scholarly journals Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided By Transoesophageal Echocardiography In Patients With Cryptogenic Stroke: A Retrospective Study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Caichan Xie ◽  
Jiao Yi ◽  
...  
Keyword(s):  
Large Volume ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Foramen Ovale ◽  
Short Term ◽  
Group A ◽  
Group B

Abstract Background: Patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and data on regular postsurgical follow-up with the transthoracic ultrasound foaming test (UFT) is rare. Thus, this study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs.Methods: Clinical records, echocardiographic data, and UFT results of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n=21), small volume of right-to-left shunts; group B (n=22), moderate volume of right-to-left shunts; and group C (n=32), large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery.Results: No significant differences in preoperative data, length of hospital stay, or operative time were noted between the groups (p>0.05). The length of the PFO and diameter of the occluder differed between the groups as follows: group A=group B<group C (p<0.001). One patient in group C developed recurrent stroke 11 months postoperatively. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups as follows: group A=group B<group C (p<0.05). A preoperative large-volume shunt was negatively associated with a negative UFT rate 12 months postoperatively (RR=0.255, p=0.003).Conclusions: In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. Although the positive UFT rate in our study gradually decreased, some patients still had positive UFT results 12 months postoperatively. Preoperatively, a large volume of right-to-left shunts and a longer PFO were two risk factors for positive UFT results postoperatively. Further studies are required to clarify the relationship between positive UFT results postoperatively and stroke recurrence.

scholarly journals Short-Term Results of Percutaneous Closure of Patent Foramen Ovale Guided by Transoesophageal Echocardiography in Patients with Cryptogenic Stroke: A Retrospective Study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Xiaoqi Wang ◽  
Zelun Chen ◽  
...  
Keyword(s):  
Large Volume ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Stroke Recurrence ◽  
Foramen Ovale ◽  
Short Term ◽  
Group A ◽  
Group B

Abstract Background Patent foramen ovale (PFO) is a risk factor for cryptogenic stroke (CS), and interventional therapy for PFO can reduce the recurrence rate of CS. However, interventional therapies are primarily guided by X-ray imaging, and regular postsurgical follow-up with transthoracic ultrasound foaming test (UFT) is rarely performed. Thus, this study aimed to assess the short-term (1 year) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular UFTs. Methods Clinical records, echocardiographic data, and UFT results of 27 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A (n = 4), small volume of right-to-left shunts; group B (n = 8), moderate volume of right-to-left shunts; and group C (n = 15), large volume of right-to-left shunts. All patients were treated using an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 1 year post-surgery. Results No significant differences in preoperative clinical data, echocardiographic data, or operative time were noted between the groups (P > 0.05). The length of the PFO and the diameter of the occluder differed between the groups as follows: group A = group B < group C (p < 0.05). One year postoperatively, there was no stroke recurrence. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. The positive UFT rate gradually decreased postoperatively, and 50% of patients still had a positive UFT 11.75 months after surgery. The positive UFT rate 1 year postoperatively differed between the groups as follows: group A = group B < group C (p = 0.010). A preoperative large-volume shunt was negatively associated with a negative UFT rate 1 year postoperatively (b=-2.118, RR = 0.120, p = 0.002). Conclusion In patients with PFO and CS, interventional therapy guided by TEE led to excellent short-term (1 year) outcomes. The positive UFT rate gradually decreased within 1 year of surgery. Preoperatively, a large volume of right-to-left shunts and large occluders were two risk factors for positive UFT results after surgery. Further studies are required to clarify the relationship between positive UTF results postoperatively and stroke recurrence.

scholarly journals Short-term results of percutaneous closure of patent foramen ovale guided by transoesophageal echocardiography in patients with cryptogenic stroke: A retrospective study

2021 ◽  
Author(s):  
Yilong Guo ◽  
Zhensu Shi ◽  
Yin Zheng ◽  
Caichan Xie ◽  
Jiao Yi ◽  
...  
Keyword(s):  
Large Volume ◽  
Recurrent Stroke ◽  
Cryptogenic Stroke ◽  
Length Of Hospital Stay ◽  
Transoesophageal Echocardiography ◽  
Interventional Therapy ◽  
Stroke Recurrence ◽  
Short Term ◽  
Amplatzer Occluder ◽  
Group A

