Patent Foramen Ovale Closure Research Articles

Prophylactic antibiotic therapy during endovascular closure of patent foramen ovale: a clinical study

Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO). Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively). Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00]. Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

Embolic Ischemic Cortical Stroke in a Young Flight Instructor with a Small Patent Foramen Ovale

BACKGROUND: Stroke in young patients is frequently associated with a patent foramen ovale (PFO). Controversy exists over whether the PFO is a cause, a risk factor, or an incidental finding. Estimating the individualized risk of stroke recurrence has been difficult to ascertain. This has implications for aeromedical certification for pilots following stroke recovery. CASE REPORT: A 28-yr-old male flight instructor presented with sudden onset unilateral facial paresthesia, hand weakness, and blurred vision, accompanied by gradual onset bilateral headache. While the cranial symptoms resolved, left hand weakness persisted for 3 d. MRI revealed two punctate ischemic foci in the right precentral gyrus and superior parietal lobe. A transesophageal echocardiogram revealed a PFO with a small bidirectional shunt. His cardiologist and neurologist advised the PFO was unlikely to have caused his stroke and estimated an annual recurrence rate of < 1.8%. He was treated medically and declined PFO closure. He was able to return to flying light-sport aircraft. However, an enduring copilot restriction for general aviation activities was placed on his Class 1 and 2 medical certificates. DISCUSSION: This case highlights the difficulty in determining individualized recurrence risks for pilots recovering from a stroke associated with a PFO. While medical treatment does reduce the risk of recurrence, PFO closure provides marginal additional benefit in certain patients with a risk of side effects. Contemporary evidence-based risk scoring systems combined with echocardiography findings may be used together to better risk stratify patients and suitability for medical aviation recertification. Rengel AC, Gericke C. Embolic ischemic cortical stroke in a young flight instructor with a small patent foramen ovale. Aerosp Med Hum Perform. 2024; 95(10):784–787.

TCT-111 Transcranial Doppler as a Screening Test for Evaluation of Residual Shunt After Patent Foramen Ovale Closure

TCT-111 Transcranial Doppler as a Screening Test for Evaluation of Residual Shunt After Patent Foramen Ovale Closure

Comparison of Patent Foramen Ovale Sizing by Transesophageal Echocardiography and Balloon Sizing in Patients Undergoing Percutaneous Closure

BackgroundA patent foramen ovale (PFO) has a complex anatomy, and evaluating the size before closure may be challenging. We aimed to investigate the correlation between preprocedural transesophageal echocardiography (TEE) and balloon sizing of PFO in patients undergoing percutaneous PFO closure. MethodsA retrospective single-center study with analysis of 100 patients who, due to paradox thromboembolism in the left circulation, underwent percutaneous PFO closure. The PFO sizing was compared to measures attained by TEE and balloon sizing using linear regression analysis. ResultsPFO size measured by TEE occurred smaller than balloon sizing (2.19 mm [95% CI: 1.91 to 2.46] vs. 8.51 mm [95% CI: 8.02 to 9.00], p < 0.001). Additionally, neither the PFO channel length nor the atrial septal mobility measured by TEE correlated to the PFO size attained by balloon sizing, respectively (slope ?0.018 [95% CI: ?0.117 to 0.081], R = 0.036, p = 0.719) and (slope 0.049 [95% CI: ?0.043 to 0.141], R = 0.105, p = 0.297). Statistically significant difference in regression analysis but poor correlation was found between both TEE attained PFO and shunt size when compared to balloon sizing. Diverting patients according to the size of the PFO shunt was not statistically significant between PFO of moderate size compared, respectively, to a large and small PFO size. However, a difference was observed between a small and large PFO shunt size. ConclusionsPFO defect and shunt size measured by TEE showed a poor correlation with balloon sizing. Neither PFO channel length nor septal mobility were correlated to the PFO size measured by balloon sizing.

