Cases Of Patent Foramen Ovale Research Articles

Cardiac Hypertrophy in Neonates Born to Diabetic Mothers at Farhat Hached of Sousse University Hospital

<i>Introduction:</i> The association between cardiac hypertrophy and hyperinsulinism is mainly observed in the newborn, although the onset in older infants has also been described. The aim of our study is to research a cardiac hypertrophy in newborns of diabetic mothers. <i>Methodology</i>: This was a cross-sectional study, involving one hundred and twenty (120) newborns of diabetic mothers from August 1^stto November 30, 2020. These newborns of diabetic mothers had received an echocardiographic examination at the laboratory of the FARHAT HACHED University Hospital in Sousse (Tunisia) regardless of the associated cardiac or extracardiac pathology, during the study period, to detect cardiac hypertrophy. <i>Results:</i> The sex ratio was in favor of the female gender at 0.90. The average weight was 3554.04 g, with extremes ranging from 1,600 g to 5,200 g. Twelve (12) newborns had a weight greater than or equal to 4,000 g (10.00% of macrosomes). Among mothers, there were 03 types of diabetes: type 1 diabetes (2.65%), type 2 diabetes (0.88%) and gestational diabetes (96.46%). Echocardiography was normal in 91 neonates (75.83%) and abnormal in 29 neonates (24.17%). The prevalence of cardiac hypertrophy was 09.17% and that of other associated cardiac abnormalities was 21.66%. There were 11 cases of patent foramen ovale, 11 cases of patent ductus arteriosus, 02 cases of ostium secundum atrial septal defect, 01 case of interrupted aortic arch, 01 case of pulmonary stenosis. These abnormalities were associated on the one hand with the septal hypertrophy and on the other hand, associated with each other in the same newborn. Left ventricular ejection function was normal in all neonates with an average of 66% and extremes between 59% and 76%. <i>Conclusion:</i> Cardiac hypertrophy described in the newborn of diabetic mother is characterized by hypertrophy of the ventricular walls more often predominating over the septum. Transthoracic echocardiography is the reference (non-invasive) technique for diagnosing and monitoring these hypertrophies.

Adult Congenital Heart Disease and Percutaneous Interventions : Analysis of Cases over five years in a Bangladeshi Center

Background: In recent year ‘s considerable progress has been made in the early diagnosis and treatment of congenital heart disease (CHD) and a significant number of children are expected to survive into adulthood after completion of treatment. This has created a scope of a substantial population of patients with adult congenital heart disease. In Bangladesh, milder or simple from of congenital heart diseases are prevalent among populations but palliated and treated cases of CHD are gradually increasing the load of work for adult congenital heart disease (ACHD) professionals. Many of these cases can be treated by transcatheter intervention with excellent outcome. Methods: This is a retrospective study conducted in a tertiary level cardiac hospitals of Bangladesh from January 2015 to December 2020. All cases aging 18 years and above were included who had undergone cardiac catheterization or percutaneous interventions. Data were collected from Echocardiography department, Catheterization Laboratory and indoor department. Follow up data were collected from echocardiography and outpatient department. Results: Total Two hundred Ninety-four cases were enrolled for cardiac catheterization. Two hundred eighteen cases had various types of intervention. Most of the cases were in 18-25 years age group. Among shunt lesions, 165 cases (56.12%) had atrial septal defect (ASD), 48(22.02%) had ventricular septal defect (VSD), 32 (14.67%) had patent ductus arteriosus (PDA), and 4(1.83%) had patent foramen ovale (PFO). Device closure was performed in 120(55.04%) cases of ASD, 13(5.96%) cases of VSD, 30 (13.76%) cases of PDA and in 4(1.83%) cases of PFO. Nineteen (8.72%) had valvuloplasty for pulmonary stenosis (PS), 2 (0.68%) had valvuloplasty for aortic stenosis (AS), 2(0.068%) had coarctoplasty for coarctation of the aorta (CoA), 4 (1.83%) had percutaneous pulmonary valve implantation (PPVI). Seventeen (7.79%) cases had double intervention of ASD device closure and pulmonary stenosis, 5 (2,29%) cases had ASD and PDA device closure and 2 (0.92%) cases had PDA device closure and balloon coarctoplasty. ASD device was embolized in 4 cases. There were no other complications. Conclusion: Outcome of intervention in ACHD was found safe and effective and no significant short or long-term complications were noticed. Cardiovasc j 2022; 14(2): 121-127

