Transcatheter Closure of Patent Foramen Ovale - A Single Center Experience.

Percutaneous closure of patent foramen ovale after cryptogenic stroke - a comparison between patients < 60 versus ≥ 60 years-of-age.

Tailoring Antiplatelet Therapy Duration After PFO Closure: Insights From the PROLONG Registry.

Anxiety disorders are prevalent mental health conditions with complex pathogenesis and limited treatment efficacy. While links between patent foramen ovale (PFO) and migraine, and between migraine and anxiety are established, no study has explored PFO-anxiety association in non-migraine populations. We conducted a retrospective observational study to examine PFO-anxiety correlation in anxiety disorder patients and propose potential mechanistic pathways. A total of 103 consecutive patients with ICD-10-confirmed anxiety disorders were recruited from Hebei General Hospital. Anxiety severity was stratified into mild-to-moderate and severe groups using the Hamilton Anxiety Rating Scale (HAMA). The grade of right-to-left shunt (RLS) through patent foramen ovale (PFO) was quantified via agitated saline contrast echocardiography (ASCE). Correlation analysis and multiple linear regression were applied to identify factors associated with anxiety severity. Fifty-four patients had mild to moderate anxiety, and forty-nine patients had severe anxiety. Eighty (77.67%) patients with anxiety were positive for patent foramen ovale. Furthermore, the anxiety level of inpatients was greater than that of outpatients and the anxiety level of patients with a positive right-to-left shunt via patent foramen ovale was greater than that of patients with a negative shunt. Spearman correlation analysis revealed a strong positive association between RLS grade and anxiety severity (r = 0.817, p < 0.001). This preliminary observational study identifies a statistically significant association between anxiety severity, PFO presence and RLS grade in patients with anxiety disorders. A key limitation of this work is its retrospective design, which precludes confirmation of causal relationships between the observed variables. Potential underlying mechanisms including neurohumoral dysregulation, cerebrovascular compromise, and autonomic nervous system dysfunction are proposed for future investigation. These findings provide a novel perspective for anxiety pathophysiology research, and further validation in large, well-controlled cohort studies is warranted.

Amniotic fluid embolism (AFE) is a rare but devastating complication during pregnancy. We present an instance of an embolic stroke following an AFE in labor with a concurrent patent foramen ovale (PFO). The patient was a 34‐year‐old G4P2 who had an acute seizure event intrapartum. She was taken for an emergent cesarean delivery during which she was noted to have cardiopulmonary compromise. A cesarean hysterectomy was performed due to ongoing DIC and hemorrhage. Postoperatively, she was found to have evidence of thrombotic emboli as well as a PFO. She had a good neurologic recovery with supportive measures even prior to discharge from the hospital and has continued to do well. When more common etiologies of intrapartum seizures have been excluded, providers should maintain a high index of suspicion for embolic stroke.

Acute maternal hyperoxygenation (MH) testing may be useful to predict need for balloon atrial septostomy (BAS) in fetal d-transposition of the great arteries/intact ventricular septum (d-TGA/IVS). We present our d-TGA/IVS MH experience. MH was performed in late third trimester with O2 at 8L/min via a non-rebreather mask for 10min followed by evaluation of septum primum position, patent foramen ovale (PFO) dimension, and pulmonary vasoreactivity (PVr). Mean gestational age of 18 d-TGA/IVS fetuses at MH and birth were 35.9 and 39 weeks respectively. Nine newborns underwent BAS. During MH, in BAS group, septum primum phasically centralized but stayed leftwards of the septum secundum in 8/9 fetuses. Atrial septum was assessed in 8/9 fetuses in the no BAS group. In all 8, septum primum was bidirectional phasically crossing rightwards of the septum secundum. Mean MH sagittal PFO dimension between BAS and no BAS groups were 2.5 ± 0.6 and 4.7 ± 0.9mm respectively (p < 0.001). PVr was noted in 15/16 fetuses with available data. Interobserver reliability for septum primum position showed 100% agreement. d-TGA/IVS fetuses commonly demonstrate PVr with MH. Smaller PFO dimension and septum primum not crossing rightwards of the septum secundum despite PVr predicted need for BAS. Larger prospective studies are needed to validate these findings.

