Patent Foramen Ovale Research Articles

Role of Closure of Patent Foramen Ovale in Children with Cryptogenic Stroke: Incidence, Evidence and Guidelines

Patent foramen ovale (PFO) is post-natal persistence of interatrial communication and have shown to have association with various clinical manifestations including transient ischemic attack and strokes. The diagnosis of PFO requires transthoracic and transesophageal Echocardiogram. Closure of PFO with percutaneous device closure can prevent recurrence of strokes in selected patients with cryptogenic stroke and it has been included in recent guidelines also. In this mini review, we will discuss couple of cases of PFO closures followed by discussion upon recent guidelines on the same.

Assessment of Bi-Atrial Mechanical Function in Patients with Isolated Atrial Septal Aneurysm.

Atrial mechanical dysfunction may be an alternative mechanism underlying the increased risk of systemic embolism in patients with atrial septal aneurysm (ASA). This study aimed to evaluate left atrial (LA) and right atrial (RA) function using two-dimensional speckle tracking echocardiography (2D STE) in patients with isolated ASA. Fifty-four patients with ASA (mean age 50.3 ± 12.48, 37% male) and 48 healthy individuals of similar age and gender (mean age 48.3 ± 10.84, 39.6% male) were included in the study. To assess atrial mechanical function, measurements of left and right atrial reservoir strain (RS), peak contraction strain (PCS), and conduit strain (CS) were conducted using 2D STE, in addition to conventional evaluation with transthoracic echocardiography. LA RS and PCS values were significantly lower in the ASA group than in the controls (37.52 ± 2.89 vs. 40.16 ± 2.68%, P < 0.001 and 17.29 ± 2.5 vs. 19.18 ± 2.23%, P < 0.001, respectively). Similarly, RA RS and RA PCS were significantly lower in patients with ASA (36.97 ± 2.19 vs. 39.77 ± 2.36%, P < 0.001 and 16.78 ± 2.10 vs. 18.54 ± 2.43%, P < 0.001, respectively). A multivariate regression analysis revealed a strong independent association between ASA and the measures LA RS, LA PCS, RA RS, and RA PCS. Our findings indicate that bi-atrial function are diminished in patients with isolated ASA. This may be a possible cause for the increased risk of arterial embolism in this patient group, aside from atrial arrhythmias and patent foramen ovale. Validating these results with larger studies may influence the treatment and follow-up strategies for patients with isolated ASA.

Clinical Presentation and Therapy of d-Transposition of the Great Arteries.

d-Transposition of the great arteries (d-TGA) is the most common form of congenital heart disease that presents with cyanosis in a newborn. The aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. It constitutes 3-5% of all congenital heart defects. In a simple d-TGA (about two-thirds of patients), there is no other cardiac abnormality other than a patent foramen ovale (PFO) and a patent ductus arteriosus (PDA). In a complex d-TGA additional cardiac abnormalities such as VSD, pulmonary stenosis or coronary abnormalities are present. About one-third to 40% of patients with d-TGA have an associated ventricular septal defect. Among patients with d-TGA, 6% of those with intact ventricular septum and 31% of those with ventricular septal defect have associated pulmonary stenosis. Coronary abnormalities are of importance with regard to the complexity of surgical repair.

Predictive value of right heart contrast echocardiography combined with STAF in cardioembolism

Cardioembolism (CE) is a prevalent cerebrovascular disease in clinical practice. This study aims to assess the predictive efficacy of right heart contrast echocardiography combined with the Score for Targeting Atrial Fibrillation (STAF) for diagnosing CE. A total of 149 patients with CE and 93 patients with non-CE (NCE) were classified into the study group and control group, respectively, and their data were retrospectively analyzed. All patients underwent right heart contrast echocardiography and STAF assessment, and comparative analyses between the groups were performed. In addition, the predictive potential of combining right heart contrast echocardiography with STAF for CE was evaluated, and the CE patients underwent a one-year follow-up to assess survival and prognostic factors. The results of this study showed that patients in the CE group had higher incidences of grade 1 + 2 + 3 right-to-left shunt, patent foramen ovale (PFO) positivity, greater foramen ovale length, larger shunt inner diameter, and higher STAF score compared to the NCE group (p &lt; 0.05). Receiver operating characteristic curve analysis revealed that the predictive values for CE, in terms of right-to-left shunt grade, PFO positivity, foramen ovale length, shunt inner diameter, and area under the curve (AUC) for STAF, were 0.582, 0.570, 0.679, 0.808 and 0.750, respectively. The combined AUC value for all these parameters was 0.905. Univariate and multiple logistic regression analysis indicated that atrial fibrillation, total cholesterol and fibrinogen were not prognostic factors in CE patients (p &gt; 0.05), whereas National Institute of Health stroke scale (NIHSS) score, PFO positivity, foramen ovale length and STAF at admission were prognostic factors (p &lt; 0.05). Therefore, combining right heart contrast echocardiography with STAF may enhance the predictive efficacy for CE.

