Treatment Of Patent Foramen Ovale Research Articles

Chinese expert consensus on the standardized diagnosis and treatment of patent foramen ovale

Chinese expert consensus on the standardized diagnosis and treatment of patent foramen ovale

Transesophageal echocardiography: A bibliometric analysis from 1979 to 2022.

Heart disease poses a significant global health challenge. Transesophageal echocardiography (TEE) has gained prominence in clinical practice because of advancements in visual medicine. The present bibliometric analysis provides an overview of TEE research, identifies trends, and highlights emerging topics. A comprehensive search of TEE-related literature from the establishment of the Web of Science Core Collection (WOSCC) until 2022 was conducted. Utilizing the CiteSpace software, we performed an in-depth analysis of the literature data encompassing disciplines, publication years, countries, institutions, authors, journals, cited references, and keywords. A total of 17032 TEE-related articles were included in this study. The most active disciplines in TEE research were Cardiac & Cardiovascular Systems, Anesthesiology, and Respiratory System. The number of publications displayed a consistent upward trajectory over the years. Notably, research contributions predominantly originated from developed countries, mainly Europe and North America, with the United States, Germany, Italy, and Japan leading the way. Analysis of institutions, authors, and journals revealed the United States' significant role in TEE research. Furthermore, the analysis of cited references and keywords identified the treatment of patent foramen ovale and its association with stroke as emerging hot topics in recent years. This study highlights that TEE remains a research hotspot, with the United States at the forefront. Future research should investigate the relationship between heart disease and brain function.

Comparison of the short-term efficacy of different Amplatzer models and similar occluders in the treatment of patent foramen ovale.

To compare the recent efficacy and safety of different Amplatzer models and similar occluder in the treatment of patent foramen ovale (PFO). Patients with PFO complicated with cryptogenic stroke or migraine who underwent transcatheter closure of PFO in the First Affiliated Hospital of Nanjing Medical University from September 2019 to March 2021 were selected. Patients were grouped according to the type of occluder device. The basic data of the patients were collected and followed up within 1 year after occlusion. Effectiveness was defined as no recurrence of stroke/remission of migraine symptoms and a negative postoperative foaming test, and safety events were counted as the combined results of serious adverse events. A total of 92 patients were selected, including 45 cases in the symmetrical group and 47 cases in the asymmetric group. There were no serious adverse events in the 2 groups during follow-up. 3 days and 1 month after occlusion, the number of shunt patients in the asymmetric group was significantly less than that in the symmetric group (χ2 = 5.484, P = 0.019; χ2 = 5.146, P = 0.023). The negative rate of blocked residual shunts in the asymmetric group was higher than that in the symmetric group at 1, 3, 6 and 12 months after occlusion (χ2 = 6.473, P = 0.011; χ2 = 4.305, P = 0.038; χ2 = 4.842, P = 0.027; χ2 = 4.034, P = 0.045). Headache in migraine patients in the asymmetric group was significantly better than headache in patients in the symmetric group (P = 0.038; P = 0.049). Asymmetric Amplatzer and similar occluders provide greater efficacy in short-term occlusion than symmetric ones.

P3721Clinical and echocardiographic outcomes after treatment of patent foramen ovale with two transcatheter occlusion devices: mononcenter observational study

