Patient with systemic emboli in the setting of Klebsiella oxytoca tricuspid valve endocarditis and patent foramen ovale treated with NobleStitch and AngioVac

2021 ◽  
Vol 14 (8) ◽  
pp. e243370
Author(s):  
John Leso ◽  
Majd Al-Ahmad ◽  
Drinnon O Hand
Keyword(s):  
Tricuspid Valve ◽  
Patent Foramen Ovale ◽  
Klebsiella Oxytoca ◽  
Signs And Symptoms ◽  
Foramen Ovale ◽  
Surgical Debulking ◽  
History Of ◽  
Infectious Disease Specialists ◽  
High Index Of Suspicion ◽  
Pfo Closure

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.

Does persistent (patent) foramen ovale closure reduce the risk of recurrent decompression sickness in scuba divers?

2021 ◽  
Vol 51 (1) ◽  
pp. 63-67
Author(s):  
Björn Edvinsson ◽  
◽  
Ulf Thilén ◽  
Niels Erik Nielsen ◽  
Christina Christersson ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Foramen Ovale ◽  
Residual Shunt ◽  
Interatrial Communication ◽  
Scuba Divers ◽  
Increased Risk ◽  
History Of ◽  
Catheter Closure ◽  
Pfo Closure

Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited. Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS. Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile. Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

Is Migraine Associated with Right-to-Left Shunt a Separate Disease? Results of the SAM Study

Cephalalgia ◽  
2008 ◽  
Vol 28 (4) ◽  
pp. 360-366 ◽  
Author(s):  
GP Anzola ◽  
G Meneghetti ◽  
C Zanferrari ◽  
A Adami ◽  
L Dinia ◽  
...  
Keyword(s):  
Family History ◽  
Observational Study ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Genetic Linkage ◽  
Personal History ◽  
Coagulation Disorders ◽  
Foramen Ovale ◽  
History Of ◽  
Pfo Closure

Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 ± 10 vs. 37.1 ± 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.

scholarly journals Patent Foramen Ovale and Cryptogenic Stroke or Transient Ischemic Attack: To Close or Not to Close? A Systematic Review and Meta-Analysis

2018 ◽  
Vol 45 (5-6) ◽  
pp. 193-203 ◽  
Author(s):  
Simona Lattanzi ◽  
Francesco Brigo ◽  
Claudia Cagnetti ◽  
Mario Di Napoli ◽  
Mauro Silvestrini
Keyword(s):  
Transient Ischemic Attack ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Bleeding Complications ◽  
Stroke Recurrence ◽  
Foramen Ovale ◽  
History Of ◽  
Ischemic Attack ◽  
Pfo Closure ◽  
New Onset

Background: The optimal strategy of secondary stroke prevention in patients with patent foramen ovale (PFO) is controversial. This study was performed to evaluate the efficacy and safety of the device closure (DC) versus the medical therapy (MT) in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO. Summary: Randomized controlled trials with active and control groups receiving the DC plus MT and MT alone in patients with history of cryptogenic stroke/TIA and diagnosis of PFO were systematically searched. The main efficacy outcome was stroke recurrence. Subgroup-analyses were performed according to age, shunt size, and presence of atrial septal aneurysm (ASA). Safety endpoints included any serious adverse event (SAE), atrial fibrillation (AF), and major bleeding complications. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were estimated. Five trials were included, involving 3,440 participants (DC = 1,829, MT = 1,611). There was a protective effect of closure in the risk of recurrent stroke (RR 0.43 [0.21–0.90]; p = 0.024; HR = 0.39 [0.19–0.83]; p = 0.014). The benefit of PFO closure was significant in patients with PFO associated with substantial right-to-left shunt or ASA. There were no differences in the risks of SAEs and major bleedings between the groups. The rate of new-onset AF was higher in the DC than in the MT arm (RR 4.46 [2.35–8.41]; p < 0.001). Successful device implantation and effective PFO closure were achieved in 96 and 91% of the patients respectively. Key Messages: In selected adult patients with PFO and history of cryptogenic stroke, the DC plus MT is more effective to prevent stroke recurrence and is associated with an increased risk of new-onset AF compared to the MT alone.