Pushing boundaries in cardiac surgery: minimally invasive mitral valve repair combined with tricuspid valve repair and/or other concomitant procedures.

Minimally invasive mitral valve repair/replacement has emerged as a widely accepted surgical approach for managing mitral valve disorders. Continuous technological progress has contributed to the refinement of this procedure, leading to improved safety, decreased surgical trauma, and faster recovery times. Despite these advancements, there remains a scarcity of data concerning minimally invasive complex mitral valve repair surgeries when combined with additional procedures. Between November 2008 and December 2022, 153 patients underwent an operation using a minimally invasive technique. All patients underwent mitral valve surgery for severe mitral valve insufficiency/stenosis in combination with at least one additional procedure for tricuspid valve repair (n = 52, 34%), patent foramen ovale or atrial septal defect closure (n = 34, 22.2%), left atrial appendage occlusion (n = 25, 16.3%), or electrophysiological procedure (n = 101, 66.0%). Two concomitant procedures were conducted in 98 patients (64.1%), three concomitant procedures in 49 patients (32%), and four concomitant procedures in 6 patients (3.9%). Surgical success was achieved in 99.3% of the patients (n = 152), one patient required a revision of the mitral valve repair on the first postoperative day due to systolic anterior motion phenomenon. Mitral valve repair was performed in 136 patients (88.9%), while 15 patients (9.8%) received a mitral valve replacement as per a preoperative decision due to severe mitral valve stenosis, and two patients (1.3%) underwent other mitral valve procedures. Therapeutic success in treating atrial fibrillation was achieved in 86 patients (85.1%) of the 101 who received an additional maze-procedure. The 30-day mortality rate was 0.7%, with one patient succumbing to respiratory failure. Neurological complications occurred in 7 patients (4.6%). Freedom from reoperation was calculated as 98% at 5-year follow-up and 96.5% at 10-year follow-up. Minimally invasive mitral valve surgery, even when performed alongside concomitant procedures, stands out as a reproducible and safe technique with outstanding outcomes. It is imperative to advance towards the next frontier in minimally invasive surgery, encouraging experienced surgeons to undertake more complex procedures using minimally invasive approaches. These results help envision extending the boundaries of minimally invasive surgery by performing complex mitral valve procedures and associated interventions entirely through endoscopic means in suitable patients.

Research Progress on the Relationship between Patent Foramen Ovale and Migraine from the Perspective of Traditional Chinese Medicine

Research Progress on the Relationship between Patent Foramen Ovale and Migraine from the Perspective of Traditional Chinese Medicine

Hemorragia digestiva como primeira manifestação na síndrome de Alagille - Relato de caso

Introduction: The aim of this report is to describe a case of gastrointestinal bleeding that started at 1 month of age in a patient with Alagille Syndrome. Case report: Patient started recurrent gastrointestinal bleeding, leading to hypovolemic shock in the second month of life. During the investigation, cholestasis and incoagulable INR were evidenced. The facial stigmata, associated with the posterior embryotoxon in the ophthalmologic examination and transthoracic echocardiogram with stenosis of the pulmonary branches and patent foramen ovale, suggested the hypothesis of Alagille Syndrome, later confirmed by compatible liver biopsy and genetic testing with a mutation in the JAGGED1 gene. After administration of vitamin K, the patient evolved with normalization of the coagulogram, without new episodes of gastrointestinal bleeding. At follow-up, replacement of fat-soluble vitamins and treatment with ursodeoxycholic acid were initiated. Discussion: Reports in the literature describe bleeding episodes in patients with Alagille Syndrome, however, the main site of bleeding is the central nervous system. There is no description of bleeding in the gastrointestinal tract as the initial and neonatal manifestation of the syndrome. The case reported is an uncommon form of presentation and shows the importance of diagnostic suspicion in cases of neonatal cholestasis with gastrointestinal bleeding, allowing for adequate treatment and improved prognosis.