Background: This study aimed to assess the short-term (12 months) results of PFO occlusion guided by transoesophageal echocardiography (TEE) and the results of regular transthoracic ultrasound foaming test (UFT). Methods: Data of 75 patients who underwent interventional therapy for PFO and CS were retrospectively analysed. The patients were grouped according to their preoperative UFT results: group A, small volume of right-to-left shunts; group B, moderate volume of right-to-left shunts; and group C, large volume of right-to-left shunts. All patients were treated with an Amplatzer occluder under TEE guidance. UFT follow-up was conducted regularly until 12 months after surgery. Results: No remarkable differences in preoperative data, length of hospital stay, or operative time were noted between the groups. Length of the PFO and diameter of the occluder differed between the groups: group A=group Bp<0.001). One patient in group C developed recurrent stroke 11 months postoperatively. Two patients in group C developed atrial arrhythmia, which improved after 3 months of antiarrhythmic treatment. However, 19 patients still had positive UFT results 12 months postoperatively. Furthermore, the positive UFT rate 12 months postoperatively differed between the groups: group A=group Bp<0.05). Conclusions: In patients with PFO and CS, interventional therapy guided by TEE could lead to satisfactory short-term (12 months) outcomes. A longer PFO and preoperative large-volume shunt were negatively associated with a negative UFT rate 12 months postoperatively. Further studies are required to clarify the relationship between positive UFT results postoperatively and stroke recurrence.

Abstract WP264: Frequency of Hypercoagulability in Patients With Embolic Stroke of Undetermined Source and Patent Foramen Ovale

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Liu ◽  
Srikant Rangaraju ◽  
Alexander Duncan ◽  
Samir Belagaje ◽  
Trina Belair ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Embolic Stroke ◽  
Composite Outcome ◽  
Foramen Ovale ◽  
Primary Mechanism ◽  
Detailed Evaluation ◽  
D Dimer

Introduction: Patent foramen ovale (PFO) is more commonly found in patients with cryptogenic stroke and paradoxical embolism is commonly assumed to be the primary mechanism. Our objective was to determine the frequency of hypercoagulability in cryptogenic stroke patients and PFO. Methods: Consecutive patients with embolic stroke of undetermined source (ESUS) seen at the Emory Clinic from January 1, 2017 to June 30, 2019 who underwent echocardiogram with bubble study and markers of coagulation and hemostatic activation (MOCHA) testing (serum d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer) were included; abnormal MOCHA was defined as ≥ 2 elevated markers. Venous thromboembolism, malignancy, other defined hypercoagulable state, and the composite outcome were assessed at routine follow-up and compared across groups based on PFO status. Results: Of 172 patients (mean age 63 ± 16 years, 60% female), 40 (23%) had a PFO. Compared to the PFO- group, the PFO+ group was younger (p=<0.001), less likely to have hypertension (p<0.001) and diabetes (p=0.011), and had a higher ROPE score (p=0.007) (Table 1). There was no difference in the frequency of abnormal MOCHA between groups and the composite outcome was less frequent in PFO+ versus PFO- patients (p=0.017). In the subgroup of patients <60 years old, there was no difference in the frequency of abnormal MOCHA and the composite outcome. Conclusion: Hypercoagulability as measured by MOCHA was not associated with the presence of PFO in ESUS patients. Based on our results, ESUS patients should undergo a detailed evaluation for alternative causes of stroke other than paradoxical embolism.

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.

Tethered cord syndrome in adults

2011 ◽  
Vol 15 (3) ◽  
pp. 258-270 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Short Term ◽  
Group A ◽  
The Mean ◽  
Group B

Object The treatment of tethered cord syndromes in adults is discussed regarding the natural history and surgical indications. The author analyzes data obtained in patients who were diagnosed with a tethered cord in adulthood and either underwent surgical or conservative therapy between 1991 and 2009. Methods Since 1991, data obtained in 2515 patients with spinal cord pathologies were entered into the spinal cord database, and prospective follow-up was performed through outpatient visits and questionnaires. Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. The tethering effect was caused either by a split cord malformation, a thick filum terminale, a conus medullaris lipoma with extradural extension, or various combinations of these mechanisms. The mean age of the patients was 46 ± 13 years (range 23–74 years) and the mean follow-up duration was 61 ± 62 months. Two groups were distinguished based on the absence (Group A, 43 patients) or presence (Group B, 42 patients) of an associated lipoma or dysraphic cyst (that is, dermoid, epidermoid, or neurenteric cyst). Surgery was recommended for patients with symptoms only. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. Results For all patients, pain was the most common major complaint. Severe neurological deficits were rare. In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. Among individuals who did not undergo surgery, 17 patients refused surgery and 25 patients underwent recommended conservative treatment. Short-term postoperative results indicated a significant improvement of pain and a stabilization of neurological symptoms. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. The benefit of secondary operations in Group B was limited, with eventual clinical deterioration occurring in all patients within 10 years. For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Twenty-eight patients remained in stable clinical condition. Only 5 of the conservatively treated patients experienced clinical deterioration over time; in 4 of these individuals with deterioration, surgery had been recommended but was refused by the patient. The clinical recurrence rate in all conservatively treated patients was 21% after 10 years. With a recommendation for surgery this figure rose to 47% within 5 years. Conclusions Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. A conservative approach is warranted, however, in adult patients without neurological deficits. Revision surgery in patients with complex dysraphic lesions should be performed in exceptional cases only.

