Comparison of upper extremity versus lower extremity vein injections of bubble contrast in assessment of patent foramen ovale

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Mutlu ◽  
E Durmaz ◽  
M.H Karpuz ◽  
B Karadag ◽  
B Ikitimur ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Patent Foramen Ovale ◽  
Superior Vena ◽  
Vena Cava ◽  
Interatrial Septum ◽  
Contrast Study ◽  
Foramen Ovale ◽  
Eustachian Valve ◽  
Extremity Veins

Abstract Background Patent foramen ovale (PFO) is one of the causes of cardioembolism and closure of PFO is recommended by the current guidelines in patients with recurrent stroke. Transoesophageal echocardiography (TEE) using bubble-contrast study is the gold standard imaging modality for the assessment of interatrial septum. Upper-extremity veins are the most common way of injection, however, the presence of Eustachian valve and flow dynamics when bubble-contrast injection performed via upper extremity veins limits the assessment of interatrial septum in several cases. In this study, we aimed to compare the efficacy of bubble-contrast study between upper extremity injection and lower extremity injection. Material/Methods Patients with a suspicion of cardioembolism who were undergoing TEE study were included in this study. After routine assessment of cardiac structures, the bubble-contrast study was performed using agitated saline from both upper-extremity vein and lower-extremity vein with Valsalva manoeuvre. Right-to-left shunt and numbers of bubbles transmitted from the septum were recorded. Results We prospectively included 45 patients and 21 PFOs were detected. There were 9 patients with prominent Eustachian valve and in 6 patients Eustachian valve hampered the complete opacification of the right atrium. In 3 patients flow from the superior vena cava was directed towards the tricuspid valve and hampered the complete opacification. Among 21 patients with PFO, in 6 patients right-to-left shunt was not observed when agitated-saline was injected via the upper-extremity vein, however, the shunt was observed when the agitated-saline was injected via the lower-extremity vein. In 14 patients amount of bubbles passing through the interatrial septum were significantly higher when the injection was performed via the lower-extremity vein especially in patients with prominent Eustachian valve. Conclusion Our preliminary results indicated that compared to upper-extremity veins, injection via the lower-extremity veins provides better opacification of right atrial septum and assessment of interatrial septum. Therefore, injection through the lower-extremity veins would be the preferred choice particularly in patients with prominent Eustachian valve or downward directed flow from the superior vena cava. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect

2020 ◽  
Author(s):  
Niloufar Samiei ◽  
Nehzat Akiash ◽  
Sepideh Djafari Naeini ◽  
Akbar Nikpajouh ◽  
Mahboubeh Pazoki
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Superior Vena ◽  
Vena Cava ◽  
Sinus Venosus ◽  
Foramen Ovale ◽  
Control Groups ◽  
And Control ◽  
Superior Type

Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.

scholarly journals P772 Percutaneous transcatheter patent foramen ovale closure: does size really matter?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M F Ramis Barcelo ◽  
C Mas Llado ◽  
A Rodriguez ◽  
I Valadron ◽  
M Noris ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Superior Vena ◽  
Cryptogenic Stroke ◽  
Vena Cava ◽  
Closure Device ◽  
Foramen Ovale ◽  
Device Closure ◽  
Residual Shunt ◽  
Device Size ◽  
Pfo Closure