A Case Report of Nursing Care of Cardiac Tamponade after Transcatheter Occlusion of Patent Foramen Ovale (PFO)

A Case Report of Nursing Care of Cardiac Tamponade after Transcatheter Occlusion of Patent Foramen Ovale (PFO)

Reviewing migraine-associated pathophysiology and its impact on elevated stroke risk.

Migraine affects up to 20 percent of the global population and ranks as the second leading cause of disability worldwide. In parallel, ischemic stroke stands as the second leading cause of mortality and the third leading cause of disability worldwide. This review aims to elucidate the intricate relationship between migraine and stroke, highlighting the role of genetic, vascular, and hormonal factors. Epidemiological evidence shows a positive association between migraine, particularly with aura, and ischemic stroke (IS), though the link to hemorrhagic stroke (HS) remains inconclusive. The shared pathophysiology between migraine and stroke includes cortical spreading depression, endothelial dysfunction, and genetic predispositions, such as mutations linked to conditions like CADASIL and MELAS. Genetic studies indicate that common loci may predispose individuals to both migraine and stroke, while biomarkers such as endothelial microparticles and inflammatory cytokines offer insights into the underlying mechanisms. Additionally, hormonal influences, particularly fluctuations in estrogen levels, significantly impact migraine pathogenesis and stroke risk, highlighting the need for tailored interventions for women. The presence of a patent foramen ovale (PFO) in migraineurs further complicates their risk profile, with device closure showing promise in reducing stroke occurrence. Furthermore, white matter lesions (WMLs) are frequently observed in migraine patients, suggesting potential cognitive and stroke risks. This review hopes to summarize the links between migraine and its associated conditions and ischemic stroke, recognizing the profound implications for clinical management strategies for both disorders. Understanding the complex relationship between migraine and ischemic stroke holds the key to navigating treatment options and preventive interventions to enhance overall patient outcomes.

Endovascular closure of patent foramen ovale under intracardiac echocardiography guidance without fluoroscopy

Endovascular closure of patent foramen ovale under intracardiac echocardiography guidance without fluoroscopy

Methods of cost-effectiveness evaluation of endovascular patent foramen ovale closure for secondary prevention of cryptogenic stroke

Methods of cost-effectiveness evaluation of endovascular patent foramen ovale closure for secondary prevention of cryptogenic stroke

The Role of Transcranial Doppler in Patients with Cryptogenic Stroke

Identifying the stroke mechanism is crucial for secondary prevention of ischemic stroke. However, approximately 20% to 30% of patients with ischemic stroke do not display a discernible cause after standard diagnostic evaluation and are classified as having cryptogenic stroke. Most cryptogenic strokes are believed to be of embolic origin, referred to as embolic stroke of undetermined source. Several potential causes, including occult atrial fibrillation, aortic arch atheroma, non-stenotic atherosclerosis, coagulopathy, and patent foramen ovale (PFO), are significant contributors to cryptogenic stroke. Among these, PFO-associated strokes often manifest as small cortical lesions in the posterior circulation and are associated with fewer traditional risk factors. Ischemic stroke is considered a high risk if there is a large PFO with significant shunting or the presence of an atrial septal aneurysm. Although transesophageal echocardiography is regarded as the gold standard for diagnosing PFO, its invasiveness, high cost, and challenges in certain stroke patients necessitate alternative approaches. Recently, transcranial Doppler (TCD) has emerged as a valuable screening tool for detecting high-risk PFOs, as supported by recent research. Accurate determination of the culprit PFO responsible for ischemic stroke remains crucial for guiding appropriate treatment decisions. This article provides a comprehensive review of the different modalities used to diagnose PFO, strategies for assessing the risk of PFO causing paradoxical embolism, and the role of TCD in patients with cryptogenic stroke caused by other etiologies.