Turner syndrome (TS) is associated with cardiovascular abnormalities and metabolic risk, but karyotype-specific phenotypes remain incompletely defined, particularly in pediatric and adolescent cohorts assessed by transthoracic echocardiography (TTE). We conducted a retrospective cross-sectional study of 289 patients with TS evaluated between October 2016 and October 2023. Patients were grouped as 45,X monosomy (n = 149) or mosaic/structural karyotypes (n = 140). Baseline or preoperative TTE data were used. The primary endpoint was a clinically relevant structural cardiovascular disease (CVD) composite based on explicit baseline/preoperative diagnoses of major lesions; patent foramen ovale, isolated persistent left superior vena cava, and minor valve regurgitation were treated as descriptive findings. Aortic dilatation based on ASI > 20mm/m² was analyzed separately as an aortic-size phenotype. The structural CVD composite was more frequent in the 45,X group than in the mosaic/structural group (49/149 [32.9%] vs. 26/140 [18.6%], p = 0.006). In multivariable logistic regression, 45,X remained associated with the structural CVD composite after adjustment for age, BMI, systolic blood pressure, LDL-C, and HOMA-IR (OR 1.88, 95% CI 1.05-3.35; p = 0.033). Aortic dilatation by ASI > 20mm/m² did not differ significantly between groups (28.9% vs. 32.9%, p = 0.462). Elevated total cholesterol was more frequent in the 45,X group, and LDL-C was independently associated with the structural CVD composite. LVDD was modestly lower in the 45,X group (33.6 ± 6.6 vs. 35.4 ± 6.4mm; p = 0.017). In this single-center TS cohort, 45,X monosomy was associated with a higher burden of clinically relevant structural cardiovascular abnormalities and an adverse lipid profile, whereas ASI-defined aortic dilatation alone did not differ significantly by karyotype. These findings support karyotype-aware cardiovascular surveillance, while underscoring the need for cautious interpretation of small TTE differences and validation in multicenter longitudinal studies.

Population-based characterization of left atrial and appendage variations: Prevalence, risk factor associations, and sex-specific morphology.

This narrative, hypothesis-generating review examines whether patent foramen ovale (PFO), usually discussed through stroke prevention, may be linked to atrial cardiomyopathy (AtCM) in selected large-shunt and/or atrial septal aneurysm (ASA) phenotypes. We synthesize heterogeneous clinical imaging, electrophysiology, hemodynamic, and translational data rather than a formal systematic evidence base. Observational cohorts and small mechanistic studies suggest associations between high-shunt PFO phenotypes and left atrial enlargement, impaired mechanics, atrial vulnerability (e.g., shorter effective refractory periods or atrial fibrillation inducibility), and post-ablation arrhythmia recurrence; these signals are phenotype-specific, potentially confounded, and do not establish causality. We propose a candidate high-shunt PFO research phenotype based on shunt magnitude and septal morphology (contrast echocardiography and TEE features), with atrial substrate and electrophysiology (EP) measures treated as downstream modifiers/endpoints. Closure-related reverse remodeling, antiarrhythmic effects, and heart-failure outcomes should be interpreted cautiously because existing evidence is largely non-randomized. We outline candidate "shunt-on vs shunt-off" studies with prespecified EP endpoints integrated with hemodynamics and multimodal imaging to test causality, reversibility, and net clinical benefit.

Total Knee Arthroplasty in the Presence of Congenital Heart Disease: An Under-Recognized Risk

In 2023, Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by Guideline Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and heart failure with preserved ejection fraction (HFpEF), as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Valsalva maneuver is essential for evaluating left ventricular diastolic function and diagnosing patent foramen ovale (PFO). Furthermore, in association with the recent insurance coverage for myocardial myosin inhibitors, a new drug for hypertrophic cardiomyopathy, the Valsalva maneuver has become increasingly important in the diagnosis of hypertrophic obstructive cardiomyopathy. Based on the above background, the Guideline Committee of the Japanese Society of Echocardiography prepared the practice guidance for "Stress echocardiography using the Valsalva maneuver" as the focused update incorporated into the "Practice guidance for the implementation of stress echocardiography."

Impact of patent foramen ovale on transvenous lead extraction characteristics and outcomes.

