Surgical Closure of Patent Foramen Ovale is the Preferred Treatment to Prevent Recurrent Cerebral Ischemic Events in Young Patients

1998 ◽  
Vol 31 (2) ◽  
pp. 39A
Author(s):  
B Cujec
Keyword(s):  
Patent Foramen Ovale ◽  
Young Patients ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Cerebral Ischemic ◽  
Ischemic Events

scholarly journals Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

2005 ◽  
Vol 63 (2b) ◽  
pp. 427-429 ◽  
Author(s):  
Marcus Tulius T. Silva ◽  
Roíza Rodrigues ◽  
João Tress ◽  
Rosaura Victer ◽  
Francisco Chamiê
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Young Patients ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Small Series ◽  
Percutaneous Device ◽  
Ischemic Events

OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

scholarly journals Prevalence of Myocardial Scar in Patients With Cryptogenic Cerebral Ischemic Events and Patent Foramen Ovale

2010 ◽  
Vol 3 (8) ◽  
pp. 833-839 ◽  
Author(s):  
Jochen Wöhrle ◽  
Matthias Kochs ◽  
Vinzenz Hombach ◽  
Nico Merkle
Keyword(s):  
Patent Foramen Ovale ◽  
Myocardial Scar ◽  
Foramen Ovale ◽  
Cerebral Ischemic ◽  
Ischemic Events

Surgical Patent Foramen Ovale Closure for Prevention of Paradoxical Embolism–Related Cerebrovascular Ischemic Events

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Joseph A. Dearani ◽  
Baran S. Ugurlu ◽  
Gordon K. Danielson ◽  
Richard C. Daly ◽  
Christopher G. A. McGregor ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Ischemic Events ◽  
Pfo Closure

Background —The role of surgical closure of patent foramen ovale (PFO) for cerebral infarction (CI) or transient ischemic attack (TIA) resulting from paradoxical embolism is unclear, and its effect on recurrence is unknown. Our objective was to determine the outcome of surgical closure of PFO in patients with a prior ischemic neurological event, define the rate of CI or TIA recurrence after PFO closure, and identify risk factors for these recurrences. Methods and Results —We retrospectively analyzed 91 patients (58 men, 33 women) with ≥1 previous cerebrovascular ischemic events who underwent surgical PFO closure between April 1982 and March 1998. The presence of a PFO with a right-to-left shunt was confirmed with transesophageal echocardiography. Mean age was 44.2±12.2 years. The index event was a CI in 59 and a TIA in 32; a Valsalva-like episode preceded the event in 15 patients. Deep venous thrombosis was documented in 9 patients, and a hypercoagulable state was identified in 10. Surgical closure was performed with extracorporeal circulation by either direct suture (n=82) or patch closure (n=9). Limited incisions were used in 18.7% of patients. There was no operative mortality. Morbidity included transient atrial fibrillation (n=11), pericardial drainage for effusion (n=4), exploration for bleeding (n=3), and superficial wound infection (n=1). Follow-up totaled 176.3 patient-years, and mean follow-up was 2.0 years. No one had a CI, and 8 had a TIA during follow-up, with 1 caused by temporal arteritis. Transesophageal echocardiography demonstrated all closures to be intact in these patients. The overall freedom from TIA recurrence during follow-up was 92.5±3.2% at 1 year and 83.4±6.0% at 4 years. Having multiple neurological events before PFO closure was the only significant risk factor for TIA or CI recurrence after closure by univariate analysis ( P =0.05); the small number of post-PFO closure cerebral ischemic events precluded multivariate analysis. Conclusions —Surgical closure of PFO can be performed with minimal morbidity and mortality. PFO closure may decrease the risk of recurrent stroke or TIA and may avoid lifelong anticoagulation in the young adult if there is no other indication. Recurrent cerebrovascular ischemic events after surgery should prompt further evaluation to identify causes other than paradoxical embolism.

Age Is Not a Predictor of Patent Foramen Ovale with Right-to-Left Shunt in Patients with Cerebral Ischemic Events

2004 ◽  
Vol 21 (6) ◽  
pp. 517-522 ◽  
Author(s):  
Abutaher M. Yahia ◽  
Aasma Shaukat ◽  
Jawad F. Kirmani ◽  
Adnan I. Qureshi
Keyword(s):  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Cerebral Ischemic ◽  
Ischemic Events

scholarly journals Relation between the size of patent foramen ovale and the volume of acute cerebral ischemic lesion in young patients with cryptogenic ischemic stroke

2021 ◽  
Author(s):  
Federica Benvenuti ◽  
◽  
Francesco Meucci ◽  
Luisa Vuolo ◽  
Rita Nistri ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Young Patients ◽  
Lesion Volume ◽  
Foramen Ovale ◽  
Cerebral Infarcts ◽  
Ischemic Lesion ◽  
Septum Primum ◽  
Cerebral Ischemic ◽  
Maximum Separation ◽  
Septum Secundum

Abstract Background Patent foramen ovale (PFO) closure is superior to medical therapy alone to prevent stroke recurrence in selected patients. Small cortical infarcts and large right to left shunts seem to identify patients who will benefit most from closure. We aimed to study the correlation between the size of the PFO and the volume of cerebral ischemic lesions in young patients with cryptogenic ischemic stroke. Methods PFO dimensions and acute ischemic lesion volume of 20 patients, aged<55 years, were analyzed with transesophageal echocardiography and brain magnetic resonance imaging, respectively. The association between the volume of ischemic lesions with the length of PFO, maximum separation between septum primum and septum secundum, and the combination of the twos was explored. Results A direct statistically significant correlation was found between cerebral lesion volume and maximum separation of septum primum and septum secundum (p=0.047). Length of PFO showed a non-significant trend towards an inverse correlation with lesion volume (p=0.603). Multiple linear regression analysis showed that cerebral lesion volume was dependent directly on maximum separation and inversely on length of PFO (regression coeff. −0,837; p= 0.057; 2,536, p=0.006, respectively). Conclusions These data suggest that even small PFO might be pathogenetic in case of small cerebral infarcts and that large cerebral infarcts might be PFO related if the shunt is large. If confirmed, the combination of detailed characteristics of PFO with the volume of cerebral infarct could be integrated in a new score to select patients who would take real advantage from a percutaneous closure.

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