Infective Endocarditis After Percutaneous Device Closure of Atrial Septal Defects: Incidence, Diagnosis, and Treatment. Case Report and Literature Review.

Infective endocarditis (IE) on atrial septal defect (ASD) closure devices, while extremely rare, has been reported to be more frequent early after the procedure. We describe a case of late IE after percutaneous closure of patent foramen ovale (PFO). We also performed a literature review on this subject. We reviewed a total of 42,365 patients who were treated with percutaneous devices: 13,916 for ostium secundum (OS) (32%), 24,726 for PFO (58%) and 3,723 for OS+PFO (8%). Among these patients, we identified 50 cases of IE after atrial septal defect device closure (0.001%). In contrast to previous reports, nearly 66% of IE in this setting occurred late, after at least 6 months from the procedure (33/50 patients). A statistical analysis clearly showed that the mean time from the procedure to IE increased in the last five years, probably associated with a change in antiplatelet therapy after ASD closure. Management of IE on an ASD occluder should always be discussed in the setting of a multidisciplinary heart team that includes a cardiologist, cardiac surgeon, and anesthetist. While surgical strategies gave excellent results, conservative management might be considered in cases of small IE vegetations and for patients in good general condition. However, in these cases, the patient must be closely observed with repeated blood and instrumental tests.

Secondary Stroke Prevention in Patients with Patent Foramen Ovale: To Anticoagulate or Not? Fragility Index Meta-analysis of Published Randomized Controlled Studies

Secondary Stroke Prevention in Patients with Patent Foramen Ovale: To Anticoagulate or Not? Fragility Index Meta-analysis of Published Randomized Controlled Studies

Een ongebruikelijke oorzaak van acute desaturatie

An unusual cause of acute desaturation A 61-year-old man presented with symptoms of rapidly increasing dyspnea, chest pain and significant hypoxemia for which the initial investigations revealed no clear explanation. There was a remarkable improvement of the saturation in supine position. A contrast transesophageal echocardiography established the presence of a patent foramen ovale (PFO), which was successfully closed via a percutaneous transcatheter. Platypnoea-orthodeoxia syndrome (POS) is a rare entity characterized by the presence of arterial hypoxemia in upright position with resolution of the hypoxemia in supine position. It is most frequently caused by a PFO. A PFO is, however, merely an essential precondition and the development of POS nearly always requires the presence of other (functional) factors.

Cryptogenic cerebrovascular accident due to foramen ovale: clinical case report

Strokes of cryptogenic origin or of undetermined origin represent 20% to 30% of the total etiologies that make up ischemic strokes. It is for this reason that the purpose of this article is to review our current knowledge and the most recent recommendations on the most used diagnostic tests in strokes of undetermined origin, with the most frequent causes being paroxysmal atrial fibrillation, atrial heart disease, patent foramen ovale as in this case, as well as sub stenotic atherosclerotic disease.Results: to emphasize the diagnostic tests used in cryptogenic stroke, of apparent embolic origin.Conclusions: cerebrovascular accidents of undetermined origin represent a clinically relevant subtype of cerebrovascular accident, which justifies a careful evaluation due to their degree of recurrence and the great economic costs that this type of pathology entails in our society, due to its great disabling capacity. or due to major diagnostic limitations.