A Case of Patent Foramen Ovale as a Cause of Persistent Hypoxia

A Case of Patent Foramen Ovale as a Cause of Persistent Hypoxia

CT Diagnosis of Paradoxical Embolism via a Patent Foramen Ovale in a Patient with a Pulmonary Embolism and Prominent Eustachian Valve

While there is a high prevalence of patent foramen ovale in adults, paradoxical embolism via a patent foramen ovale is rare. Previous echocardiographic studies indicated that paradoxical embolism might only occur in patients with high-risk features of patent foramen ovale (i.e., large defect size, presence of a Eustachian valve, and high right atrial pressure). Here, we present a case of patent foramen ovale with high-risk CT features for paradoxical embolism.

Ischemic Stroke in the Young.

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.

Assessment and Reduction of Unnecessary Thrombophilia Testing in Patients 18-60 Years with Acute Cryptogenic Ischemic Stroke

Patients &lt; 60 years with acute ischemic stroke (AIS) are commonly tested for thrombophilia. Underlying this practice is the perception that the stroke may be the result of a hypercoagulable state, especially when an alternative cause is not evident. Although certain conditions, such as antiphospholipid antibody syndrome (APS), can be associated with AIS and require anticoagulation, inherited thrombophilia, largely, is not a risk factor for AIS even in young adults with cryptogenic stroke, as supported by case-control and prospective observational studies. Moreover, testing in the acute phase of AIS may give erroneous results (i.e., increase of Factor 8 as an acute phase reactant), and increase health care costs. To assess our institutional performance on this matter, we conducted a retrospective chart review of 104 patients, age 18-60 years, who were admitted for AIS to Memorial Hermann Hospitals at the Texas Medical Center between 11/2016 and 7/2018, and whose stroke was considered cryptogenic or of undetermined origin (i.e., more than one possible causes) after initial diagnostic evaluation. Mean age at the time of event was 43 (range 20-58) years. There were 61 (59%) males. Fifty nine (57%) patients were White, 42 (40%) Black, 18 (17%) Hispanic, 2 (2%) Asian, and one (1%) of unknown race. Risk factors for AIS were: hypertension in 64 (61%) patients, diabetes in 26 (25%), smoking in 27 (26%), dyslipidemia in 32 (31%), prior AIS in 17 (16%), coronary artery disease in 4 (4%), and obesity in 10 (10%). None had known atrial fibrillation or other cardiac arrhythmia. Thrombophilia testing (at least one test) was performed in 82 (79%) of the patients. In the vast majority (70 patients, 85%) of cases, such testing was done within 1-3 days of admission as part of the initial stroke evaluation. A total of 752 tests were performed on the 82 patients, 56 (7%) of which were positive. Increased Factor 8 (F8) activity (i.e., ≥200%) was the commonest abnormality observed (31/58 patients tested, or 53%), followed by low protein S (PS) activity (13/77, 17%), Factor V Leiden (FVL) mutation (3/71, 4%), low antithrombin (AT) activity (3/73, 4%), elevated homocysteine (2/79, 3%), low protein C (PC) activity (1/76, 1%), and positive APL (1/251, 1%), while no prothrombin gene mutation was seen. All but one of F8, PS, and AT tests were performed in the acute phase of the stroke. The estimated annual cost for testing was $65000. Forty-two (51%) of the 82 patients tested had at least one abnormal test. In 2/42 (5%) of these patients, repeat testing (i.e., PS activity, F8) was done at least a month later, which, however, did not confirm the abnormality. Forty-seven (45%) patients were seen in the Outpatient Neurology Clinic after their stroke, for a median follow up of 5 (0.2 - 24) months. In 54 (52%) patients the cause of stroke remained undetermined even after thorough evaluation. Sixteen (15%) patients had a patent foramen ovale (PFO). Of all patients tested, thrombophilia was confirmed in three, i.e., two patients with heterozygous FVL mutation and one with known homozygous FVL mutation and a significant personal history of venous thromboses. Only in one patient (1/82, 1%) management was changed taking into account the thrombophilia testing results: a 57 year old male with low PS activity (tested 3 months after the stroke) and a PFO not amenable to closure, for whom anticoagulation was started despite the lack of venous thromboembolism. Based on these results, and due to concerns of indiscriminate testing, we created a practice guideline supported by current literature, as a reference for clinicians (see Figure). Briefly, we eliminated inherited thrombophilia testing in the acute phase, and rendered it optional in the chronic phase at the discretion of the treating physician, when anticoagulation is considered (i.e., some cases of PFO or recurrent stroke). Accordingly, we removed these tests from the admission order panel in the Electronic Medical Record. After internal audit and feedback from health care providers across disciplines, we submitted the new guideline for multidisciplinary review and system-wide adoption (i.e., multiple hospitals). We conclude that routine thrombophilia testing is not an effective tool for secondary stroke prevention even in young patients with cryptogenic AIS. Institutional practice guidelines are helpful in tailoring such testing, hence avoiding misdiagnosis of a thrombophilic state and unnecessary costs. Figure Disclosures No relevant conflicts of interest to declare.