Relationship between epilepsy and patent foramen ovale

This study aimed to investigate the prevalence and clinical characteristics of epilepsy in patients with patent foramen ovale (PFO) and the effect of PFO closure on seizures. Patients diagnosed with PFO were recruited and underwent brain magnetic resonance imaging, electrocardiography, transesophageal echocardiography, and transthoracic echocardiography with right ventriculography. In patients with epilepsy, electroencephalography was performed. A total of 110 patients completed the assessment. A chief complaint of chest tightness or palpitations was proportionately higher in patients aged<18 years, whereas headaches and seizures were higher in patients aged≥18 years (χ2=4.69,P<0.05). Comorbid epilepsy was observed in 20.9% of patients with PFO. The age at admission in the epileptic group (14-66(27±14)years) was significantly lower than that in the non-epileptic group (16-81(38±21)years) and that in patients with headache as the chief complaint (16-68(39±12)years) (t=3.29, P<0.05). The multivariate analysis found no risk factors related to the prognosis of epilepsy. The incidence of epilepsy was significantly higher in patients with PFO than in the general population.

TCT-311 Identifying Success Factors for Patent Foramen Ovale Closure in Cryptogenic Stroke

TCT-311 Identifying Success Factors for Patent Foramen Ovale Closure in Cryptogenic Stroke

TCT-113 Patent Foramen Ovale Closure in Patients >60 Years: Age Stratified Results From U.S. Medicare Beneficiaries

TCT-113 Patent Foramen Ovale Closure in Patients >60 Years: Age Stratified Results From U.S. Medicare Beneficiaries

TCT-114 Suture-Mediated PFO Closure: Long-Term Outcomes and Predictors of Success

TCT-114 Suture-Mediated PFO Closure: Long-Term Outcomes and Predictors of Success

Patent Foramen Ovale and Other Cardiopathies as Causes of Embolic Stroke With Unknown Source.

In patients with stroke caused by cardiac embolism, the responsible heart diseases include atrial fibrillation, acute myocardial infarction, sick sinus syndrome, valvular disease, and significant heart failure. When there is no clear source of the embolism, the condition is referred to as "embolic stroke with unknown source (ESUS)." Recent studies have shown that the most common cause of ESUS is a right-to-left cardiac shunt through a patent foramen ovale (PFO). However, considering that PFOs are found in up to 25% of the general population, their presence does not necessarily indicate causality. In patients with ESUS associated with a PFO, either anticoagulants or antiplatelets are used for the prevention of future strokes or transient ischemic attacks. However, it currently remains unclear which treatment is superior. Nevertheless, recent randomized clinical trials have shown that percutaneous closure of the PFO more effectively reduces the incidence of recurrent strokes compared to medical therapy alone in patients with PFO-related strokes. This benefit is especially significant when the PFO carries high-risk features, such as a large shunt or the presence of an atrial septal aneurysm. Furthermore, the effectiveness of PFO closure has been well documented in young patients (<60 years) with a high-risk PFO development. In other cases, the therapeutic decision should be made through discussion among neurologists, cardiologists, and patients. Notably, in ESUS patients without a PFO, the underlying heart condition itself may be the source of embolism, with left atrial enlargement being the most important factor. Theoretically, anticoagulants such as non-vitamin K antagonist oral anticoagulants (NOACs) would be an effective therapy in these cases. However, recent trials have failed to show that NOACs are superior to antiplatelets in preventing further strokes in these patients. This may be due to the still uncertain definition of emboligenic cardiopathy and the presence of other potential embolic sources, such as mild but emboligenic arterial diseases. Overall, further research is needed to elucidate the source of embolism and to determine an effective management strategy for patients with ESUS.

Advances in the Study of the Correlation Between Patent Foramen Ovale and Migraine.

This article examines the relationship between patent foramen ovale (PFO) and migraine, emphasizing the mechanisms underlying the connection and the historical status of transcatheter PFO closure as a treatment for migraine. Patent foramen ovale is the most prevalent congenital cardiac defect in adults and frequently co-occurs with migraine, particularly migraine with aura. This article reviews several studies that have identified a significant prevalence of PFO in patients with migraine, implying that PFO and migraine may be more closely associated than previously thought. The underlying mechanisms of this association involve the transfer of emboli from the venous system to systemic circulation through the PFO, which can result in a range of clinical conditions. Transcatheter PFO closure therapy has demonstrated benefits in some patients with migraine; however, additional research is required to determine its effectiveness and safety. This article offers a comprehensive review of the current understanding of the link between PFO and migraine and emphasizes the need for further research in this field.