Apixaban versus Aspirin for Embolic Stroke of Undetermined Source

BackgroundRivaroxaban and dabigatran were not superior to aspirin in trials of patients with embolic stroke of undetermined source (ESUS). It is unknown whether apixaban is superior to aspirin in patients with ESUS and known risk factors for cardioembolism.MethodsWe conducted a multicenter, randomized, open-label, blinded-outcome trial of apixaban (5 mg twice daily) compared with aspirin (100 mg once daily) initiated within 28 days after ESUS in patients with at least one predictive factor for atrial fibrillation or a patent foramen ovale. Cardiac monitoring was mandatory, and aspirin treatment was switched to apixaban in case of atrial fibrillation detection. The primary outcome was any new ischemic lesion on brain magnetic resonance imaging (MRI) during 12-month follow-up. Secondary outcomes included major and clinically relevant nonmajor bleeding.ResultsA total of 352 patients were randomly assigned to receive apixaban (178 patients) or aspirin (174 patients) at a median of 8 days after ESUS. At 12-month follow-up, MRI follow-up was available in 325 participants (92.3%). New ischemic lesions occurred in 23 of 169 (13.6%) participants in the apixaban group and in 25 of 156 (16.0%) participants in the aspirin group (adjusted odds ratio, 0.79; 95% confidence interval, 0.42 to 1.48; P=0.57). Major and clinically relevant nonmajor bleeding occurred in five and seven participants, respectively (1-year cumulative incidences, 2.9 and 4.2; hazard ratio, 0.68; 95% confidence interval, 0.22 to 2.16). Serious adverse event rates were 43.9 per 100 person-years in those given apixaban and 45.7 per 100 person-years in those given aspirin. The Apixaban for the Treatment of Embolic Stroke of Undetermined Source trial was terminated after a prespecified interim analysis as a result of futility.ConclusionsApixaban treatment was not superior to cardiac monitoring-guided aspirin in preventing new ischemic lesions in an enriched ESUS population. (Funded by Bristol-Myers Squibb and Medtronic Europe; ClinicalTrials.gov number, NCT02427126.)

Efficacy of interventional closure therapy on cryptogenic stroke with coexisting patent foramen ovale in young patients and its impact on serum fibrinogen and D-dimer levels

Objective To explore the efficacy of interventional closure therapy in young patients with cryptogenic stroke and coexisting patent foramen ovale and analyze its impact on serum fibrinogen and D-dimer levels. Methods All subjects in this study were young stroke patients with PFO. After excluding patients who did not meet the inclusion criteria, they were registered and divided into two groups based on the treatment method: the closure group and the medical group. Results There were no significant differences in basic clinical data between the two groups, indicating comparability (p > 0.05). The closure group showed better heart function after treatment compared to the medical group, with significant differences (p < 0.05). Headache symptoms in the closure group were less severe than those in the medical group after treatment, with significant differences (p < 0.05). Laboratory indicators in the closure group were better than those in the medical group after treatment, with significant differences (p < 0.05). Serum fibrinogen and D-dimer levels in the closure group were lower than those in the medical group after treatment, with significant differences (p < 0.05). Conclusion Interventional closure therapy demonstrated positive effects on young patients with cryptogenic stroke and coexisting PFO, showing improvements in heart function, headache symptoms, and blood coagulation parameters. While the study suggests potential benefits, cautious interpretation is warranted, given the observational study design. Further research with a larger sample size and long-term follow-up is needed to validate these findings.

Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges.

Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.

Decrease in lipid metabolic indexes in infants with neonatal respiratory distress syndrome.

Incomplete pulmonary function and insufficient production of pulmonary surfactant in premature infants may affect alveolar relaxation, inducing neonatal respiratory distress syndrome (NRDS). The present study was a retrospective comparison of lipid metabolism indexes and clinic information between NRDS and non-NRDS infants. Data on general information, pregnancy, clinical symptoms, family history as well as plasma biochemical and lipid metabolic indexes were retrospectively collected and statistically analyzed from 79 patients with NRDS and 44 non-NRDS infants. Infants in the NRDS group showed lower body weight (2,055 vs. 3,225 g) and gestation age (33.39 vs. 38.53 weeks) than those in the non-NRDS group (P<0.05). Baseline information was corrected by the inverse probability of treatment weighting (IPTW) analysis. The weighted adjusted median age was the same in both groups and there was no significant difference between two groups in birth weight. The IPTW analysis revealed that the levels of plasma triglyceride (TG), total cholesterol, low-density lipoprotein, free triiodothyronine, free thyroxine, glucose, calcium (Ca2+) and phosphorus in the NRDS infants were significantly lower compared with those in the non-NRDS infants. Additionally, NRDS infants had significantly higher incidence rates of pneumonia, sepsis, brain injury infection, preterm birth, patent foramen ovale, patent ductus arteriosus and premature rupture of membranes compared with the non-NRDS infants (P<0.05). Multivariate logistic analysis showed that TG and Ca2+ were risk factors associated with NRDS (P<0.05). Infants with NRDS have significantly lower levels of plasma lipid indexes. The results of the present study provide data to guide the clinical management of NRDS.