Abstract Introduction Patent foramen ovale (PFO) has been associated with cryptogenic stroke. Percutaneous transcatheter PFO closure has been in development for the last years. In recent studies, it has shown a reduction of recurrent ischemic stroke events. Several manufactures of PFO device closure have developed guidelines for selection of device size based on anatomic measurements obtained through echocardiography. A study showed that according to the guidelines few patients had adequate tissue rim to allow device implantation, and yet almost all the patients had an effective closure. Purpose and methods The aim of this study was to evaluate the characteristics of PFO with transesophageal echocardiogram (TEE) (size, distance between foramen ovale-superior vena cava (FO-SVC) and distance between FO-aortic annulus (FO-AoAn)) and to determinate the correlation between the size of PFO device implanted and the theoretical device size according to the guidelines. We performed a retrospective study among patients who underwent a PFO closure procedure between 2006 and 2018. Results 42 patients were included, 55% male, mean age 56 years and mean BSA 1,83 m². The PFO mean diameter and length were 3 and 13 mm respectively. The majority of PFO were complex: 91% of patients had defects larger than 8mm and 36% had atrial septum aneurism. Characteristic of PFO were measured (Table). In older patients the distance between PFO-SVC and PFO-AoAn was larger and the septum secundum was thicker (p 0.02). The right-to-left shunt was moderated or severe in most cases (75%). The PFO closure device was successfully implanted in all patients. The majority of them received an Amplatzer PFO device (45%) followed by an Hyperion PFO device. The size of the device was 25mm in half of the patients followed by 30mm device. According to the guidelines, in 67% of the cases the wrong size was chosen and the mean size of the device should had been 30mm (SD ±5,2). TEE examination during follow up showed no residual or mild residual shunt in 80% of the patients. Residual shunt was more prevalent with larger devices (p 0.008) Conclusions These results showed that the size of PFO closure device implanted in our population differed from the size recommended by guidelines. Smaller devices have been used. According to our results, larger devices are associated with more residual shunt, which suggests that a different approach may be necessary to establish new protocols for PFO device closure Table Minimal Maximal Mean SD SVC (mm) 10 30 17.55 ±3,7 AoAn (mm) 9 23 14.1 ±3,5 Minimal and maximal distance between PFO-SVC and AoAn

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.

The feasibility and safety of PICCs accessed via the superficial femoral vein in patients with superior vena cava syndrome

2018 ◽  
Vol 19 (1) ◽  
pp. 34-39 ◽  
Author(s):  
Yonghui Wan ◽  
Yuxin Chu ◽  
Yanru Qiu ◽  
Qian Chen ◽  
Wei Zhou ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Femoral Vein ◽  
Vena Cava ◽  
Superficial Femoral Vein ◽  
Catheter Malposition ◽  
Vena Cava Syndrome ◽  
Central Catheters ◽  
Extremity Veins

Objective: To investigate the feasibility and safety of the peripherally inserted central catheters (PICCs) accessed via the superficial femoral vein in patients with superior vena cava syndrome (SVCS). Methods: From October 2010 to December 2014, 221 cancer patients with SVCS in our center received real-time ultrasound-guidance of the superficial femoral vein inserted central catheters (FICCs) at the mid-thigh. PICC insertion via upper extremity veins had also been investigated in 2604 cancer patients without SVCS as control. The average catheterization time, one-time puncture frequency, catheter duration and complications were compared between two groups. Results: In the FICC group, the mean catheterization time was 31.60 ± 0.15 minutes, one-time puncture frequency was 1.05 ± 0.08, and catheter duration was 168.95 ± 20.47 days. There was no significant difference compared with the upper extremity veins PICC group: 31.11 ± 3.86 minutes, 1.03 ± 0.30, and 173.58 ± 39.81 days, respectively. The major complications included skin allergy to chlorhexidine gluconate (CHG) dressings, exudation, catheter-related infection, catheter occlusions, unplanned catheter withdrawal, venous thrombosis, mechanical phlebitis, and catheter malposition. It is interesting that a higher rate of catheter malposition was observed in the upper extremity veins PICC group than in the FICC group (2.15% vs. 0.00%). There were no significant differences in other complications between the two groups. Conclusions: Real-time ultrasound-guided PICCs accessed via the superficial femoral vein at the mid-thigh is a new modified technique with low complications, which can be a feasible and safe alternative venous access for patients with SVCS.

Superior vena cava–right atrium junction flow‐pattern post‐transcatheter closure of patent foramen ovale

2019 ◽  
Vol 36 (9) ◽  
pp. 1698-1700
Author(s):  
Sergey Yalonetsky ◽  
Roi Tal ◽  
Doron Aharonson ◽  
Gil Gross ◽  
Avraham Lorber
Keyword(s):  
Flow Pattern ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Patent Foramen Ovale ◽  
Transcatheter Closure ◽  
Superior Vena ◽  
Vena Cava ◽  
Foramen Ovale ◽  
Junction Flow
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