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Bai H, Cho LD, Cooke PV, Ting W. Endovascular Intervention for May-Thurner Syndrome in a Pregnant Patient with a Patent Foramen Ovale and Paradoxical Embolism. Vasc Endovascular Surg 2022; 56:517-520. [PMID: 35354415 DOI: 10.1177/15385744221086135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
May-Thurner syndrome (MTS) is a known structural risk factor for deep vein thrombosis (DVT) and embolism. In patients with a patent foramen ovale (PFO), emboli originating from the deep veins are able to paradoxically reach the systemic circulation via the PFO, consequently resulting in transient ischemic attacks (TIA) or stroke.We report the case of a 31-year-old pregnant woman, with a recent history of TIA, who presented with chronic bilateral numbness, pain, and swelling in the lower extremities. On imaging, she was found to have a PFO and MTS. Her pregnancy was subsequently terminated. This decision was made independently by the patient. Her care team did not advise her to terminate her pregnancy as there was no specific medical reason to do so. However, the patient was in significant physical pain and distress and ultimately was not comfortable continuing with the pregnancy. This highlights the complex, multifactorial decision-making process that pregnant patients with comorbid health conditions undertake. The patient then underwent transcatheter PFO closure and stents were placed bilaterally in the left and right common iliac veins. Following the stent procedure, lower extremity symptoms swiftly resolved, allowing the patient to significantly improve her ability to ambulate. There have been no signs of TIA since her procedures, and her venous symptoms have been stable.In patients with TIA or stroke from a paradoxical embolism, MTS should be considered as a potential etiology. Endovascular intervention to treat the underlying MTS should also be considered to decrease the risk of recurrent DVT and embolism.
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Affiliation(s)
- Halbert Bai
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Logan D Cho
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter V Cooke
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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52
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Al-Hajjaj M, Kanjo M, Almoshantaf MB, Swed S, Ezzdean W. Cerebrovascular accident after transurethral resection of the prostate: A rare complication. Int J Surg Case Rep 2022; 93:106948. [PMID: 35364387 PMCID: PMC8971614 DOI: 10.1016/j.ijscr.2022.106948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Benign prostatic hyperplasia is considered a worldwide disease among males in middle age. Transurethral resection of the prostate (TURP) is a wide used intervention for this condition. A few reports mentioned cerebrovascular accidents after TURP. PRESENTATION OF CASE A 65-year-old male presented with recurrent urinary retention in the past two years. Clinical examination showed a full urinary bladder with abdominal discomfort. Abdominal ultrasound revealed an enlarged prostate (90 ml) with approximately 500 ml of urine. After that, we performed transurethral resection of the prostate (TURP). The surgery was uneventful. After three days of discharge, he presented with a loss of vision in the left eye and left lower limb pain. Computed tomography of the brain showed right occipital lobe infarction. Ultrasound of the left lower limb revealed deep venous thrombosis. Echocardiography showed a patent foramen ovale. As a result, he had deep venous thrombosis with patent foramen ovale that led to infarction. We started with anticoagulants for two weeks. Later, he reclaimed his vision completely. CLINICAL DISCUSSION Cerebral vascular accidents are a rare complication of transurethral resection of the prostate. Early recognition and diagnosis of this condition will lead to good results. Searching for cardiac anomalies is the first step to reaching the diagnosis. CONCLUSION Urologists should suspect cardiac anomalies in patients who underwent TURP surgery and develop cerebrovascular accidents. Collaboration with other specialties is considered basic to help with this complication.
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Affiliation(s)
- Maher Al-Hajjaj
- Department of Urology, Aleppo University Hospital, Aleppo, Syria.