scholarly journals Safety and efficacy of endovascular patent foramen ovale closure: the first results of a Russian multicenter study

2020 ◽  
Vol 12 (6) ◽  
pp. 26-32
Author(s):  
D. V. Ognerubov ◽  
A. S. Tereshchenko ◽  
A. N. Samko ◽  
G. К. Arutyunyan ◽  
O. A. Sivakova ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Paradoxical Embolism ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
History Of ◽  
Pfo Closure

Patent foramen ovale (PFO) is detectable in more than 25% of the adult population and is generally clinically insignificant. However, it can be a cause of paradoxical embolism in some cases. Randomized trials indicate that endovascular PFO closure in patients with a history of cryptogenic stroke is an effective method for the secondary prevention of catastrophic brain damage.Objective: to study the safety and efficiency of endovascular PFO closure in young patients with a history of cryptogenic stroke.Patients and methods. Sixty-two patients, including (22 males and 40 females) women, underwent percutaneous PFO closure in May 2018 to March 2020. The patients' mean age was 37.4±7.6 years. The inclusion criteria were a prior cryptogenic ischemic stroke lasting less than 12 months and PFO with a high risk for paradoxical embolism (PFO concurrent with atrial septal aneurysm or hypermobility; PFO, ≥2 mm size; the presence of the Chiari network and/or the Eustachian valve).Results and discussion. The technical success of the operation was achieved in all cases. In 50 (80.6%) patients, the right chamber of the heart was completely isolated from the left one in the first 3 months. During the first year, the atria were also completely isolated in 10 (16.1%) patients. A left-to-right shunt persisted in 2 (3.2%) patents 12 months later. Two patients were found to have main procedural complications: one had perioperative atrial fibrillation and the other had pseudoaneurysm formation at the puncture site.Conclusion. Endovascular PFO closure is a safe and effective operation for the secondary prevention of recurrent ischemic stroke. In our study, blood shunting through the PFO was stopped in 96.6% of patients at less than 6 months after surgery, which suggests that there is a rapid and effective reduction in the risk of paradoxical embolism.

Percutaneous closure of patent foramen ovale for the secondary prevention of decompression illness in sports divers: mind the gap

2019 ◽  
pp. 625-632
Author(s):  
Martin Vanden Eede ◽  
◽  
An Van Berendoncks ◽  
Daniel De Wolf ◽  
Catherine De Maeyer ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Patent Foramen Ovale ◽  
Decompression Illness ◽  
Foramen Ovale ◽  
Tertiary Referral Center ◽  
Scuba Divers ◽  
Procedural Complications ◽  
History Of ◽  
Pfo Closure

Objective: To evaluate the efficiency of percutaneous patent foramen ovale (PFO) closure on the recurrence of decompression illness (DCI). Design: Retrospective, observational study with interview and questionnaire Setting: Tertiary referral center. Population: 59 scuba divers with a history of DCI who received a percutaneous PFO closure. Main outcome measurements: Questionnaire about health status, dive habits and recurrence of DCI after PFO closure. Results: A total of 59 divers with DCI were included. The most common manifestations of DCI were cutaneous or vestibular DCI. Procedural complications occurred in four patients but none with long-term consequences. Four patients had recurrence of DCI after closure during a 10-year follow-up. In three of these cases there was residual shunting, all of which were initially considered closed. The fourth patient had aggravating factors for his recurrent DCI. A quarter of the patients stated to have changed their diving habits. Four patients quit diving. Conclusion: Percutaneous PFO closure for secondary prevention of DCI is associated with few, but not negligible, complications. As a large portion of our cohort changed their diving habit after closure it is difficult to ascertain the efficiency of PFO closure for secondary prevention of DCI. However, the study shows that PFO closure does not fully protect against DCI, emphasizing that the relationship between PFO and DCI is but an association. As such it is imperative that divers be counseled to ensure they understand the risks as well as the benefits of percutaneous PFO closure in their specific case.