Abstract Background Percutaneous closure of patent foramen ovale (PFO) after cryptogenic stroke (CS) is strongly recommended in the current guidelines. Most available evidence has been obtained from randomized studies in which Amplatzer PFO occluder device or Groe occluder device were implanted. Several occluder devices are used off-label for percutaneous treatment of PFO. Rate of recurrent CS and rate of residual shunting after percutaneously occlusion of PFO varies between different occlusion devices. To date, there are no randomized clinical studies that compare the effectivity and safety of several devices in patients with CS. Aim The aim of this study was to compare rate of residual shunting and recurrent CS after percutaneus treatment of PFO with the most common used PFO occluder devises. Methods This was a retrospective, non-randomized, monocenter study. Between 2008 and 2014, all patients with CS or transient ischemic attack (TIA) treated with transcatheter occlusion of PFO with Amplatzer PFO occlusion device or Occlutech occlusion device were included. Patients were followed up at 1 and 6 months with contrast-enhanced transesophageal echocardiography (TEE), and at 3 months with contrast-enhanced transthoracic echocardiography. Primary endpoint was residual shunting at 6 months. Secondary endpoint was recurrent CS or TIA at 6 months after the procedure. Results 220 consecutive patients (57±12 year, 131 men) were treated with Amplanz PFO occlusion device (140 patients) or Occlutech PFO occlusion device (80 patients) after CS or TIA. Procedural success was 100% in both groups. Residual shunting was observed directly after the procedure in 26 patients in the Amplatzer group and 22 patients in the Occlutech group (19% and 27%, respectively; p=0.003), at 1 months follow (15% and 25%, respectively; p=0.064) and at 6 months (9% and 16%, respectively; p=0.024). There was no significant difference between both groups according recurrent CS (0.7% and 0%, respectively; p=0.449). At 6 months follow up atrial fibrillation was detected in 2 patients from Amplatzer group and 5 patients from Occlutech group (1.4% and 6.0%, respectively; p=0.050). Death, aortic erosion and pericardial effusion was not observed in both groups. Clinical and echocardiographic outcome Variable Amplatzer occluder device (N=140) Occlutech occluder device (N=80) p-value Clinical outcome at 6 months follow up Death, n (%) 0 (0%) 0 (0%) 1.000 Stroke, n (%) 1 (1%) 0 (0%) 0.449 Transient ischemic attack, n (%) 0 (0%) 0 (0%) 1.000 Atrial fibrillation, n (%) 2 (1.4%) 5 (6%) 0.050 Aortic erosion, n (%) 0 (0%) 0 (0%) 1.000 Pericardial effusion, n (%) 0 (0%) 0 (0%) 1.000 Echocardiographic Outcome at 6 months follow up Residual shunting after Implantation directly, n (%) 26 (19%) 22 (27%) 0.003 Residual shunting at one month, n (%) 21 (15%) 20 (25%) 0.064 Residual shunting at 6 months, n (%) 13 (9%) 16 (20%) 0.024 Conclusion Percutaneous treatment of PFO after CS or TIA with Amplatzer PFO occluder device was associated with lower rate of residual shunting and lower rate of atrial fibrillation at 6 months follow up, whereas rate of recurrent CS and TIA was comparable between both groups.

Acute Pulmonary Embolism and Paradoxical Embolism in Patients with Patent Foramen Ovale: to Close or Not to Close…That is the Question!

<p>Nowadays, the treatment of patent foramen ovale (PFO) after acute pulmonary embolism (PE) remains matter of speculation. Absence of both randomized trials and recommendations in current international guidelines complicate the decisions making in such patients. In the present manuscript we discuss about the reasons for which PFO should be closed after acute PE.</p>

Hjerneinfarkt ved åpent foramen ovale

There is no sound scientific documentation of current guidelines for the treatment of cerebral infarction assumed to be due to patent foramen ovale. In this article, we present a young patient with this condition. In addition, we provide a general overview of the prevalence, recommended assessment and indications for treatment of patent foramen ovale in ischaemic stroke patients. The article is based on a non-systematic search in PubMed. We emphasise three recently published randomised trials on the subject. Transoesophageal echocardiography with saline contrast is the gold standard for detecting patent foramen ovale. Just who will benefit from the diagnosis and treatment of this condition remains unclear, however. None of the three randomised studies of antithrombotic treatment versus transcatheter closure in patients who have suffered ischaemic stroke show a difference in outcomes, but subgroup analyses indicate that closure in young patients (age <50 years) with a large foramen ovale reduces the number of recurrent ischaemic events. Two other randomised studies of antithrombotic treatment alone versus closure are presently ongoing. For stroke patients with patent foramen ovale, the choice between lifelong antithrombotic therapy alone and transcatheter closure is a difficult one. Treatment with antiplatelet agents remains the first choice in most cases. Well-designed studies are needed to identify which patients will benefit most from closure.