| | - Muhamad Kanjo
- Department of Internal Medicine, Aleppo University Hospital, Aleppo, Syria
| | | | - Sarya Swed
- Faculty of Human Medicine, Aleppo University, Aleppo, Syria
| | - Weaam Ezzdean
- Department of Urology, Ibn Al-Nafees Hospital, Damascus, Syria
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Different patterns of white matter lesions among patent foramen ovale, atherosclerotic cerebral small vessel disease and cerebral venous thrombosis. J Thromb Thrombolysis 2022; 53:911-925. [PMID: 34985685 DOI: 10.1007/s11239-021-02624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 01/10/2023]
Abstract
None of studies are available on the predictive ability of white matter lesions (WMLs) among patent foramen ovale (PFO), atherosclerotic cerebral small vessel disease (aCSVD) and cerebral venous thrombosis (CVT). Herein, we aimed to uncover the difference of the WML patterns among the three disease entities in a real-world setting to provide clinical references for predicting probable WML etiologies. We retrospectively reviewed data from consecutive patients with imaging-confirmed PFO, aCSVD, or CVT enrolled from 2014 through 2020. WMLs presented on fluid-attenuated inversion recovery (FLAIR) maps were compared among the three groups based on visual evaluation, Fazekas and modified Scheltens scales. Propensity score matching (PSM) was implemented to correct age and hypertension differences among groups. A total of 401 patients were entered into final analysis, including PFO (n = 112, 46.5 ± 12.8 years), aCSVD (n = 177, 61.6 ± 11.8 years) and CVT (n = 112, 37.4 ± 11.4 years) groups. In this study, WMLs occurred in all of the involved patients in the three groups (100%), which were independent to age, symptom onset and disease durations. On visual evaluation, PFO-WMLs were multiple spots distributed asymmetrically around bilateral subcortex and peri-ventricles. aCSVD-WMLs were dots or sheets distributed symmetrically in subcortex and peri-ventricles, and often coexisted with lacunar infarctions. CVT-WMLs were cloud-like around bilateral peri-ventricles, and enabled to attenuate after recanalization. Fazekas and modified Scheltens scores of PFO-WML vs. aCSVD-WML were significantly different even after being matched by 1:2 PSM (all p < 0.05), meaning that the WML burden in aCSVD was considerably heavier than that in PFO. WML patterns induced by PFO, aCSVD and CVT were obviously different, and were therefore of great clinical significance to preliminarily predict and differentiate the three diseases entities.
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54
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Wilfling S, Kilic M, Tsoneva B, Freyer M, Olmes D, Wendl C, Linker R, Schlachetzki F. Recurrent vertebrobasilar strokes and transient-ischemic attacks with challenging workup: Case report. Brain Circ 2022; 8:50-56. [PMID: 35372722 PMCID: PMC8973451 DOI: 10.4103/bc.bc_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/06/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Detecting the stroke etiology in young patients can be challenging. Among others, determining causality between ischemic stroke and patent foramen ovale (PFO) remains a complicated task for stroke neurologists, given the relatively high prevalence of PFOs. Thorough diagnostic workup to identify incidental vascular risk factors and rare embolic sources is crucial to avoid premature PFO closure suggesting successful secondary stroke prevention. In this paper, we report on a 38-year-old patient with recurrent vertebrobasilar territory, especially right posterior inferior cerebellar artery (PICA) territory strokes. After the initial suspicion of a left vertebral artery (VA) dissection was not confirmed by ultrasound and magnetic resonance imaging (MRI) and other major risk factors were excluded, a PFO was detected and closed. Successful PFO closure was confirmed by transesophageal echocardiography, yet recurrent transient-ischemic attacks and vertebrobasilar strokes, especially during nighttime and in the early morning, occurred despite various antiplatelet and antithrombotic regimes and a persistent right-to-left shunt was detected by bubble transcranial Doppler. Finally, MRI after another vertebrobasilar infarction detected a transient left VA occlusion that finally led to the diagnosis of a left VA pseudoaneurysm from an incident emboligenic dissection in the atlas segment. This pseudoaneurysm together with an anatomical variant of the right PICA originating with the right anterior inferior cerebellar artery from the basilar artery finally explained the recurrent ischemic events of the patient. After successful treatment with coil occlusion, the patient suffered no further stroke and recovered completely. In summary, stroke in the young remains a diagnostic challenge. The incidental finding of a PFO should not deter from thorough stroke workup and the follow-up of these patients including PFO closure verification should be performed under the guidance of vascular neurologists.
