scholarly journals Patent Foramen Ovale Closure: State of the Art

2020 ◽  
Vol 15 ◽  
Author(s):  
Joel P Giblett ◽  
Lynne K Williams ◽  
Stephen Kyranis ◽  
Leonard M Shapiro ◽  
Patrick A Calvert
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Recurrent Stroke ◽  
Adult Population ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Arterial Circulation ◽  
Arterial Embolisation ◽  
Randomised Control Trials ◽  
Paradoxical Embolus

Patent foramen ovale (PFO) is a common abnormality affecting between 20% and 34% of the adult population. For most people, it is a benign finding; however, in some people, the PFO can open widely to enable paradoxical embolus to transit from the venous to arterial circulation, which is associated with stroke and systemic embolisation. Percutaneous closure of the PFO in patients with cryptogenic stroke has been undertaken for a number of years, and a number of purpose-specific septal occluders have been marketed. Recent randomised control trials have demonstrated that closure of PFO in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke. After a brief overview of the anatomy of a PFO, this article considers the evidence for PFO closure in cryptogenic stroke. The article also addresses other potential indications for closure, including systemic arterial embolisation, decompression sickness, platypnoea–orthodeoxia syndrome and migraine with aura. The article lays out the pre-procedural investigations and preparation for the procedure. Finally, the article gives an overview of the procedure itself, including discussion of closure devices.

scholarly journals Patent Foramen Ovale Closure in 2019

2019 ◽  
Vol 14 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Joel P Giblett ◽  
Omar Abdul-Samad ◽  
Leonard M Shapiro ◽  
Bushra S Rana ◽  
Patrick A Calvert
Keyword(s):  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Recurrent Stroke ◽  
Adult Population ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Arterial Circulation ◽  
Paradoxical Embolus ◽  
Randomised Controlled ◽  
Pfo Closure

Patent foramen ovale (PFO) is a common abnormality affecting between 20% and 34% of the adult population. For most people it is a benign finding; however, in some the PFO can open widely, enabling a paradoxical embolus to transit from the venous to arterial circulation, which is associated with stroke and systemic embolisation. Percutaneous closure of PFO in patients with cryptogenic stroke has been undertaken for a number of years, and a number of purpose-specific septal occluders have been marketed. Recent randomised controlled trials have demonstrated that closure of PFO in patients with cryptogenic stroke is associated with reduced rates of recurrent stroke. After a brief overview of the anatomy of a PFO, this review considers the evidence for PFO closure in cryptogenic stroke. The review also addresses other potential indications for closure, including systemic embolisation, decompression sickness, platypnoea–orthodeoxia syndrome and migraine with aura. It lays out the pre-procedural investigations and preparation for the procedure. Finally, it gives an overview of the procedure itself, including discussion of closure devices.

scholarly journals Patent Foramen Ovale and Cryptogenic Stroke: Challenges in Diagnosis and Management

2021 ◽  
Vol 42 (3) ◽  
Author(s):  
Dhanang Ali Yafi ◽  
Azmi Azmi
Keyword(s):  
Patent Foramen Ovale ◽  
Adult Population ◽  
Management Strategies ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Arterial Circulation ◽  
Systemic Embolization ◽  
The Relationship ◽  
Pfo Closure

A patent foramen ovale (PFO) is a common disorder that affects between 20-34% of the adult population. This condition is a benign finding for most people. However, In some the PFO can open widely and enabling paradoxical embolism to transit from venous to arterial circulation, which is associated with stroke and systemic embolization. There are still unclear to date regarding the effectiveness of pharmacological anticoagulant therapy, defined as antithrombin or antiplatelet therapy, which has proven to be more beneficial for patients with PFO and cryptogenic stroke. In addition, surgical and transcutaneous PFO closure has been proposed for secondary prevention of stroke in patients with cryptogenic stroke with PFO. Both catheter-based and surgical modes of closure have been shown to reduce the incidence of subsequent embolism substantially. This review will discuss the evidence regarding the relationship between PFO and cryptogenic stroke and decision making for management strategies.