Transesophageal Echocardiography in Cardiogenic Embolic Cerebral Infarction.

Objective:To evaluate the diagnostic values of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in cardiogenic embolic cerebral infarction.Methods:Fifty patients with occult cerebral infarction who were admitted to the hospital between June 2015 and June 2016 were selected as research subjects. The patients were diagnosed by transesophageal echocardiography and transthoracic echocardiography. Diagnostic data were compared to analyze the values of the two diagnostic methods.Results:Sixteen out of fifty patients were diagnosed as cardiogenic embolic cerebral infarction by TEE (32%), including two cases of aortic plaques, six cases of atrial septal defect, two cases of atrial septal aneurysm, two cases of patent foramen ovale, one case of left atrial spontaneous echo contrast, one case of mitral prolapse and two case of mitral stenosis. Four cases were diagnosed as cardiogenic embolic cerebral infarction by TTE (8.0%), including one case of patent foramen ovale, one case of left atrial spontaneous echo contrast, one case of mitral prolapse and one case of mitral stenosis. The difference was statistically significant (P<0.05). The main difference of TEE and TTE was detection of aorta atheromatous plaques and atrial septal lesions. Aortic atheromatous plaques of two cases and atrial septal lesions of eight cases were missed in the diagnosis by TTE.Conclusion:Detection and diagnosis of cardiac embolic cerebral infarction with TEE is highly accurate and advantageous. Therefore, TEE is worth promotion and application.

Etiology analysis of upper airway obstruction in 54 newborn infants

Objective To explore the etiology of neonatal upper airway obstruction(UAO)in order to perform early diagnosis and treatment, and to improve the prognosis. Methods Retrospectively analysis of the clinical data of 54 cases of neonatal UAO in Shengjing Hospital of China Medical University from Jan.2005 to Dec.2011 was performed.All patients received CT three dimensional reconstruction reconstruction, 30 patients received the direct laryngoscopy, 5 cases received the video laryngoscope, 8 cases received pathological examination.All the cases received the determination of serum total calcium and ionized calcium, 6 cases received upper gastrointestinal imaging, 8 cases received chromosome inspection and 20 cases received echocardiography. Results CT scan: abnormal in 21 cases, among them 15 cases of congenital cyst, 5 cases of tongue fall blocking airway, and 1 case of choanal atresia(bilateral); another 33 patients were normal.Direct laryngoscopy results: abnormal in 13 cases, among them 12 cases of congenital cyst, and 1 case of glossoptosis; another 17 cases were normal.Electronic laryngoscopy results: 5 cases were diagnosed as congenital laryngomalacia.Pathological examination results: 7 cases of cyst wall by squamous epithelium composition, and 1 case of cyst wall by columnar epithelium composition.Serum total calcium and ion calcium level results: all patients were in the normal range.Chromosome examination results were normal.Upper gastrointestinal imaging results: 1 normal case, 5 cases of mild gastroesophageal reflux. Echocardiography results: 4 cases were normal, 10 cases of patent foramen ovale, 2 cases of patent ductus arteriosus, 4 cases of congenital heart disease (2 cases of atrial septum defect, 1 case of ventricular septal defect, and 1 case of interatrial septum merger ventricular septal defect). Conclusions In the etiology of neonatal UAO, there is a lot of organic diseases except for congenital laryngomalacia.For the UAO induced by laryngeal stridor or undefinitely cause, CT scan should be taken as soon as possible. Key words: Upper airway obstruction; CT scan; Newborn, infant