The first clinical experience with the new GORE® septal occluder (GSO)

A new GORE® septal occluder (GSO) was granted CE mark in Europe in June 2011 for the treatment of patent foramen ovale and atrial septal defect. Major changes have been made to the device and delivery system compared to the HELEX® device. The new delivery system has simplified the implantation procedure and the retrievability of the device after deployment if needed. The design of the GSO has improved the device apposition ability and tissue response whilst keeping its atraumatic design, low septal profile with minimal septal distortion and long-term biocompatibility. The first three clinical cases of GSO use in the world are briefly described and the immediate and short-term outcome of the first eleven patients who underwent PFO or ASD closure using GSO in our centre are reported. The mean age of the eleven patients was 53±9 years and six of them were women. Ten of these patients had patent foramen ovale and one had secundum atrial septal defect. In all the cases, the GSO devices were successfully deployed in the first attempt without any complication. Only one patient had a minor residual shunt detected immediately after the device deployment. All the patients were re-assessed 70±33 days later and no residual shunt was detected in any of them. One of the patients had an episode of paroxysmal atrial fibrillation. There was no device fracture found in the six patients who also had a fluoroscopic examination during follow-up. Our initial experience with GSO shows promise in handling and occlusion rate. Larger-scale and longer-term outcome on the performance of GSO is required to ensure safety and efficacy.

The percutaneous treatment of Patent Foramen Ovale, an effective and safe therapeutic choice

Abstract

Transcatheter Treatment of Patent Foramen Ovale Combined with Abnormal Drainage of Left Superior Vena Cava to Left Upper Pulmonary Vein

Patent foramen ovale (PFO) has been known to be the cause of transient ischemic attacks or stroke, and transcatheter device closure has been the treatment of choice for these defects. Combined defect of abnormal drainage of left superior vena cava (LSVC) to left superior pulmonary vein (LSPV) in PFO patients is an uncommon combination, and both can act as a pathway for paradoxical embolism. We report a successful closure of PFO, using Amplatzer® PFO occluder (St. Jude Medical, St. Paul, MN, USA) and persistent LSVC connected to LSPV using an Amplatzer® Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Because this combined anomaly of PFO and persistent LSVC can be treated by a single transcatheter intervention, if clinically suspected, a complete evaluation for this anomaly should be considered.

Prevention Strategies for Cardioembolic Stroke: Present and Future Perspectives~!2009-05-11~!2009-12-23~!2010-06-09~!

Atrial fibrillation (AF) is the most common cause of cardioembolism. An update on secondary prevention strategies, used to protect patients from the risk of stroke in many common cardiac conditions, is presented in the paper. The main line of actions of stroke prevention in cardioembolism is mostly connected with antithrombotic drugs, but also other, more invasive, techniques are quickly emerging. Also the classic pharmacological prevention with coumarins may soon be overcome by new generation anticoagulants. Is an aggressive treatment of Patent Foramen Ovale (PFO) always recommended? One of the main challenges of the future years will be to understand competitiveness between old and new preventive strategies.

Unusual treatment of patent foramen ovale after pneumonectomy

To the Editors: As has often been said by Dr Harold C. Urschel Jr, pneumonectomy is “a disease” in itself. It is a major procedure with frequent perioperative complications such as empyema, fistula, cardiac problems or respiratory insufficiency. Besides frequent post-operative cardiac and respiratory complications, long-term sequelae are also seen. After pneumonectomy, anatomical adaptations occur with repositioning of intrathoracic structures. Common changes are elevation of the hemidiaphragm (especially after phrenic nerve damage), mediastinal shift, diminished intercostal space and filling of the postpneumonectomy space with fluid. Infrequently, these adaptations may lead to invalidating complications. The most frequent complication is the so-called post-pneumonectomy syndrome caused by compression of the remaining bronchus against the vertebral column or aorta. Since positioning of the organs may take years, symptoms may occur even after 5–10 yrs. In this letter, we will focus on a rare complication, shunting through a patent foramen ovale (PFO), as a long-term complication of right-sided pneumonectomy or bilobectomy. Only a few cases have been published, although this complication might be under-reported since the diagnosis of PFO is difficult, especially after pneumonectomy. This letter describes three patients who were diagnosed with shunting through a PFO following lung resection. In these patients, right ventricular compression by the elevated right hemidiaphragm was the main cause of PFO and surgical plication of the right hemidiaphragm was sufficient to close the PFO. ### Patient A A 67-yr-old male underwent a right-sided pneumonectomy 14 yrs earlier because of a bronchial carcinoid. Partial resection of the pericardium with transection of the phrenic nerve were needed for complete resection He developed progressive dyspnoea during exercise and when bending down. Echocardiography demonstrated a right-to-left interatrial shunt when increasing intra-abdominal pressure (valsalva manoeuvre) with a shunt fraction of 18%. Further analysis with right heart catheterisation at our institution showed a mean right atrial resting pressure ( P ra …

IN69-FR-03 The current concept behind treatment of patent foramen ovale for migraine

IN69-FR-03 The current concept behind treatment of patent foramen ovale for migraine

Clinical manifestation and current management of patent foramen ovale

There is increasing interest in the evaluation and treatment of patent foramen ovale, which has been associated with various pathologic conditions, such as cryptogenic stroke, platypnea–orthodeoxia syndrome and migraine. However, optimal treatment of patients with patent foramen ovale has not been established. This article aims to review the clinical manifestation and current therapeutic options for patent foramen ovale.