scholarly journals Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases

2015 ◽  
Vol 86 (6) ◽  
pp. 1078-1084 ◽  
Author(s):  
Mikaeil Mirzaali ◽  
Maureen Dooley ◽  
Dylan Wynne ◽  
Nina Cooter ◽  
Lorraine Lee ◽  
...  
Keyword(s):  
Transient Ischaemic Attack ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Long Term Follow Up ◽  
Ischaemic Attack

Closure of patent foramen ovale in “cryptogenic” stroke: Has the story come to an end?

2018 ◽  
Vol 13 (3) ◽  
pp. 240-242 ◽  
Author(s):  
Jean-Louis Mas ◽  
Gilles Chatellier
Keyword(s):  
Antiplatelet Therapy ◽  
Patent Foramen Ovale ◽  
Oral Anticoagulants ◽  
Cryptogenic Stroke ◽  
Stroke Recurrence ◽  
Foramen Ovale ◽  
Permanent Disability ◽  
Increased Risk ◽  
Procedural Complications

Contrasting with three randomized trials that failed to show any superiority of patent foramen ovale closure over antithrombotic therapy, two trials recently reported lower rates of stroke recurrence among patients assigned to patent foramen ovale closure than among those assigned to antiplatelet therapy. In addition, one of the initially negative trials concluded in favor of patent foramen ovale closure after an extended follow-up period. A better selection of patients, the use of reference treatment groups that included patients who received antiplatelet therapy alone (rather than antiplatelet drugs or oral anticoagulants, according to physician preference), and a longer follow-up of patients, may explain the divergent findings across studies. Procedural complications were reported in 1.5% to 5.9% of the patients, none of which led to permanent disability or death. Patent foramen ovale closure was associated with an increased risk of new-onset atrial fibrillation in several studies and of venous thromboembolism in one study.

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.

scholarly journals Short-term outcome of Manual Thrombus Aspiration for patients Undergoing Primary PCI for Acute STEMI Showing LargeThrombus burden

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M N Penjameen ◽  
E M Elfekky ◽  
R R Elias ◽  
A I Nassar
Keyword(s):  
Systolic Function ◽  
P Value ◽  
Primary Pci ◽  
Thrombus Aspiration ◽  
Culprit Lesion ◽  
Short Term ◽  
St Segment ◽  
Group A ◽  
Group B

Abstract Background Thrombus aspiration (TA) might have a potential role in STEMI patients with heavy thrombus burden. The objective of several prospective trials whether routine TA in STEMI patients, contributes to a reduced mortality. After the first promising results, mainly based on the single center (TAPAS trial), results of the largest randomized trials to date (TASTE) study and (TOTAL) study, have not shown any significant differences in all-cause mortality, re-hospitalizations or stent thrombosis after a maximum of one-year follow-up period Objectives The aim of this prospective study is to study the in-hospital & short term out-come of using manual thrombus aspiration in STEMI patients undergoing primary PCI & showing large thrombus burden. Results The study included 209 patients referred to (CCU) of (Ain Shams University hospitals) with diagnosis of STEMI, who had under-gone primary PCI, with evidence of heavy thrombus burden . All the patients received DAPT, 99% had received GPIIbIIIa antagonists. The patients were divided into 2 groups: group (A) included 73 patients, who had under-gone manual thrombus aspiration followed by PCI to culprit lesion +/- other vessels & and group (B) included 136 patients, who had under-gone primary PCI of culprit lesion+/- other vessels, using the standard technique, without thrombus aspiration, within the period from 11/2016 till 7/2018(21 months),and they were followed up during hospital stay & for one month following hospital discharge. No stents were used in 13.7% of group (A), but no stents were used on 3.7% of group (B) (p value= 0.007). TIMI III flow had been achieved in 94.5% of group (A), 80.1% of group (B)(p value = (0.020) . MBG 3 had been achieved in 82.2% of group (A), 58.1% of group (B) . ST-segment resolution &gt; 70% had been achieved in 8.2% of group (A), that hadnot been achieved in group (B) (p value =0.003). Mortality(among MACE) was the only event detected (p value 0.026). Follow up MACE were statisticalLy significant results (p value=0.022) . Statistically highly significant results regarding, LV systolic function EF %, p vaue= 0.001, had been achieved . Conclusion In STEMI patients with evidence of heavy thrombus burden, a strategy of manual aspiration thrombectomy is valuable in reducing index hospitalization mortality, and 1 month follow-up rates of mortality, TIMI flow, better MBG, ST-segment resolution, in addition to left ventricular systolic function .

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