A Case of Patent Foramen Ovale in the Dog

A Case of Patent Foramen Ovale in the Dog

Abstract 5796: Real-Time 3D Transesophageal Echo Enhances the Diagnostic Capabilities of Patent Foramen Ovale in Patient’s with Cerebral Vascular Accidents

Real-time 3D transesophageal echo (RT3D TEE) is a novel technology whereby RT3D rendering of ultrasound images is performed resulting in unique views of cardiac structures. We have presented initial data reporting the incidence of optimal en face visualization of cardiac structures including the fossa ovalis (FO). We aimed to further characterize the FO. Therefore, our hypotheses were that the FO could be seen en face in full circumferential view (CV) in most patients and saline contrast RT3D TEE would enhance the accuracy of patent foramen ovale (PFO) diagnosis compared to contrast 2D TEE. Therefore, in an unselected series of 124 patients referred for TEE, we performed RT3D TEE with specific views of the FO using the Philips x7–2t RT3D TEE transducer. Images of the FO were acquired in the real-time 3D, 3D zoom, and full volume modes. Visualization of the FO was scored by 2 separate observers using the following scale: full CV of the FO &gt;1/2 CV &lt;1/2 CV no visualization. The visualization score was 1.44. The average maximal and minimal diameters of the FO during the cardiac cycle were 1.46±0.90 and 1.12±0.12cm and an average maximum area of 169±20mm2. The sensitivity of saline contrast RT3DTEE for PFO diagnosis was 100% with specificity of 96% due to 3 cases where PFO was seen only by RT3D TEE. RT3DTEE allows complete circumferential visualization of the FO in the majority of cases. Our determination of the size of the FO compares favorably with pathologic series Some cases of PFO can be expected to be detected only by RT3DTEE and therefore this technique should be performed when 2D TEE is negative for PFO but clinical suspicion remains high.

ECG-Gated Cardiac CT Angiography Using 64-MDCT for Detection of Patent Foramen Ovale

The purpose of our study was to show the feasibility of ECG-gated, 64-MDCT cardiac angiography for the detection of patent foramen ovale (PFO). Chart review was performed on 214 consecutive patients referred for clinically indicated 64-MDCT angiography. The study cohort consisted of 20 patients who had previously undergone transesophageal echocardiography (TEE). Blinded consensus review of each CT angiography was performed by two experienced cardiac radiologists and results were compared with TEE, which served as a reference standard. CT criteria for the diagnosis of PFO were distinct left atrial "flap" in the expected location of the septum primum, continuous column of contrast material connecting this flap to the right atrium, and a "jet" of contrast material from the column into the right atrium. Of the 20 patients who underwent both TEE and cardiac CT angiography, six (30%) were found to have a PFO by TEE. Using the presence of a left atrial flap as the only diagnostic criterion, all six cases of PFO were detected using CT (sensitivity = 100%). Of the 14 patients with no PFO seen on TEE, 12 of these were correctly identified using CT (specificity = 86%). Using all three criteria together, the sensitivity decreased to 66% and the specificity increased to 100%. ECG-gated cardiac CT angiography performed with a 64-MDCT scanner can be used to reliably detect PFO.

Incidences of venous air embolism and patent foramen ovale among patients undergoing selective peripheral denervation in the sitting position.

The incidence and severity of venous air embolism (VAE), a potentially fatal complication, among patients undergoing selective peripheral denervation in the sitting position have never been clearly established. We designed this retrospective study to assess the incidence and severity of VAE, the incidence of paradoxical air embolism, and the occurrence of patent foramen ovale, as detected with transesophageal echocardiography, as well as the effects of its detection on patient treatment. After institutional review board approval, data were collected from the charts of all patients who underwent selective peripheral denervation at our institution between 1988 and 2001. The severity of VAE was assessed by using a 5-point scale. Data for 342 patients were available for analyses. Seven patients exhibited VAE, yielding an incidence of 2%. The severity of VAE was 2/5 for three patients, 3/5 for three patients, and 4/5 for one patient. Air could be aspirated from the central venous catheter for three patients. No deaths occurred. Among the 96 transesophageal echocardiographic examinations performed, 5 cases of patent foramen ovale were detected (5.2%). For those patients, surgery was performed in the prone or park-bench position. No paradoxical air embolism was detected. This is the first large study to directly assess the incidence and severity of VAE among patients undergoing selective peripheral denervation in the sitting position. We recommend that the detection of a patent foramen ovale prompt a change in position for this surgical procedure.