Simultaneous treatment of patent foramen ovale and pulmonary arteriovenous fistula in a patient with paradoxical embolism

Simultaneous treatment of patent foramen ovale and pulmonary arteriovenous fistula in a patient with paradoxical embolism

Patent foramen ovale, systemic embolization and closure

The recognition, evaluation and treatment of patent foramen ovale has attracted increasing interest as the importance and frequency of paradoxical embolism has become better understood. The interest in this field has been driven largely by the widespread application of echocardiography with identification of a patent foramen ovale and/or an atrial septal aneurysm. The evaluation of the role of a patent foramen ovale in patients with a neurologic event is complex because the patent foramen ovale or atrial septal aneurysm may either be an innocent bystander or could be the etiologic mechanisms involved in the paradoxical embolus. In patients younger than 55 years, a causal relationship between a patent foramen ovale/atrial septal aneurysm and a neurologic ischemic event is considerably stronger than in those patients older than 55 years. In patients with a presumed diagnosis of paradoxical embolus in the setting of a patent foramen ovale, percutaneous closure is now possible and 2 devices are relatively widely used. Both of these devices reliably close the defect with a very acceptable risk profile and have been found in the longer term to be associated with excellent outcome. The exact role, however, that these devices play vis a vis continued medical therapy for prevention of recurrent events is being tested in 2 randomized clinical trials. The field continues to change with new technology being developed and with new applications. A recently exciting finding has been the identification that closure of a patent foramen ovale may be associated with dramatic improvement in symptoms of patients with disabling migraine headaches. Other potential applications of these devices include those patients who are deep-sea divers, in whom the potential for “bends” exists, or high altitude airplane pilots.

Diagnosis and Treatment of Patent Foramen Ovale (PFO) in Patient Supported with Left Ventricular Assist Devices(LVAD)

Early diagnosis and treatment of PFO in patients with LVAD have been challenging. LVAD unloads left ventricle and decreases left atrial pressure. Such hemodynamic change causes right to left shunting via PFO resulting in hypoxemia immediately or days after implantation of LVAD. Frequently the diagnosis was missed and treatment was delayed due to the lack of understanding of dynamic nature of PFO in LVAD patients. In this study we prospectively performed intraoperative transesophageal echocardiography (TEE) in all patients receivin LVAD (HeartMate) to determine the dynamic nature of PFO. Method: TEE was performed in our recent six consecutive patients receivin LVAD. The patients were all males, with an average age of 56. The etiologies for heart failure were ischemic cardiomyopathy in 4, acute myocardial infarction in and idiopathic cardiomyopathy in 1. A four-chamber view morphologic study and bubble contrast study were obtained in each patient before bypass and after LVAD was turned on. Oxygen saturation (O2 Sat) was recorded simultaneously as well. Bi-caval venous cannulation was used for bypass in each patient in preparation for possible PFO closure. Results: The four-chamber view reviewed that the atrial septum was bulgin towards right atrium before bypass and bulging towards left atrium after LVAD was turned on in all 6 patients. The bubble contrast study was negative for PFO in all 6 patients (0/6) before bypass and was positive for PFO in 3 out of 6 patients (3/6 after LVAD was turned on. O2 Sat was 100% in all 6 patients before bypass an was less than 90% in 2 out of 3 patients with positive PFO after LVAD was turne on. All three TEE documented PFO were confirmed grossly and surgically close during the same procedure. There were no operative death and no PFO closur related complications. Conclusions: The diagnosis of PFO by TEE in LVAD patients can be made reliably only when LVAD was turned on. Early closure of PFO in LVAD patients is important to avoid post LVAD implantation hypoxemia and its related complications. Routine bi-caval venous cannulation in LVAD implantation make closure of unexpected PFO easy.