Current status of transcatheter closure of patent foramen ovale

2020 ◽  
Vol 128 (3) ◽  
pp. 296-306
Author(s):  
Igor F. Palacios
Keyword(s):  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Adult Population ◽  
Cryptogenic Stroke ◽  
Current Status ◽  
Diagnostic Tools ◽  
Foramen Ovale ◽  
Exercise Induced ◽  
Ischemic Attack

A patent foramen ovale (PFO) is a highly prevalent structure among the adult population. It allows the shunt of blood through the inter-atrial septum and has been associated with cryptogenic stroke, transient ischemic attack, significant right to left shunting resulting in resting and exercise-induced hypoxemia, platypnea orthodeoxia syndrome, and decompression sickness after scuba diving and migraines. Currently, transthoracic and transesophageal echocardiography and transcranial Doppler are the most important diagnostic tools, for the diagnosis of PFO. The sensitivity and specificity of the study depend on the modalities available: transthoracic (TTE), transesophageal (TEE), and transcranial Doppler (TCD), as well as the intravenous use of agitated saline and the site of injection.

Abstract TMP13: Baseline DWMRI Characteristics In Patients With Cryptogenic Stroke And Patent Foramen Ovale: Results From The Closure I Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Richard Jung ◽  
Benny Kim ◽  
Joseph Massaro ◽  
Anthony J Furlan
Keyword(s):  
Patent Foramen Ovale ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Patient Characteristics ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Multivariate Proportional Hazard

Background: Cryptogenic stroke may have several etiologies including paradoxical embolism through a patent foramen ovale (PFO). A cardiac source of embolism may be suggested by multiple infarcts, sometimes hemorrhagic, in different vascular distributions or a cortical wedge shaped infarct. We report the baseline diffusion weighted MRI (DWMRI) characteristics in patients with cryptogenic stroke and a patent foramen ovale (PFO) from the CLOSURE I trial. Methods: CLOSURE I compared device closure versus medical therapy for secondary prevention in patients with cryptogenic TIA or stroke and a PFO. Of 909 patients randomized, 562 patients demonstrated acute infarcts on baseline DWMRI and are included in this analysis. Multivariate proportional hazard Cox regression compared imaging subgroups with remaining randomized patients Results: Single infarcts were found in 62% of patients. Of these, 61% were anterior circulation, 30% posterior, and 8.5% were of uncertain territory. Of the anterior circulation infarcts, 40% were cortical, 36% subcortical, and 24% affected both the cortical and subcortical regions. Of the posterior circulation infarcts, 45% were thalamic or cerebellar. Of 562 patients, 18.5% had a single subcortical lesion <1.5cm in diameter and met the radiological definition of an acute lacunar infarct. Multiple infarcts were found in 38%. Infarcts in a single vascular territory were found in 23%, often in the anterior circulation (66%). Infarcts in multiple vascular territories were found in 15%. Hemorrhagic infarction was present in 9%. Adjusting for patient characteristics, no significant difference in 2 year rate of TIA, stroke or death was found compared to remaining randomized patients. Discussion: The specificity of infarct patterns for embolism in patients with cryptogenic stroke and a PFO is uncertain. We found no significant relationship between lacunar or subcortical infarction and the risk of recurrent TIA or stroke. Baseline infarct patterns on DWMRI in patients with cryptogenic stroke and PFO may not be useful in predicting recurrent stroke risk or determining best prevention therapy.

scholarly journals Patent Foramen Ovale in Fetal Life, Infancy and Childhood

2020 ◽  
Vol 8 (3) ◽  
pp. 25
Author(s):  
Bibhuti B. Das
Keyword(s):  
Patent Foramen Ovale ◽  
Life Support ◽  
Decompression Sickness ◽  
Cryptogenic Stroke ◽  
Anatomical Variations ◽  
Fetal Life ◽  
Foramen Ovale ◽  
Ventricular Assist ◽  
Echocardiographic Finding ◽  
Diagnostic Modalities

A patent foramen ovale (PFO) is a common, incidental echocardiographic finding in otherwise healthy and asymptomatic infants and children. However, a variety of clinical conditions have been ascribed to the presence of a PFO in childhood, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine, although the data on these are controversial and sometimes contradictory. This review discusses embryology and correlation with post-natal anatomy, anatomical variations of the atrial septum, diagnostic modalities in special circumstances of PFO associated clinical syndromes, and the role of PFO in congenital heart disease, pulmonary hypertension, dilated cardiomyopathy and heart failure in children who require an extracorporeal membrane oxygenator or ventricular assist device as life support.

scholarly journals Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

2019 ◽  
Vol 67 (2) ◽  
pp. 93-102
Author(s):  
Krzysztof Dziewiatowski ◽  
Piotr Siermontowski
Keyword(s):  
Left Atrium ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Adult Population ◽  
Venous Blood ◽  
Arterial System ◽  
Foramen Ovale ◽  
Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

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