Effectiveness of pulse oximetry screening for congenital heart disease in asymptomatic newborns.

To determine the sensitivity, specificity, predictive value, and accuracy of a program of pulse oximetry screening of asymptomatic newborns for critical congenital cardiovascular malformation (CCVM). Pulse oximetry was performed on asymptomatic newborns in the well-infant nurseries of 2 hospitals. Cardiac ultrasound was performed on infants with positive screens (saturation <or=95% at >24 hours). Data regarding true and false positives as well as negatives were collected and analyzed. Oximetry was performed on 11 281 asymptomatic newborns, and 3 cases of CCVM were detected (total anomalous pulmonary venous return x2, truncus arteriosus). During the study interval, there were 9 live births of infants with CCVM from a group of 15 fetuses with CCVM detected by fetal echocardiography. Six infants with CCVM were symptomatic before screening. There was 1 false-positive screen. Two infants with negative screens were readmitted (coarctation, hypoplastic left pulmonary artery with aorto-pulmonary collaterals). Other cardiac diagnoses in the database search were nonurgent, including cases of patent foramen ovale, peripheral pulmonic stenosis, and ventricular septal defect. The prevalence of critical CCVM among all live births was 1 in 564 and among the screened population was 1 in 2256 (sensitivity: 60%; specificity: 99.95%; positive predictive value: 75%; negative predictive value: 99.98%; accuracy: 99.97%). This screening test is simple, noninvasive, and inexpensive and can be administered in conjunction with state-mandated screening. The false-negative screen patients had lesions not amenable to detection by oximetry. The sensitivity, specificity, and predictive value in this population are satisfactory, indicating that screening should be applied to larger populations, particularly where lower rates of fetal detection result in increased CCVM prevalence in asymptomatic newborns.

Hypoxemia after Blunt Chest Injury: Right-To-Left Intracardiac Shunt Managed Non-Operatively

A case of patent foramen ovale with right-to-left intracardiac shunt after blunt chest injury is presented. The association of pulmonary contusion, pulmonary hypertension, and patent foramen ovale in a previously healthy subject is discussed. In such a case reduction of the afterload on the right ventricle is the suggested modality of treatment for hypoxemia due to the right-to-left shunt.

Congenital hydrocephalus-analysis of 49 cases

The causes of congenital hydrocephalus vary widely and have an important effect in determining the future counseling of affected cases. We analyzed the postmortem findings of 49 autopsies diagnosed as hydrocephalus to find the causes and related conditions. The cases were collected during the last 10 years (1981-1990). The cases consisted of 25 cases associated with various congenital malformations of the central nervous system (CNS), 14 cases of posthemorrhagic hydrocephalus, 4 cases of postinfection hydrocephalus, and 2 cases of hydranencephaly. Four cases were associated with supracerebellar arachnoid cyst (1) and unknown causes (3). Twenty-five cases associated with congenital malformation of the CNS consisted of 10 cases of holotelencephaly, 5 cases of stenosis of the Sylvian aqueduct, 4 cases of agenesis of the corpus callosum, and 3 cases each of Dandy-Walker malformation and Arnold-Chiari malformation. Various malformations of other organs were associated with these cases. Cardiovascular malformations were common, consisting of 11 cases of patent ductus arteriosus (PDA), 7 cases of atrial septal defect (ASD), and 6 cases of patent foramen ovale (PFO). Among the anomalies of the respiratory system, abnormal lobation was commonly associated, as well as hypoplasia of the lung. Gastrointestinal malformations included Meckel's diverticulum, diaphragmatic hernia, mobile intestine, and midline small liver. Cryptorchidism was the most common malformation in the genitourinary system. Holotelencephaly cases showed multiple craniofacial anomalies, as well as other malformations in the central nervous system. Skeletal malformations included polydactyly, simian crease, and flexion deformity. There were no specific constellations of malformations in these different groups of CNS malformations associated with hydrocephalus.

Case of Patent Foramen Ovale in Advanced Life

Case of Patent Foramen Ovale in Advanced Life