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55
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Lombardi M, Del Buono MG, Princi G, Locorotondo G, Lombardo A, Vergallo R, Montone RA, Burzotta F, Trani C, Crea F, Sanna T. Platypnoea-Orthodeoxia Syndrome as an Uncommon Cause of Dyspnoea: a Literature Review. Intern Med J 2021; 52:921-925. [PMID: 34935270 PMCID: PMC9321992 DOI: 10.1111/imj.15669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Abstract
Platypnoea-Orthodeoxia syndrome (POS) is an uncommon but challenging clinical condition characterized by positional dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position that improve in the supine position. Since its first description, many cases have been reported and many conditions have been associated with this syndrome. Herein we review the clinical presentation, pathophysiology, diagnostic work-up and management of patients with POS, aiming at increasing the awareness of this often misdiagnosed condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marco Lombardi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Giuseppe Princi
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Tommaso Sanna
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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56
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Paolucci M, Vincenzi C, Romoli M, Amico G, Ceccherini I, Lattanzi S, Bersano A, Longoni M, Sacco S, Vernieri F, Pascarella R, Valzania F, Zedde M. The Genetic Landscape of Patent Foramen Ovale: A Systematic Review. Genes (Basel) 2021; 12:genes12121953. [PMID: 34946902 PMCID: PMC8700998 DOI: 10.3390/genes12121953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022] Open
Abstract
Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest the involvement of the Notch pathway and other cardiac transcription factors (GATA4, TBX20, NKX2-5) in Foramen Ovale closure. This review evaluates the contribution of genetic alterations in PFO development. We systematically reviewed studies that assessed rare and common variants in subjects with PFO. The protocol was registered with PROSPERO and followed MOOSE guidelines. We systematically searched English studies reporting rates of variants in PFO subjects until the 30th of June 2021. Among 1231 studies, we included four studies: two of them assessed the NKX2-5 gene, the remaining reported variants of chromosome 4q25 and the GATA4 S377G variant, respectively. We did not find any variant associated with PFO, except for the rs2200733 variant of chromosome 4q25 in atrial fibrillation patients. Despite the scarceness of evidence so far, animal studies and other studies that did not fulfil the criteria to be included in the review indicate a robust genetic background in PFO. More research is needed on the genetic determinants of PFO.
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Affiliation(s)
- Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
- Correspondence:
| | - Chiara Vincenzi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
| | - Michele Romoli
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
| | - Giulia Amico
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy; (G.A.); (I.C.)
- DINOGMI-Universite degli Studi di Genova, Largo P. Daneo,3, 16132 Genova, Italy
| | - Isabella Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy; (G.A.); (I.C.)
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Anna Bersano
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Marco Longoni
- Neurology Unit, “M. Bufalini” Hospital, AUSL Romagna, Viale Giovanni Ghirotti, 286, 47521 Cesena, Italy; (M.R.); (M.L.)
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy; (C.V.); (F.V.); (M.Z.)
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57
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Hassan M, Belavadi R, Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, Modi S, Sange I. Migraine and Stroke: In Search of Shared Pathways, Mechanisms, and Risk Factors. Cureus 2021; 13:e20202. [PMID: 34900505 PMCID: PMC8647778 DOI: 10.7759/cureus.20202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/01/2023] Open
Abstract
Migraines are one of the emerging causes of disabilities experienced worldwide, and strokes are the second leading cause of death globally. Migraines with aura have been reported to be associated with a higher risk of ischemic strokes, whereas hemorrhagic strokes are more closely associated with migraines without aura, possible mechanisms that link migraines to strokes. These can be categorized into vascular mechanisms such as vasospasm, endothelial and platelet dysfunction, and alteration in the vessel wall seen in migraineurs, further perpetrated by vascular risk factors such as hypertension and hyperlipidemias. Cerebral hypoperfusion that occurs in migraines can cause an electrical aberrance, leading to a phenomenon known as "spreading depression" which can contribute to strokes. In this review, we discuss bloodstream elevation in procoagulants such as antiphospholipid antibodies, homocysteine, von Willebrand factor, and prothrombin. Maintaining pregnant women who actively experience migraines with aura under close observation may be of some value in achieving better outcomes. Women who experience migraines after starting hormonal contraception are at a higher risk of experiencing strokes and stand to benefit from being switched to non-hormonal methods. In this article, we discuss the mechanisms linking migraines and strokes, briefly discuss the pathogenesis, and explore the risk factors contributing to the association therein. In addition, we examine the relationship between migraines and ischemic strokes, as well as hemorrhagic strokes, and review management considerations.
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Affiliation(s)
- Mohammad Hassan
- Internal Medicine, Mohi-ud-Din Islamic Medical College, Mirpur, PAK
| | - Rishab Belavadi
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | | | | | - Harini Gajjela
- Research, Our Lady of Fatima University College of Medicine, Valenzuela, PHL
| | - Iljena Kela
- Family Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Chandra L Kakarala
- Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Srimy Modi
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Research, K. J. Somaiya Medical College, Mumbai, IND
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58
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Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia. HEARTS 2021. [DOI: 10.3390/hearts2040041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.