scholarly journals Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale

2021 ◽  
Author(s):  
X. Jin ◽  
Y. M. Hummel ◽  
W. T. Tay ◽  
J. F. Nauta ◽  
N. S. S. Bamadhaj ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Diastolic Function ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Foramen Ovale ◽  
Short And Long Term ◽  
Interatrial Shunt ◽  
Pfo Closure

Abstract Background Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure. Methods In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included. Results Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e’ ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure. Conclusion Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.

Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt following pneumonectomy

2021 ◽  
Vol 14 (10) ◽  
pp. e245699
Author(s):  
Matthew Steward ◽  
Anthony Hall ◽  
Ross Sayers ◽  
Christopher Dickson
Keyword(s):  
Patent Foramen Ovale ◽  
Transoesophageal Echocardiography ◽  
Foramen Ovale ◽  
Success Rates ◽  
Interatrial Communication ◽  
Population Prevalence ◽  
Contrast Enhanced ◽  
High Index Of Suspicion ◽  
Interatrial Shunt

A 62-year-old man presents with breathlessness 6 months following right pneumonectomy for lung adenocarcinoma. Previous investigations had not yielded a diagnosis and his symptoms were progressing. The patient described worsened symptoms when stood up (platypnoea), with profound hypoxia until laid supine (orthodeoxia). Platypnoea-orthodeoxia syndrome due to a right-to-left interatrial shunt was diagnosed on contrast-enhanced transoesophageal echocardiography with the patient undergoing successful percutaneous patent foramen ovale closure. Patent foramen ovale is often asymptomatic with a population prevalence of around 20%–30%. Anatomical shifts postpneumonectomy can open, or worsen a previously closed interatrial communication leading to right-to-left shunting of blood. Platypnoea-orthodeoxia is under-recognised, impairing quality of life and patient outcome. Investigations can be falsely reassuring, or poorly sensitive for the causative pathology. Percutaneous closure is safe with high success rates and this case highlights the need for a high index of suspicion for shunts, particularly in postpneumonectomy patients.

Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials

Angiology ◽  
2018 ◽  
Vol 70 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Simone Vidale ◽  
Filippo Russo ◽  
Carlo Campana ◽  
Elio Agostoni
Keyword(s):  
Medical Treatment ◽  
Patent Foramen Ovale ◽  
Transcatheter Closure ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Transient Ischemic Attacks ◽  
Foramen Ovale ◽  
End Points ◽  
Pfo Closure ◽  
New Onset

Cryptogenic strokes account for about 25% to 40% of total ischemic strokes, and 1 of the 3 of these have a patent foramen ovale (PFO). A meta-analysis concerning the effectiveness and safety of PFO closure in cryptogenic strokes or transient ischemic attacks (TIAs) was performed. We systematically searched Medline, Embase, and the Cochrane Library through April 2018. Eligible studies were randomized clinical trials. Primary and secondary end points were, respectively, stroke or TIA and stroke recurrences. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for all end points using fixed- and random-effects meta-analyses. Data were included from 6 trials involving 3560 patients. In the pooled analysis, PFO closure was superior to medical treatment for both primary (RR: 0.39; 95% CI: 0.18-0.82; P < .02) and secondary end points (RR: 0.58; 95% CI: 0.44-0.76; P < .001). Transcatheter closure significantly increased the risk of new-onset atrial fibrillation (AF; RR: 5.74; P < .001). Percutaneous closure is superior to medical treatment in reducing stroke and TIA recurrence, even if with a significant risk increasing for new-onset AF. These findings suggest that transcatheter closure is indicated in patients with cryptogenic strokes and large PFO.

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