Which characteristics of patent foramen ovale and associated anatomical structures determine risk of cryptogenic brain ischemia?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Dubrava ◽  
R Sidlo
Keyword(s):  
Risk Factors ◽  
Atrial Septal Defect ◽  
Brain Ischemia ◽  
Septal Defect ◽  
Cryptogenic Stroke ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Eustachian Valve ◽  
Functional Features ◽  
Chiari Network

Abstract Background Linking of the characteristics of persistent foramen ovale (PFO) and associated septal/atrial structures to a causal role in cryptogenic stroke is not definitely known. Purpose In a prospective study to assess the risk of morphological and functional features of PFO and selected septal/atrial structures for cryptogenic stroke or transient ischemic attack (TIA). Methods A total of 1 270 consecutive patients underwent contrast transesophageal echocardiography – 702 patients with cryptogenic brain ischemia and 568 controls without the history of stroke or TIA. We compared 224 patients with cryptogenic stroke or TIA and PFO (31.9% of all patients with brain ischemia) to 106 controls with PFO (18.7% of the control group) (p<0.001). We analyzed diameter and length of the PFO, presence of the large PFO (diameter ≥4 mm), long PFO (length ≥10 mm), atrial septal aneurysm (excursion ≥15 mm), Eustachian valve or Chiari network, shunt severity (graded with a 1–3 scale) and the right-to-left shunt present under basal conditions. Results All parameters of PFO significantly increased relatíve risk (RR) of cryptogenic stroke/TIA vs population without PFO [RR (95% CI); p]: PFO – 2.04 (1.57; 2.66); <0.001, large PFO – 4.99 (2.67; 9.39); <0.001, PFO with diameter ≥ median 2.4 mm – 3.20 (2.19; 4.68); <0.001, long PFO – 2.25 (1.65; 3.06); <0.001, PFO with length ≥ median 12 mm – 2.26 (1.61; 3.17); <0.001, moderate or large shunt – 2.25 (1.65; 3.08); <0.001, shunt present under basal conditions – 2.47 (1.74; 3.52); <0.001. None of the associated structures (atrial septal aneurysm, atrial septal aneurysm + PFO, Eustachian valve or Chiari network, atrial septal defect) significantly increased RR of cryptogenic stroke/TIA vs population without the respective structure. In a multivariable logistic regression model PFO diameter ≥ median 2.4 mm and long PFO emerged as significant risk factors of stroke or TIA. Patients with brain ischemia had significantly larger PFO diameter and higher prevalence of large PFO compared to controls (3.1±2.0 mm vs 2.3±1.4 mm, p<0.001; 8.8% vs 2.1%, p<0.001). Symptomatic patients had significantly higher prevalence of long tunnel (23.2% vs 12.3%, p<0.001) and of moderate/large shunt (22.2% vs 11.8%, p<0.001). There was no significant difference between patients and controls in prevalence of atrial septal aneurysm, atrial septal aneurysm + PFO, Eustachian valve or Chiari network, atrial septal defect. Conclusions Among the parameters of PFO large diameter was the most powerful risk factor of cryptogenic brain ischemia. Long PFO, moderate/large shunt and shunt present under basal conditions also significantly increased the risk. Associated septal/atrial structures were not found as risk factors. Funding Acknowledgement Type of funding source: None

Modified Technique to Control the Eutachian Valve During Transcatheter Closure of Atrial Septal Defect/Patent Foramen Ovale

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Sahar El Shedoudy ◽  
Fatma Abo Elsoud ◽  
Eman El Dokhlaha ◽  
Reem Rashed ◽  
Mohammad Abdelghani
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Vena Cava ◽  
Right Atrial ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Eustachian Valve ◽  
Jude Medical

