scholarly journals Case fatality rate and fatal bleeding complication in patients with pulmonary embolism and patent foramen ovale

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Hobohm ◽  
V H Schmitt ◽  
T Munzel ◽  
S V Konstantinides ◽  
K Keller
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Bleeding Events ◽  
Systemic Thrombolysis ◽  
Federal States ◽  
Intracerebral Bleeding ◽  
Increased Risk ◽  
Acute Pe

Abstract Objectives In patients with acute pulmonary embolism (PE), right atrial pressure is elevated, which increases risk for right-to-left shunt when patent foramen ovale (PFO) is present and thus potentially increases risk for paradoxical embolism. Little is known about the clinical outcome of patients with PE and concomitant PFO. Methods We analysed data on patient characteristics, treatments and in-hospital outcomes for all PE patients (ICD-code I26) with concomitant presence of PFO in Germany 2005–2018 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, and own calculations). Results Between January 2005 and December 2018, 1,174,235 patients with acute PE (53.5% females) were included in this analysis; of those, 5,486 (0.5%) had a concomitant diagnosis of PFO. Trends analysis demonstrating an increasing frequency of diagnosed PE with additional PFO from 2005 (n=299) to 2018 (n=556; p<0.001). While patients with PE and PFO presented more often with signs of haemodynamic compromise such RV dysfunction (37.6% vs. 28.5%) or shock (7.1% vs. 3.9%) as well as paradox arterial emboli (47.8% vs. 3.2%) or intracerebral bleeding (3.3% vs. 0.6%), PE patients with PFO died less often compared to PE patients without PFO (11.1% vs. 15.8%). Patients with PE and PFO were younger (65 [IQR 52–75] vs. 72 [60–80]; P<0.001) and were more often treated invasively with a reperfusion treatment approach like embolectomy (10.2% vs. 4.2%) or systemic thrombolysis (5.0% vs 0.1%). A multivariate logistic regression analysis revealed a 27.6-fold increased risk for paradox arterial emboli (OR, 27.6 [95% CI 26.1–29.1]; p<0.001) and a 3.9-fold increased risk for intracerebral bleeding events (OR, 3.9 [95% CI 3.3–4.54]; p<0.001) for patients with PE and concomitant PFO. In normotensive patients with RVD and PFO, embolectomy were not associated to affect the rate of intracerebral bleeding events (OR, 0.8 [95% CI 0.2–2.6]; p=0.720) compared to conventional non-reperfusion treatment; instead of systemic thrombolysis, which is associated with a higher risk of intracerebral bleeding (OR, 3.5 [95% CI 1.8–6.59]; p<0.001) compared to conventional non-reperfusion treatment. Conclusion Patients with acute PE and the concomitant presence of PFO are associated with a high risk for paradox arterial emboli and intracranial bleeding events. Especially in normotensive patients, the use of systemic thrombolysis should be considered with cautious. Thus, our findings may improve the clinical management of patients with PE and PFO. FUNDunding Acknowledgement Type of funding sources: None.

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

2017 ◽  
Vol 11 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Randomized Trials ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
International Guidelines ◽  
Acute Pe

<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>

Abstract 120: Prevalence and Impact of Patent Foramen Ovale in Patients with Obstructive Sleep Apnea

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Phillip Camp ◽  
Abinash Achrekar ◽  
Umar Malik ◽  
Warren Laskey
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patent Foramen Ovale ◽  
Right Atrial ◽  
Apnea Hypopnea Index ◽  
Foramen Ovale ◽  
Contrast Injection ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Study Population

Introduction: It is well known that obstructive sleep apnea (OSA) prevalence increases as body mass index (BMI) increases. Lesser known is patent foramen ovale (PFO) is found in 12 to 35 percent of adults. Patients with OSA experience nocturnal apnea which result in hypoxemia, elevation of right atrial pressure, and an increase in right to left shunting and a theoretical increased risk of stroke. A few studies have suggested an association between the severity of OSA and a PFO. As such, OSA diagnosis and therapy may be tailored to address right-to-left shunting in these patients. If the prevalence of PFO in OSA patients is increased, it may be appropriate to include transthoracic echocardiography (TTE) testing as a component of routine evaluation of patients with OSA. Hypothesis: We hypothesize that patients with hypoxemia related to OSA are more likely to have a PFO with right-to-left shunting than those with less dramatic hypoxemia. We hope to determine the prevalence and clinical relevance of intra-cardiac shunting in patients with OSA by prospectively analyzing and correlating polysomnography and TTE findings. Methods: 80 patients with OSA were referred for TTE by the UNM Sleep Center. All patients underwent saline contrast TTE in the UNM echo lab. The prevalence of PFO in the general UNM echo population was calculated over the last year for comparison. Results: Of 80 patients with varying degrees of OSA, 12.5% had right to left shunting. PFO was not statistically associated with DI (Desaturation Index), nor any AHI (Apnea Hypopnea Index). The only statistically significant association was between OSA and BMI (p=0.013). BMI associated with DI and AHI was statistically significant (p=0.003 and p=0.005, respectively). Over the last year, 216 PFO’s were found from 1858 echo studies with contrast injection performed at UNM with a prevalence rate of 11.6%. Conclusions: In contrast to previous studies, there was no association between OSA of any severity and PFO in our study population. There was a statistically significant association between BMI and OSA, which is well established. Our study prevalence was found to be similar to the UNM general echo population as well, indicating that OSA patients within our study group were not as likely to have an associated PFO.

scholarly journals Catheter-directed therapy for acute pulmonary embolism: navigating gaps in the evidence