Clinical Efficacy of Transcatheter Closure of Patent Foramen Ovale with Positive Foaming Test

Background and Aims: To explore and evaluate the clinical therapeutic effect of interventional occlusion in the treatment of patent foramen ovale (PFO) with positive foaming test in the prevention and treatment of cryptogenic stroke (CS) and to provide clinical basis for individualized treatment of CS patients with PFO. Methods: A total of 151 patients who was admitted to Beijing Anzhen Nanchong Hospital Hospital from January 2019 to June 2021 were divided into two groups: drug therapy group (n = 63) and interventional occlusion + drug therapy group (n = 88). The general clinical data of the patients were collected by retrospective study, including sex, age, body weight, right to left shunt (RLS) magnitude, the degree of migraine before treatment, and telephone follow-up of all patients after treatment. Results: There was no significant difference in general clinical data (p &gt; 0.05). In the interventional occlusion + drug therapy group, the stroke recurrence rate within 6th month after operation was significantly lower than that in the drug therapy group, and the difference was statistically significant (p &lt; 0.05); The degree of migraine was lower than that in the drugs treatment group at the 3rd month after operation and the difference was statistically significant (p &lt; 0.01); The degree of migraine at the 6th month was lower than that in the drug therapy group but the difference was not statistically significant (p &gt; 0.05). The results of comprehensive generalized analysis showed that the risk of moderate or severe headache in the interventional occlusion + drug therapy group decreased by 40% (odds ratio [OR] = 0.60, p &lt; 0.05). The degree of migraine in female patients was statistically lower after three and six months postoperatively (p &lt; 0.05 and p = 0.01, respectively). Combined with generalized analysis, the risk of moderate or severe migraine in female patients was reduced by 55%. There were significant differences in the migraine before operation, migraine at the 3rd month and migraine at the 6th month in patients with three different kinds RLS grades (p &lt; 0.01, p &lt; 0.01, p &lt; 0.05). Compared with the preoperative migraine and the migraine at the 3rd month, patients with RLS grade 3 had the most obvious migraine relief at the 6th month after operation than those with RLS grade 2. Conclusion: Compared with the drug therapy, interventional occlusion + drug therapy can reduce the risk of CS recurrence, improve the prognosis and significantly reduce the degree of migraine. Patients of different genders had different degrees of migraine, women had a lighter degree of migraine and a reduced risk of moderate or severe migraine, women benefited more after treatment. Patients with different RLS grades have different postoperative migraine relief. Patients with preoperative RLS grade 3 have the most obvious postoperative migraine relief and patients with preoperative RLS grade 3 benefit more after treatment.

Persistence of residual shunt at 6 and 12 months after transoesophageal echocardiography-guided percutaneous closure of a patent foramen ovale for cryptogenic stroke

BackgroundYoung patients suffering from cryptogenic stroke alongside a patent foramen ovale (PFO) are often considered for percutaneous device closure to reduce the risk of stroke recurrence. Residual right-to-left shunt after...

Transcranial Doppler With Microbubbles: Screening Test to Detect and Grade Right-to-Left Shunt After an Ischemic Stroke: A Literature Review.

Right-to-left shunt, mainly due to patent foramen ovale (PFO), is likely responsible for ≈5% of all ischemic strokes and 10% of those occurring in young and middle-aged adults. Randomized clinical trials demonstrated that, in selected young and middle-aged patients with otherwise cryptogenic acute ischemic stroke and high-risk PFO, percutaneous PFO closure is more effective than antiplatelet therapy alone in preventing recurrence. However, PFO is generally a benign finding and is present in about one-quarter of the population. Therefore, in clinical practice, identifying PFOs that are likely to be pathogenetic is crucial for selecting suitable patients for PFO closure to prevent recurrent stroke and to avoid potentially harmful and costly overtreatment. Contrast transthoracic echocardiography has a relatively low sensitivity in detecting PFO, whereas transesophageal echocardiography is currently considered the gold standard for PFO detection. However, it is a relatively invasive procedure and may not always be easily feasible in the subacute setting. Contrast transcranial Doppler is a noninvasive, inexpensive, accurate tool for the detection of right-to-left shunt. We conducted a literature review on the use of contrast transcranial Doppler to detect and grade right-to-left shunt after an acute ischemic stroke and present a clinical workflow proposal for young and middle-aged patients.

Patent foramen ovale closure for stroke prevention.

Patent foramen ovale closure for stroke prevention.

Flecainide to Prevent Atrial Arrhythmia after Patent Foramen Ovale Closure, the AFLOAT Study: A Randomized Clinical Trial.