Abstract Objective to describe an approach to perform safe transcatheter closure of Atrial Septal Defect (ASD)/Patent Foramen Ovale (PFO) associated with large redundant Eustachian Valve. Background Transcatheter device closure of ASD/PFO is feasible in a great majority of patients. However, the presence of a huge mobile Eustachian Valve can compromise device placement. Patients and Methods Six patients (3 PFO and 3 ASD patients) with a huge redundant Eustachian valve were included. Two patients had PFO with long tunnel and were closed with Occlutech FigullaFlex II PFO occluders sized 23/25 and 27/30 respectively. The other PFO patient had an associated atrial septal aneurysm (ASA) and was closed with a 25 mm Amplatzer Multi-Fenestrated Septal Occluder “cribriform” device (St. Jude Medical – Abbott Vascular). The three ASDs were closed by regular ASD occluders (2 Flex II ASD Occluders sized 30 and 33 mm and 1 Amplatzer ASD Occluder sized 24 mm). Eustachian valve was successfully held with a steerable ablation catheter to deflect it against the lateral right atrial wall, keeping it away from the inter-atrial septum to prevent its entrapment or interference with the cable, the sheath or the device. Results All ASDs/PFOs have been successfully closed with no complications with free inferior vena cava (IVC) flow, with no residual inter-atrial shunt and the eustachian valve is not interfering with the device. Conclusions Safe percutaneous ASD/PFO closure can be achieved with proper control of a large redundant Eustachian valve.

Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities

2013 ◽  
Vol 24 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Andreas Giannopoulos ◽  
Christoforos Gavras ◽  
Stavroula Sarioglou ◽  
Fotini Agathagelou ◽  
Irene Kassapoglou ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Interatrial Septum ◽  
Paediatric Population ◽  
Point Of View ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Increased Risk

AbstractObjectives: This study sought to investigate the prevalence of atrial septal aneurysms in the paediatric population and to define coexisting abnormalities and their incidence. Background: Few papers refer to the prevalence of atrial septal aneurysms in childhood. Methods: We enrolled a total of 4522 children aged more than 12 months who underwent a transthoracic echocardiography. Atrial septal aneurysm was defined as a protrusion of the interatrial septum or part of it >15 mm beyond the plane of the atrial septum or phasic excursion of the interatrial septum during the cardiorespiratory cycle of at least 15 mm in total amplitude and a diameter of the base of the aneurysm of at least 15 mm. Results: Atrial septal aneurysms were found in 47 children (1.04%). They involved almost the entire septum in 14 patients (28.89%) and were limited to the fossa ovalis in 33 (71.11%). An atrial septal aneurysm was an isolated structural defect in 17 (35.56%). In 30 (64.44%) patients, it was associated with interatrial shunting – atrial septal defect and patent foramen ovale. At the echo follow-up after a year, no changes were recorded. Conclusions: Prevalence of atrial septal aneurysms is almost 1%. The most common abnormalities associated are interatrial shunts, that is, a patent foramen ovale and an atrial septal defect. From a medical point of view, it is suggested that no action is to be taken during childhood, as a child with an atrial septal aneurysm is not at increased risk compared with a child without one. Follow-up is scheduled on an individual basis.

Stroke in patients with secundum atrial septal defect and sequelae after transcatheter closure

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319050
Author(s):  
Stephen J Dolgner ◽  
Zachary Louis Steinberg ◽  
Thomas K Jones ◽  
Mark Reisman ◽  
Jonathan Buber
Keyword(s):  
Risk Factors ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Lifestyle Changes ◽  
Adult Patients ◽  
Atrial Arrhythmias ◽  
Secundum Atrial Septal Defect ◽  
Eustachian Valve ◽  
Increased Risk ◽  
Asd Closure

ObjectiveTo evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed.MethodsWe retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF.ResultsOf 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001).ConclusionsIn this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.

