scholarly journals Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention

2018 ◽  
Vol 3 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Kristy Yuan ◽  
Scott Eric Kasner
Keyword(s):  
Patient Selection ◽  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Clinical Decision Making ◽  
Cryptogenic Stroke ◽  
Clinical Decision ◽  
Current Evidence ◽  
Secondary Stroke Prevention ◽  
Foramen Ovale ◽  
Pfo Closure

The patent foramen ovale (PFO), given its high prevalence in the general population and especially in patients with cryptogenic stroke, has long generated investigation and debate on its propensity for stroke by paradoxical embolism and its management for stroke prevention. The pendulum has swung for percutaneous PFO closure for secondary stroke prevention in cryptogenic stroke. Based on a review of current evidence, the benefit from PFO closure relies on careful patient selection: those under the age of 60 years with few to no vascular risk factors and embolic-appearing stroke deemed cryptogenic after thorough evaluation. As these data look towards influencing guideline statements and device approvals in the future, patient selection remains the crucial ingredient for clinical decision making and future trials.

scholarly journals Diagnostic Accuracy of Contrast Transthoracic Echocardiography, Contrast Transcranial Doppler and Transesophageal Echocardiography in Patients Undergoing Patent Foramen Ovale Closure

2021 ◽  
Author(s):  
Kaijing Wang ◽  
Xianda Ni ◽  
Yuxin Wu ◽  
Chen Chen
Keyword(s):  
Diagnostic Accuracy ◽  
Cardiac Catheterization ◽  
Patent Foramen Ovale ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Foramen Ovale ◽  
Group A ◽  
Group B ◽  
Pfo Closure

Abstract Purpose: To compare diagnostic accuracy of cTTE, cTCD and TEE in patients undergoing patent foramen ovale closure (PFO) so as to provide evidence for clinical decision-making.Methods: The clinical data of 140 patients with cerebral infarction or migraine who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO in our hospital were analyzed retrospectively, including clinical baseline, data of cTTE, cTCD and TEE.Results: Patients who successfully underwent PFO closure or whose right cardiac catheterization results showed no PFO were divided into group A and group B, respectively. The differences of the shunt in cTTE and cTCD, the diameter of PFO in TEE and the appearance of bubbles in cTTE were compared. The results showed that the proportion of medium-large shunt in group A was significantly higher than group B in resting cTCD, post-Valsalva cTCD and total cTCD respectively (67.35% VS 42.86%，P=0.004；100% VS 71.42%，P=0.0003；81.63% VS 51.43%，P=0.002). The proportion of medium-large shunt in group A was higher than group B in cTCD (75.90% VS 19.35%，P＜0.001). The diameters of PFO of group A were larger than group B in TEE (2.18±0.78 VS 1.19±0.78，P＜0.001). Take the successful PFO closure as the state variable. The ROC curves of cTTE, cTCD and TEE were made, and the results showed that cTCD and TEE had better sensitivity and specificity. The proportion of appearance of bubbles within 5 cardiac cycles in cTTE in group A was significantly higher than group B (73.47% VS 42.86%，P=0.005).Conclusions: For the patients with PFO to be occluded, the success rate of operation could be improved by selecting patients with larger shunt, larger diameter of foramen ovale and shorter interval in the appearance of bubbles. Otherwise, there was perhaps no PFO. cTCD and TEE had better diagnostic value for PFO closure than that of cTTE.

Hole in My Heart

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Antiplatelet Therapy ◽  
Medical Therapy ◽  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Foramen Ovale ◽  
Pfo Closure

The presence of a patent foramen ovale (PFO) is associated with cryptogenic stroke, especially in young patients. Medical therapy for patients with stroke and PFO includes antiplatelet therapy or anticoagulation. PFO closure is not routinely recommended for stroke prevention.

Secondary Stroke Prevention in Patients with Cryptogenic Stroke and Patent Foramen Ovale

2008 ◽  
Vol 3 (1) ◽  
pp. 129-141
Author(s):  
Robert Belvis ◽  
Joan Marti-Fabregas ◽  
Dolores Cocho ◽  
Josep L. Marti-Vilalta
Keyword(s):  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Secondary Stroke Prevention ◽  
Foramen Ovale

Patent foramen ovale

2020 ◽  
Vol 20 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Vafa Alakbarzade ◽  
Tracey Keteepe-Arachi ◽  
Nazia Karsan ◽  
Robin Ray ◽  
Anthony C Pereira
Keyword(s):  
Antiplatelet Therapy ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Peripheral Ischaemia ◽  
New Evidence ◽  
Pfo Closure

Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly selected population of stroke survivors: those aged 60 years or younger with a cryptogenic stroke syndrome, a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation. They benefit from percutaneous PFO closure in addition to antiplatelet therapy, rather than antiplatelet therapy alone. Current evidence does not support PFO closure in the treatment of migraine.

Patent foramen ovale closure for secondary stroke prevention

2019 ◽  
Vol 40 (28) ◽  
pp. 2339-2350 ◽  
Author(s):  
Mohamad Alkhouli ◽  
Horst Sievert ◽  
David R Holmes
Keyword(s):  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Randomized Clinical Trials ◽  
Cryptogenic Stroke ◽  
Current Data ◽  
Diagnostic Tools ◽  
Foramen Ovale ◽  
Future Landscape ◽  
Pfo Closure ◽  
Open Issues

Abstract Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke is gaining momentum after the recent publication of four randomized clinical trials suggesting its benefit. This article provides a contemporary overview of the anatomy and pathophysiology of PFO, the available diagnostic tools for the assessment and risk stratification of PFO, and the current and future landscape of PFO closure devices and their optimal utilization. It also summarizes the current data on PFO closure for stroke prevention, and discusses the remaining open issues in the field of PFO closure.

Secondary Stroke Prevention in Patients with Cryptogenic Stroke and Patent Foramen Ovale

2006 ◽  
Vol 3 (2) ◽  
pp. 129-141 ◽  
Author(s):  
Robert Belvis ◽  
Joan Marti-Fabregas ◽  
Dolores Cocho ◽  
Josep L. Marti-Vilalta
Keyword(s):  
Stroke Prevention ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Secondary Stroke Prevention ◽  
Foramen Ovale

Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations

2020 ◽  
Vol 18 (2) ◽  
pp. 135-150
Author(s):  
Harsha S. Nagarajarao ◽  
Chandra P. Ojha ◽  
Archana Kedar ◽  
Debabrata Mukherjee
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Narrow Channel ◽  
Paradoxical Embolism ◽  
Current Evidence ◽  
Foramen Ovale ◽  
The Right ◽  
The Relationship ◽  
Current Guidelines

: Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. : In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO’s for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.

scholarly journals Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yangyang Han ◽  
Xiquan Zhang ◽  
Fengwei Zhang
Keyword(s):  
Body Weight ◽  
Contrast Agents ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Percutaneous Closure ◽  
X Rays ◽  
Foramen Ovale ◽  
Pfo Closure

Abstract Background Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12–68 years old) and 65.42 ± 9.70 kg (40–95 kg), respectively. All patients only received aspirin (3–5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

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