Identifying a right-to-left shunt (RLS), commonly due to a patent foramen ovale (PFO), is essential in evaluating embolic stroke of undetermined source (ESUS). While several imaging modalities are used for PFO detection, direct comparisons in a single cohort are limited. This study evaluates and compares the diagnostic performance of 4 major modalities: transcranial Doppler (TCD), transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and cardiac CT in patients with ESUS. We retrospectively identified patients with ESUS referred to our neurosonology laboratory from July 2023 to May 2025, who underwent at least 3 of the 4 diagnostic modalities. A confirmed PFO was defined by concordant positive findings on at least 2 tests. Diagnostic performance metrics (sensitivity, specificity, positive predictive value, negative predictive value [NPV], accuracy, and area under the curve [AUC]) were calculated, with pairwise comparisons assessed using the DeLong test. Of 469 screened patients, 130 met inclusion criteria. TCD showed the highest sensitivity (100%), NPV (100%), and an accuracy of 87.6%, although specificity was moderate at 75.0%. After excluding patients with mild PFO or extracardiac shunts, specificity and accuracy improved to 81% and 90.8%, respectively. TTE achieved a sensitivity of 83.3% and specificity of 93.3%, with an overall accuracy of 88.1%. TEE had a sensitivity of 95.1%, specificity of 87.5%, and the highest overall accuracy at 91.3%. Cardiac CT had perfect specificity (100%) but the lowest sensitivity (45.8%), limiting its standalone diagnostic utility. AUC comparisons revealed superior diagnostic performance for TCD, TTE, and TEE over cardiac CT (p values <0.05), but no significant differences among TCD, TTE, and TEE. TCD is a highly sensitive, noninvasive first-line tool for detecting RLS in ESUS, particularly in acute or resource-limited settings. Confirmatory TTE, TEE, or CT can be tailored to context, with a tiered approach optimizing PFO detection and prevention strategies. Results should be interpreted cautiously, given the referral and selection bias. Larger prospective multicenter studies are needed to validate this approach and improve outcomes. This study provides Class IV evidence that (1) TCD and TEE were highly sensitive in detecting PFO; (2) TTE and cardiac CT were highly specific in detecting PFO; (3) TCD, TTE, and TEE had superior diagnostic performance over cardiac CT (as defined by AUC comparison analysis); and (4) there were no significant differences in overall diagnostic performance among TCD, TTE, and TEE.

Patent Foramen Ovale and Atrial Septal Defect.

Patent Foramen Ovale Embryology, Anatomy, and Physiology.

Patent foramen ovale (PFO) has been increasingly associated with otherwise unexplained syncope, but predictors of syncope recurrence after percutaneous closure remain unclear. This study aimed to develop and internally evaluate machine-learning models for predicting post-closure syncope recurrence. We retrospectively analyzed 284 patients with PFO and otherwise unexplained syncope who underwent transcatheter closure between January 2017 and December 2023. Syncope recurrence was modeled as a binary outcome during available follow-up; follow-up duration and time to recurrence were not incorporated into the primary model. Clinical, echocardiographic, laboratory, and procedural variables were extracted. Feature selection was performed using Boruta and least absolute shrinkage and selection operator (LASSO) regression. Ten machine-learning algorithms were trained and internally evaluated using discrimination, calibration, decision-curve analysis, and repeated stratified resampling. Syncope recurred in 41 patients (14.44%). LASSO retained ten predictors, including syncope inducements, preoperative episode frequency, plateletcrit, occluder type, D-Dimer, blood pressure status, syncope attack duration, age, platelet distribution width, and diabetes. Among candidate models, K-nearest neighbors showed the highest apparent performance in the internal hold-out test set, with an AUC of 0.993, sensitivity of 1.000, specificity of 0.986, accuracy of 0.988, precision of 0.929, and F1 score of 0.963. Repeated resampling showed performance variability, suggesting that the near-ceiling single-split performance may be optimistic. SHAP analysis identified syncope inducements, episode burden, and plateletcrit as the dominant contributors to predicted recurrence risk. A K-nearest neighbors model showed excellent apparent internal discrimination for observed syncope recurrence after PFO closure. However, because recurrence was analyzed as a binary endpoint without incorporating follow-up time, temporal and external validation were not performed, and recurrence events were limited, these findings should be considered hypothesis-generating. Prospective studies with standardized follow-up, time-to-event analysis, and external validation are required before clinical implementation.

