de Agudos Simplemente Evita, González Catán, Buenos Aires, Argentina
| | - Daniel Manigot
- Hospital Bicentenario, Esteban Echeverría, González Catán, Buenos Aires, Argentina
| | - Nicolás Caminiti
- Hospital Bicentenario, Esteban Echeverría, González Catán, Buenos Aires, Argentina
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47
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Abstract
Left-to-right shunts represent a significant portion of congenital heart disease. Such lesions are common in isolation, but are frequently seen in conjunction with other, often more complex, congenital heart disease. This review covers basic anatomy, physiology, physical examination findings, diagnosis and management for atrial septal defects, ventricular septal defects, and patent ductus arteriosa.
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Affiliation(s)
- Dale A Burkett
- Division of Pediatric Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado, 13123 East 16th Avenue, Aurora, CO, USA.
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48
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Tan BEX, Tan JL, Abu Sheika M, Thakkar S, von Doenhoff L. A ticking time bomb: thrombus straddling a patent foramen ovale. QJM 2020; 113:483-484. [PMID: 31995203 DOI: 10.1093/qjmed/hcaa016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- B E-X Tan
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - J L Tan
- Department of Internal Medicine, Crozer-Chester Medical Center, 1 Medical Center Blvd, Upland, PA 19013, USA
| | - M Abu Sheika
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - S Thakkar
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - L von Doenhoff
- Department of Internal Medicine, Division of Cardiology, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621, USA
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De Cuyper C, Pauwels T, Derom E, De Pauw M, De Wolf D, Vermeersch P, Van Berendoncks A, Paelinck B, Vermeersch G. Percutaneous Closure of PFO in Patients with Reduced Oxygen Saturation at Rest and during Exercise: Short- and Long-Term Results. J Interv Cardiol 2020; 2020:9813038. [PMID: 32265599 PMCID: PMC7109556 DOI: 10.1155/2020/9813038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A patent foramen ovale (PFO) is a rare cause of hypoxemia and clinical symptoms of dyspnea. Due to a right-to-left shunt, desaturated blood enters the systemic circulation in a subset of patients resulting in dyspnea and a subsequent reduction in quality of life (QoL). Percutaneous closure of PFO is the treatment of choice. OBJECTIVES This retrospective multicentre study evaluates short- and long-term results of percutaneous closure of PFO in patients with dyspnea and/or reduced oxygen saturation. METHODS Patients with respiratory symptoms were selected from databases containing all patients percutaneously closed between January 2000 and September 2018. Improvement in dyspnea, oxygenation, and QoL was investigated using pre- and postprocedural lung function parameters and two postprocedural questionnaires (SF-36 and PFSDQ-M). RESULTS The average follow-up period was 36 [12-43] months, ranging from 0 months to 14 years. Percutaneous closure was successful in 15 of the 16 patients. All patients reported subjective improvement in dyspnea immediately after device deployment, consistent with their improvement in oxygen saturation (from 90 ± 6% to 94 [92-97%] on room air and in upright position) (p < 0.05). Both questionnaires also indicated an improvement of dyspnea and QoL after closure. The two early and two late deaths were unrelated to the procedure. CONCLUSION PFO-related dyspnea and/or hypoxemia can be treated successfully with a percutaneous intervention with long-lasting benefits on oxygen saturation, dyspnea, and QoL.
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Affiliation(s)
- Céline De Cuyper
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Tristan Pauwels
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Daniël De Wolf
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Paul Vermeersch
- Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | | | - Bernard Paelinck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Gaëlle Vermeersch
- Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
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50
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Výborný P, Čmelo J. Can Visual Function Be Affected by an Open Foramen Ovale? Cesk Slov Oftalmol 2020; 76:274-277. [PMID: 33691427 DOI: 10.31348/2020/38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The authors present a relatively rare finding of pathological changes in the visual field, the emergence of homonymous hemianopia, in connection with trauma and paradoxical embolism in a subsequently diagnosed open foramen ovale in a 56-year-old otherwise healthy patient. Cardiac source of embolism is a significant etiology of vascular embolization. The important group is the so-called paradoxical embolism, which occurs when a blood clot (embolus) is carried from the venous side of circulation to the arterial side via foramen ovale patens, what can manifests as ischemic stroke. Foramen ovale patens becomes a risk factor for the stroke development only if there is a peripheral source of embolism and at the same time there is a hemodynamically significant right-left short circuit. Therefore, screening for the causes of cryptogenic stroke should include not only the detection of foramen ovale patens but also evaluation of the peripheral venous system, coagulation parameters and hemodynamic severity of a right-left shunt. Neuroophthalmological aspects related to the described issues are discussed.
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