The real incidence of atrial arrhythmia (AA) after patent foramen ovale (PFO) closure and whether this complication can be prevented remain unknown. This study assessed if flecainide is effective to prevent AA during the first 3 months after PFO closure, and if 6 months treatment by flecainide is more effective than 3 months to prevent AA after PFO closure. AFLOAT is a prospective, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). Patients were randomized in a 1:1:1 ratio after PFO closure to receive flecainide (150 mg once a day in a sustained-release (SR) dose) for 3 months, flecainide (150 mg od SR dose) for 6 months, or no additional treatment (standard-of-care) for 6 months. The primary endpoint was the percentage of patients with at least one episode AA (≥30s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor (ICM). The secondary endpoint was the percentage of patients with at least one episode of AA (≥30s) recorded with ICM during the 3-6 months period after PFO closure. 186 patients were included (mean age 54 years, male 68.8%) and AA (≥30s) occurred in 53 (28.5%) patients during the 6-month follow-up; 86.8% of these AA events occurred in the first month after PFO closure. The primary outcome occurred in 33/123 (26.8%) and 16/63 (25.4%) patients receiving flecainide for at least 3 months or standard of care, respectively [Risk Difference (RD) 1.4%; 95% confidence interval (CI) -12.9% to 13.8%, NS]. The secondary endpoint occurred in 3/60 (5.0%), 4/63 (6.3%), and 5/63 (7.9%) patients receiving flecainide 6 months, 3 months or standard of care, respectively [RD -2.9%; 95% CI -12.7% to 6.9%, and RD -1.6%; 95% CI -11.8% to 8.6%, respectively]. In the first 6 months following successful PFO closure, AA (≥30s) occurred in 28.5% of cases, mostly in the first month after the procedure. Flecainide did not prevent AA after PFO closure.

Intracardiac vs. transesophageal echocardiography guided transcatheter closure of patent foramen ovale and atrial septal defects

Transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO) can be performed with transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance, but data comparing both modalities in contemporary practice is lacking. Using ICD-10 codes, patients who underwent transcatheter ASD/PFO closure between 2016 and 2020 using ICE or TEE in the Nationwide Readmissions Database (NRD) were identified. Propensity-score matching was performed to compare in-hospital adverse events, length of stay (LOS), cost, and 30-day non-elective readmissions. A total of 964 patients underwent ASD/PFO closure with ICE (38.3 %, n = 369) or TEE (61.7 %, n = 595) between 2016 and 2020. Propensity score matching yielded 327 patients in each group, which were well balanced. Median (IQR) age was 59.0 (46.0, 72.0) years and 54.7 % were female. No difference was observed in the rate of in-hospital major adverse events between groups. ICE guidance was associated with a lower median cost (ICE $20,140.1 (14,622.3, 25,027.0) vs TEE $20,740.4 (14,137.5, 33,045.3), p < 0.04). In conclusion, ICE guided ASD/PFO closure was associated with lower hospitalization cost without increasing in-hospital adverse events when compared with TEE guidance.

Registry of Percutaneous Closure of Patent Foramen Ovale in the Secondary Prevention of Stroke.

The foramen ovale remains patent in about 25% of the adult population. In adult life, thrombi form in the venous circulation and can cross the interatrial septum and trigger an ischemic stroke - called paradoxical embolism. The treatment can be performed through percutaneous closure of the patent foramen ovale (PFO), but still rarely performed in Brazil because it is not available in the public health care. To evaluate the reproducibility of clinical trial results in real-life studies due to the low number of records published about the topic. This study is a retrospective cohort study including 121 patients who underwent percutaneous PFO closure for secondary prophylaxis of ischemic stroke between January 2012 and June 2022. We observed a mean age of 50.3 years and most females . Severe interatrial shunt was observed in 82.6% and the presence of atrial septal aneurysm in 84.2%. After 6 months of the procedure, no patient still had a residual shunt. There were no serious bleeding or vascular complications. Recurrence of a new cerebrovascular event occurred in 1.6% of patients. We observed a low recurrence of new ischemic neurological events and lack major complications related to the procedure.