Right bundle branch block as a marker for interatrial septal abnormalities

2011 ◽  
Vol 22 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Aurora Bakalli ◽  
Dardan Koçinaj ◽  
Ljubica Georgievska-Ismail ◽  
Tefik Bekteshi ◽  
Ejup Pllana ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Right Bundle Branch Block ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transoesophageal Echocardiography ◽  
Adult Patients ◽  
P Value ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Bundle Branch Block

AbstractBackgroundInteratrial septal anomalies, which include atrial septal defect, patent foramen ovale, and atrial septal aneurysm, are common disorders among adult patients. Early detection of interatrial septal anomalies is important in order to prevent haemodynamic consequences and/or thromboembolic events. Electrocardiogram offers some clues that should serve as hints for detection of interatrial abnormalities. The aim of our study was to analyse the interatrial septum by transoesophageal echocardiography in patients with electrocardiogram signs of right bundle branch block and in those without right bundle branch block.Methods and resultsIn a prospective study, 87 adult patients were included, that is, 41 with electrocardiogram signs of right bundle branch block forming the first group and 46 without right bundle branch block forming the second group. Interatrial septal anomalies were present in 80.5% of the patients with right bundle branch block, with patent foramen ovale (39.02%) being the most prevalent disorder, followed by atrial septal aneurysm (21.9%) and atrial septal defect (19.5%). Interatrial septal abnormalities were significantly more frequent in the first group compared with the second group (80.5% versus 6.5%, p value less than 0.001). Independently, patent foramen ovale was significantly more prevalent in patients with right bundle branch block (39.02% versus 4.3%, p value less than 0.001), as were atrial septal aneurysm (21.9% versus 2.2%, p value equal 0.01) and atrial septal defect (19.5% versus 0%, p value equal 0.004).ConclusionsRight bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.

scholarly journals P1373 Cardiac source of embolism diagnosed by transeophageal echocardiography - what to expect in nowadays clinical practice

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Branco Mano ◽  
S Aguiar Rosa ◽  
A T Timoteo ◽  
P Rio ◽  
L Moura Branco ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Valve Disease ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Spontaneous Echo Contrast ◽  
Aortic Plaque ◽  
Tertiary Centre ◽  
Cerebral Event ◽  
Aortic Plaques

Abstract Background Transeophageal echocardiography (TEE) is an essential tool to diagnose cardiac source of embolism (CSE) and to define treatment approach. Purpose: To review the identified CSE in 25 years experience in TEE at a tertiary centre. Methods: Retrospective study of consecutive patients (pts) who underwent TEE to search for CSE, from 1994 to 2019. Results: 2936 pts (55% males, mean age 53 ± 13 years). Ischemic cerebral event (96%) was the main location of embolism. TEE identified potential CSE in 41.5% and 7% had more than one diagnostic. The most frequent CSE were patnt foramen ovale (PFO) (16.3%) and atrial septal aneurysm (ASA), among these 65% had concomitant PFO or atrial septal defect (ASD) (14.1%). Aortic plaques ≥ 4mm were noted in 9.6%, followed by valve disease or prosthesis (5.4%), intracavitary thrombi (3.9%), vegetations (1.6%), ASD (1.5%), dilated cardiomyopathy (1.4%) and tumors (0.7%). In the last 15 years, the diagnostic effectiveness increased (35.6% vs 45.95%) and there was a shift in etiologies with an increased in the diagnose of PFO/ASD (26.8% vs 38.5%) and valve disease or prosthesis became less frequent (29.9% vs 3.7%). Overall, in elderly pts there was a preponderance of atherosclerotic plaques in the aorta, contrasting with younger pts who presented a predominance of PFO (Table1). The prevalence of spontaneous echo contrast increased with age. Pts with ischemic cerebral event were younger, mostly male and PFO was the main source of embolism (17%), while in pts with peripheral embolism the most frequent etiologies were intracavitary trombi (16%) and aortic plaques ≥ 4mm (14%). Conclusion: The main cause to perform a TEE to search for CSE was cerebral embolism, with a diagnostic effectiveness overall of 41.5%, that increased in the last 15years. Table 1 Characteristics &lt;50 years (n = 1191) 50-75 years (n = 1569) ≥75 years (n = 171) Male (%) 601 (50%) 931 (59%) 80 (47%) Atrial septal defect (%) 23 (2%) 20 (1%) 0 Patent foramen ovale (%) 239 (20%) 226 (14%) 12 (7%) Atrial septal aneurysm (%) 70 (6%) 130 (8%) 13 (8%) Vegetations (%) 8 (0.7%) 29 (2%) 9 (5%) Tumors (%) 10 (0.8%) 8 (0.5%) 4 (2%) Intracavitary trombi (%) 28 (2%) 74 (5%) 14 (8%) Aortic plaque ≥4mm (%) 31 (3%) 203 (13%) 48 (28%) Valve disease or prothesis (%) 54 (4.5%) 109 (6%) 11 (6%) Spontaneous echo contrast (%) 36 (3%) 155 (10%) 32 (19%) Distribution of cardiac source embolism by age

