Magnetic Resonance–Guided Placement of Atrial Septal Closure Device in Animal Model of Patent Foramen Ovale

Abstract Background Percutaneous closure of patent foramen ovale (PFO) is recommended for patients presenting with PFO-related stroke. Acute high-grade conduction disturbances occurring during PFO closure procedure have not been previously reported. Case summary We describe for the first time a case of reversible complete atrioventricular block which occurred during closure of a PFO. Discussion We hypothesized that the block was the result of atrioventricular node compression—likely caused by the right-atrial disc of the 35-mm PFO closure device. We suggest implanting smaller devices in order to prevent atrioventricular conduction disturbances.

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Patent Foramen Ovale Closure Decreases the Incidence but Not the Size of New Brain Infarction on Magnetic Resonance Imaging: An Analysis of the REDUCE Trial

Stroke ◽

10.1161/strokeaha.121.034451 ◽

2021 ◽

Author(s):

Steven R. Messé ◽

Guray Erus ◽

Michel Bilello ◽

Christos Davatzikos ◽

Grethe Andersen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Atrial Fibrillation ◽

Magnetic Resonance ◽

Patent Foramen Ovale ◽

Infarct Volume ◽

Brain Infarction ◽

Foramen Ovale ◽

Resonance Imaging ◽

Silent Mri

Background and Purpose: Randomized patent foramen ovale closure trials have used open-label end point ascertainment which increases the risk of bias and undermines confidence in the conclusions. The Gore REDUCE trial prospectively performed baseline and follow-up magnetic resonance imaging (MRIs) for all subjects providing an objective measure of the effectiveness of closure. Methods: We performed blinded evaluations of the presence, location, and volume of new infarct on diffusion-weighted imaging of recurrent clinical stroke or new infarct (>3 mm) on T2/fluid attenuated inversion recovery from baseline to follow-up MRI at 2 years, comparing closure to medical therapy alone. We also examined the effect of shunt size and the development of atrial fibrillation on infarct burden at follow-up. Results: At follow-up, new clinical stroke or silent MRI infarct occurred in 18/383 (4.7%) patients who underwent closure and 19/177 (10.7%) medication-only patients (relative risk, 0.44 [95% CI, 0.24–0.81], P =0.02). Clinical strokes were less common in closure patients compared with medically treated patients, 5 (1.3%) versus 12 (6.8%), P =0.001, while silent MRI infarcts were similar, 13 (3.4%) versus 7 (4.0%), P =0.81. There were no differences in number, volumes, and distribution of new infarct comparing closure patients to those treated with medication alone. There were also no differences of number, volumes, and distribution comparing silent infarcts to clinical strokes. Infarct burden was also similar for patients who developed atrial fibrillation and for those with large shunts. Conclusions: The REDUCE trial demonstrates that patent foramen ovale closure prevents recurrent brain infarction based on the objective outcome of new infarcts on MRI. Only clinical strokes were reduced by closure while silent infarctions were similar between study arms, and there were no differences in infarct volume or location comparing silent infarcts to clinical strokes. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT00738894.

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Faculty Opinions recommendation of Clinical and brain magnetic resonance imaging follow-up after percutaneous closure of patent foramen ovale in patients with cryptogenic stroke.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1103744.559862 ◽

2008 ◽

Author(s):

Larry Latson

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Brain Magnetic Resonance Imaging ◽

Percutaneous Closure ◽

Foramen Ovale ◽

Resonance Imaging

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May-Thurner Syndrome as a Rare Cause of Paradoxical Embolism in a Patient with Patent Foramen Ovale

Case Reports in Cardiology ◽

10.1155/2018/3625401 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Dominika M. Zoltowska ◽

Guramrinder Thind ◽

Yashwant Agrawal ◽

Vishal Gupta ◽

Jagadeesh Kumar Kalavakunta

Keyword(s):

Magnetic Resonance ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Iliac Vein ◽

Paradoxical Embolism ◽

Common Iliac Vein ◽

Foramen Ovale ◽

Anatomical Variant ◽

Vein Thrombosis ◽

Ischemic Attack

May-Thurner syndrome is an underrecognized anatomical variant that can lead to increased propensity for venous thrombosis in the lower extremities. We present a case of a 67-year-old female who presented with transient ischemic attack. Initial workup including CT scan of the head, MRI scan of the head, and magnetic resonance angiogram of the head and neck was unremarkable. A transthoracic echocardiogram with bubble study was also normal. Subsequently, a transesophageal echocardiogram was performed that revealed a patent foramen ovale with right-to-left shunt. Lower extremity duplex venous ultrasound showed no evidence of deep vein thrombosis. However, magnetic resonance venogram of the pelvis showed compression of the left common iliac vein just after its origin suggestive of May-Thurner syndrome. Hence, May-Thurner syndrome was recognized as the probable source of paradoxical embolism causing transient ischemic attack in this patient.

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