Knowledge structure and thematic organization of PFAS-associated cardiac toxicity: A bibliometric analysis.

Oxygen-ozone autohaemotherapy (O2-O3-AHT) has gained clinical interest as an adjunctive treatment for fibromyalgia (FM) based on its anti-inflammatory and anti-oxidative properties. However, comprehensive data on safety and adverse events remain limited. This scoping review aimed to systematically evaluate documented adverse events associated with O2-O3-AHT and assess risk stratification. Following PRISMA-ScR guidelines, we searched Medline, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science, TRIP, Clinical Evidence, and ROAD databases for relevant articles published in the last decade. Search terms included "ozone autohaemotherapy," "GAET," "autologous blood transfusion," "systemic ozone therapy," combined with "adverse effects," "side effects," "contraindications," and "iatrogenic complications." Studies involving local injections, hyperbaric oxygen therapy, veterinary applications, or non-systemic routes were excluded. The literature search identified predominantly case reports documenting rare but potentially serious adverse events. Major categories included: haemolysis and renal failure (associated with excessive ozone concentrations >60 μg/mL), hyperkalaemia in patients with complex comorbidities (hypertension, diabetes, chronic kidney disease), myocardial infarction and ischaemic events (attributed to vasoconstrictive and pro-thrombotic effects), cerebral gas embolism in patients with patent foramen ovale, autonomic reactions related to rapid reinfusion rates, anaphylactic reactions (linked to equipment materials), and infectious complications due to protocol breaches. The overall incidence of serious adverse events cannot be reliably quantified given the absence of prospective registries and reliable denominator data: A frequent cited historical low estimation of uncertain methodology should be interpreted with considerable caution. Most safety data were derived from mixed clinical populations and not specifically from fibromyalgia cohorts, although they are relevant for clinical decision-making in this setting. Current evidence does not identify a pattern of frequent serious unexpected harm when standardised protocol is followed. Key safety measures include mandatory glucose-6-phosphate dehydrogenase screening, adherence to recommended ozone concentrations (10-40 μg/mL), controlled reinfusion rates (<50 drops/minute), pre-treatment cardiovascular evaluation in selected cases, and strict aseptic technique. The estimated incidence of serious complications derived from historical global data on O2-O3 autohaemotherapy may be only inferred in a fibromyalgia population. Standardisation of treatment protocols and prospective adverse event registries are needed to further optimise safety.

Effectiveness of patent foramen ovale occlusion devices versus medical therapy: An indirect comparison based on reconstructed individual patient data.

Background: Patent foramen ovale (PFO) is associated with cryptogenic stroke, but mechanisms beyond paradoxical embolism remain unclear. Inflammation, fibrosis-related remodeling, and nitrosative stress may contribute to vascular vulnerability in these patients. The aim of this study was to evaluate inflammatory, fibrotic, and nitrosative biomarker profiles in patients with PFO and prior cryptogenic stroke and to determine whether these patients exhibit coupled inflammatory fibrotic nitrosative activation. Methods: This prospective, observational, single-center study included 92 patients aged <55 years with PFO and prior cryptogenic stroke and 56 age-matched controls without PFO and cerebrovascular events. Circulating interleukin-18 (IL-18), galectin-3, and 3-nitrotyrosine (3-NT) levels were measured using ELISA assays. Correlation and linear regression analyses were performed. Results: Compared with controls, patients with PFO had higher galectin-3 (11.87 vs. 10.36 ng/mL; p = 0.015), IL-18 (268.0 vs. 121.0 pg/mL; p < 0.001), and 3-NT (48.5 vs. 41.8 ng/mL; p = 0.046). Significant correlations were observed between IL-18 and galectin-3 (r = 0.565), IL-18 and 3-NT (r = 0.425), and galectin-3 and 3-NT (r = 0.292) (all p ≤ 0.002). Conclusions: Patients with PFO and prior cryptogenic stroke exhibit a distinct biomarker profile consistent with coupled inflammatory–fibrotic–nitrosative activation, suggesting a potential non-mechanical component of stroke susceptibility.