Prominent Eustachian Valve and Atrial Septal Defect Presenting With Chronic Hypoxemia in a Teenager

2020 ◽  
Vol 11 (5) ◽  
pp. 666-668
Author(s):  
Daphney Kernizan ◽  
Rami Kharouf ◽  
Bradley Robinson ◽  
Wolfgang Radtke
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrial ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Foramen Ovale ◽  
Atrial Septal Defect Closure ◽  
Eustachian Valve ◽  
Flow Through ◽  
Antegrade Flow ◽  
Chronic Hypoxemia

Prominent Eustachian valves, with obligate right-to-left shunts, have been reported as a cause of neonatal hypoxemia. This anomaly can present as an obstructive structure that inhibits antegrade flow through the tricuspid valve and furthermore contributes to right-to-left atrial shunting in the presence of a patent foramen ovale or atrial septal defect. This case highlights the evaluation and diagnostic workup for chronic hypoxemia in an adolescent female patient and considerations for percutaneous atrial septal defect closure.

scholarly journals Persistent Eustachian valve and transient arterial hypoxemia in a newborn: a clinical observation

2021 ◽  
Vol 49 (5) ◽  
pp. 342-346
Author(s):  
M. V. Tarayan ◽  
I. A. Drozdova ◽  
I. O. Bondareva ◽  
E. S. Efremov ◽  
M. V. Vishnyakova
Keyword(s):  
Inferior Vena Cava ◽  
Atrial Septal Defect ◽  
Neonatal Intensive Care ◽  
Septal Defect ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ultrasound Finding ◽  
Foramen Ovale ◽  
Eustachian Valve ◽  
Arterial Hypoxemia

The Eustachian valve (EV) is located in the orifice of inferior vena cava and belongs to structures of the normal heart. It plays an important role in the fetal blood flow by directing the flow of blood from inferior vena cava through an open foramen ovale to the left atrium, thereby ensuring the systemic flow in a fetus and bypassing the pulmonary circulation. After birth and upon closure of the foramen ovale, the valve ceases to function and tends to regress. Usually, a prominent EV is a clinically non-significant ultrasound finding. In isolated cases, however, it can cause significant hemodynamic abnormalities and subsequent rhythm disorders, delayed fetal development and transient hypoxemia in newborns. It can extremely rare be a cause of blood right-toleft shunting through the foramen ovale leading to desaturation. Clinically it can manifest by central cyanosis in newborns and infants. The differential diagnosis is made in neonatal intensive care units. We present a  case of transient arterial hypoxemia in a  newborn with prominent EV and inter-atrial shunt. A  one-month old infant was transferred from the Department of Pediatric Cardiology with a  history of transient hypoxemic spells related to right-to-left shunting via atrial septal defect caused by obstruction of the tricuspid valve by the prominent EV. The instrumental findings including contrast-enhanced tomography supported this hypothesis. The patient was stable for subsequent 10 days of the follow-up, which allowed for further conservative managements until the conventional time point for children with an atrial septal defect. Potential regress of the prominent EV, as well as natural growth of an infant and his/hers intracardiac structures, provide mostly favorable outcome without a surgical intervention. This was clearly illustrated in the clinical case.

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