Spanish cardiac catheterization and coronary intervention registry. 33rd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2023)

Introduction and objectivesThis article presents the 2023 activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC). MethodsAll interventional cardiology laboratories in Spain were invited to participate in an online survey. Data analysis was carried out by an external company and subsequently reviewed and presented by the members of the ACI-SEC board. ResultsA total of 119 hospitals participated. The number of diagnostic studies decreased by 1.8%, while the number of percutaneous coronary interventions (PCI) showed a slight increase. There was a reduction in the number of stents used and an increase in the use of drug-coated balloons. The use of intracoronary diagnostic techniques remained stable. For the first time, data on PCI guided by intracoronary imaging was reported, showing a 10% usage rate in Spain. Techniques for plaque modification continued to grow. Primary PCI increased, becoming the predominant treatment for myocardial infarction (97%). Noncoronary structural procedures continued their upward trend. Notably, the number of left atrial appendage closures, patent foramen ovale closures, and tricuspid valve interventions grew in 2023. There was also a significant increase in interventions for acute pulmonary embolism. ConclusionsThe 2023 Spanish cardiac catheterization and coronary intervention registry indicates a stabilization in coronary interventions, together with an increase in complexity. There was consistent growth in procedures for both valvular and nonvalvular structural heart diseases.

Recurrent Ischemic Stroke/Transient Ischemic Attack After Patent Foramen Ovale Closure: A cohort study.

Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure. Patients from the Central Denmark Region who underwent PFO closure at Aarhus University Hospital between November 5, 2018, and May 12, 2023, following an ischemic stroke, TIA, amaurosis fugax or retinal emboli were included. Data on patient demographics, risk factors, procedural details, post-interventional complications and recurrent stroke/TIA were collected from electronic medical records. PFO closure was performed in 310 patients (median age: 49 years). During a median follow-up of 2.6 years (interquartile range: 1.5-3.6, 814 total patient years), recurrent stroke/TIA was observed in 8 patients (2.6%) or 0.98 recurrent strokes per 100 patient years. Recurrent stroke/TIA was more frequent in patients with hypertension (50.0% vs 16.9%, p = 0.039). Recurrent stroke/TIA was related to thrombophilia or haematological conditions entailing hypercoagulability in 62.5% of patients. New-onset atrial fibrillation was observed in 9.4% of patients within 45 days after the procedure. None of these patients subsequently developed an ischemic event. Other adverse outcomes were uncommon. Rates of recurrent ischaemic stroke/TIA after PFO closure were comparable to findings in previous trials. Pre-existing vascular risk factors (hypertension), and a hypercoagulable state were associated with recurrent ischaemic stroke/TIA.

Patent foramen ovale and migraine: prevalence, pathogenetic relationship and impact of PFO closure

Background. Migraine is a chronic neurovascular disease with high prevalence (12-15% of the population) and social significance [1]. Pathogenesis of migraine has not been clear. Some studies report an association between migraine and the presence of a patent foramen ovale (PFO) and right-to-left shunt [2, 3, 4]. Introduction. The objectives of this study were to clarify the prevalence and clinical characteristics of migraine, as well as the effect of endovascular PFO closure on the course of migraine in a cohort of patients who suffered ischemic stroke (IS) by paradoxical embolism due to PFO. Material and methods. We examined 97 patients from 18 to 50 y.o. (average age 32.29 ± 2.19 years, women 70.8%) with IS due to PFO in The Research Center of Neurology since January 2018 until October 2023. All patients were assessed for migraine, characteristics of headaches and the impact of migraine on social adaptation. Endovascular surgery was performed in 61 patients. The data from a dynamic examination of 24 patients with migraine were assessed before and after PFO closure. Results. Among a cohort of IS due to PFO patients, the prevalence of migraine was 39.2% (migraine with aura - 55%, migraine without aura - 45%), the ratio of women to men was 1.9:1. The frequency of headaches was 4 [1;7] days per month. Six months after PFO closure, patients with migraine showed a significant decrease in the frequency of headaches from 4 [2; 24] up to 2 [1;5] days per month (p=0.009); reduction in pain intensity from 7 [7; 9] to 3 [3; 7] points according to VAS (p=0.0001); reduction of disability from 20 [6; 89] to 17 [2; 26] points (p=0.019) according to the MIDAS. Conclusion. The present study confirmed the high prevalence of migraine in the PFO cohort. PFO closure led to decrease in frequency and intensity of headaches and decrease of migraine’s impact on social adaptation.