2019 ◽  
Vol 21 (Supplement_I) ◽  
pp. I23-I30 ◽  
Author(s):  
Romain Chopard ◽  
Fiona Ecarnot ◽  
Nicolas Meneveau
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pressure Overload ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Systemic Thrombolysis ◽  
Risk Of Death ◽  
Risk Of Bleeding ◽  
Catheter Directed Thrombolysis ◽  
Acute Pe

Abstract Systemic thrombolysis for acute pulmonary embolism (PE) reduces the risk of death and cardiovascular collapse but is associated with an increased rate of bleeding. The desire to minimize the risk of bleeding events has driven the development of catheter-based strategies for pulmonary reperfusion in PE. These catheter-based strategies utilize lower-dose fibrinolytic regimens or purely mechanical techniques to expedite removal of the embolus. Several devices providing mechanical or suction embolectomy and catheter-directed thrombolysis, with or without facilitation by ultrasound, have been tested. Data are inconsistent regarding the efficacy and safety of mechanical and suction embolectomy. The most comprehensive data on catheter-based techniques stem from trials of ultrasound-facilitated catheter fibrinolysis. Ultrasound-facilitated catheter fibrinolysis relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial haemorrhage than historical rates with systemic fibrinolysis. However, further research is required to determine the optimal application of ultrasound-facilitated catheter fibrinolysis and other catheter-based therapies in patients with acute PE.

scholarly journals An atypical case of pulmonary embolism from a jugular vein

2018 ◽  
pp. K67-K72
Author(s):  
A E Velcea ◽  
S Mihaila Baldea ◽  
D Muraru ◽  
L P Badano ◽  
D Vinereanu
Keyword(s):  
Pulmonary Embolism ◽  
Internal Jugular Vein ◽  
Oral Anticoagulation ◽  
Jugular Vein ◽  
Multimodality Imaging ◽  
Right Atrial ◽  
List Type ◽  
Venous Malformations ◽  
Systemic Thrombolysis ◽  
Increased Risk

Summary Neck venous malformations and their potentially life-threatening complications are rarely reported in the available literature. Cases of aneurysmal or hypo-plastic jugular vein thrombosis associated with systemic embolization have not been frequently reported. We present the case of a 60-year-old male, without any known risk factors for thromboembolic disease, admitted for sudden onset dyspnea. The physical examination was remarkable for a right lateral cervical mass, expanding with Valsalva maneuver. Thoracic CT with contrast established the diagnosis of bilateral pulmonary embolism and raised the suspicion of superior vena cava and right atrial thrombosis. Bedside transthoracic echocardiography confirmed the presence of a large right atrial thrombus, with intermittent protrusion through the tricuspid valve. Systemic thrombolysis with Alteplase was initiated shortly after diagnosis, in parallel with unfractionated heparin, with complete resolution of the intracavitary thrombus documented by echocardiography. The patient showed significant improvement in symptoms and was later started on oral anticoagulation. Computed vascular tomography of the neck was performed before discharge, showing hypoplasia of the left internal jugular vein and aneurismal dilation of the contralateral internal jugular vein, without thrombosis. There were no identifiable systemic causes for thrombosis. Surgical resection of the aneurismal jugular vein was excluded, because of its potential to cause intracranial hypertension. The preferred therapeutic option in this case was long-term oral anticoagulation. Learning points: Internal jugular venous malformations, such as aneurisms or hypoplasia, could be associated with an increased risk of thrombosis and major embolic events. Systemic thrombolysis can be an efficient solution in cases of pulmonary embolism with right heart thrombosis. Multimodality imaging is greatly valuable in clarifying the diagnosis of atypical cases.

scholarly journals Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review

2020 ◽  
Author(s):  
Parinita Dherange ◽  
Nelson Telles ◽  
Kalgi Modi
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Atrial Septum ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale ◽  
Arterial Blood

Abstract Background Carcinoid heart disease is present in approximately 20% of the patients with carcinoid syndrome and is associated with poor prognosis. It usually manifests with right-sided valvular involvement including tricuspid insufficiency and pulmonary stenosis. Patent foramen ovale (PFO) is present in approximately 50% of the patients with carcinoid heart disease which is twice higher than the general population. Right-to-left shunting through a PFO can occur either due to higher right atrial pressure than left (pressure-driven) or when the venous flow is directed towards the PFO (flow-driven) in the setting of normal intracardiac pressures. We report a rare case of flow-driven right-to-left atrial shunting via PFO in a patient with carcinoid heart disease. Case summary A 54-year-old male with a metastatic neuroendocrine tumour to liver presented with progressive shortness of breath for 5 months. Patient was found to be hypoxic with oxygen saturation of 78% and examination revealed a holosystolic murmur. Arterial blood gas showed oxygen tension of 43 mmHg. A transthoracic and transoesophageal echocardiogram showed aneurysmal inter-atrial septum with a PFO, severe tricuspid regurgitation directed anteriorly towards the inter-atrial septum leading to a marked right-to-left shunt. Right heart catheterization showed right atrial pressure of 8 mmHg, mean pulmonary artery pressure of 12 mmHg, and normal oxygen saturations in the right atrium, right ventricle, and pulmonary arteries. The patient then underwent closure of the PFO along with tricuspid valve and pulmonary valve replacement at an experienced cardiovascular surgical centre and has been asymptomatic since. Conclusion Right-to-left shunting through a PFO in patients with normal right atrial pressure can be successfully treated with closure of the PFO. Thus, understanding the mechanism of intracardiac shunts is important to accurately diagnose and treat this rare and fatal condition.

Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism

2019 ◽  
Vol 171 (7) ◽  
pp. 527
Author(s):  
Preetham Kumar ◽  
M. Khalid Mojadidi ◽  
Bernhard Meier ◽  
Jonathan M. Tobis
Keyword(s):  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Foramen Ovale
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