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59
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Grudzińska E, Nowacka B, Bania B, Lubiński W, Zaborski D, Modrzejewska M. Patent foramen ovale as a cause of acute vision loss. Int J Ophthalmol 2021; 14:1125-1126. [PMID: 34282402 DOI: 10.18240/ijo.2021.07.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ewa Grudzińska
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, Szczecin 70-111, Poland
| | - Barbara Nowacka
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, Szczecin 70-111, Poland
| | - Beata Bania
- Department of Cardiology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, Szczecin 70-111, Poland
| | - Wojciech Lubiński
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, Szczecin 70-111, Poland
| | - Daniel Zaborski
- Laboratory of Biostatistics, West Pomeranian University of Technology, Klemensa Janickiego 29, Szczecin 71-270, Poland
| | - Monika Modrzejewska
- Second Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, Szczecin 70-111, Poland
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60
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Nykl R, Precek J, Sluka M, Hudec S, Richter D, Heinc P, Taborsky M. Interventional prevention of paradoxical embolism as the gold standard: End of discussion? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:241-248. [PMID: 34158673 DOI: 10.5507/bp.2021.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.
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Affiliation(s)
- Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Stepan Hudec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - David Richter
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Petr Heinc
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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61
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Emami S, Alfaham F, Shakiba B, Moghimian M, Mirzaasgari Z. Loss of vision after transurethral resection of prostate: A case report. Urol Case Rep 2021; 38:101739. [PMID: 34141590 PMCID: PMC8187236 DOI: 10.1016/j.eucr.2021.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
The overall complication rate of Transurethral resection of prostate (TURP) is about 11.1%. Amongst all complications, ocular complications are one of the rarest. In this paper, we present a case of vision loss due to paradoxical embolism as a rare complication following TURP. Ocular complications are very rare in urological surgeries but can happen due to paradoxical embolism following patent foramen ovale. Therefore, we recommend the early diagnosis and treatment of PFO prior to this type of surgery.
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Affiliation(s)
- Sepideh Emami
- Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatima Alfaham
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Iran
| | - Behnam Shakiba
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehran Moghimian
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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62
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Romano V, Gallinoro CM, Mottola R, Serio A, Di Meglio F, Castaldo C, Sirico F, Nurzynska D. Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults. J Cardiovasc Dev Dis 2021; 8:jcdd8060060. [PMID: 34070460 PMCID: PMC8228640 DOI: 10.3390/jcdd8060060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.
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Affiliation(s)
- Veronica Romano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Carlo Maria Gallinoro
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Rosita Mottola
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Alessandro Serio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Franca Di Meglio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Clotilde Castaldo
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Felice Sirico
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
- Correspondence: (F.S.); (D.N.)
| | - Daria Nurzynska
- Department of Medicine, Surgery and Dentistry “ScuolaMedicaSalernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence: (F.S.); (D.N.)
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63
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Abstract
Background Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation–perfusion mismatch and others intrapulmonary abnormalities are involved. Case presentation We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. Conclusions Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.
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64
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Liu F, Kong Q, Zhang X, Li Y, Liang S, Han S, Li G. Comparative analysis of the diagnostic value of several methods for the diagnosis of patent foramen ovale. Echocardiography 2021; 38:790-797. [PMID: 33870543 DOI: 10.1111/echo.15058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 01/16/2023] Open
Abstract
The aim of this research was to compare the sensitivity and positive predictive value of contrast transcranial Doppler (c-TCD), contrast transthoracic echocardiography (c-TTE), and contrast transesophageal echocardiography (c-TEE), to determine the best method for diagnosing patent foramen ovale (PFO) and to provide a reference for the further improvement of clinical practice. We investigated 161 patients who suffered from migraines, cryptogenic stroke, TIA, and cerebral infarction of unknown cause. All patients underwent transcatheter examination, and the results of the right heart catheterization (RHC) were considered the gold standard for PFO diagnosis. The present study revealed that c-TTE with the Valsalva maneuver had a higher sensitivity in detecting PFO related right-to-left shunt (PFO-RLS), c-TCD performed similarly to c-TEE but maybe produce more false positives. Moreover, when we observed color shunt from the slit-like channel between the septum primum and the septum secundum on TEE, the positive predictive value was the highest. Patients with suspected PFO should be examined with c-TTE and c-TEE for confirmation. When there were a large number of bubbles in the left heart, especially in the presence of color shunt, the positive predictive value was the highest. The positive results of c-TCD only point out the presence of right-to-left shunt and cannot exclude extracardiac shunt, so c-TCD should not be used as a screen for PFO, additional measures such as c-TTE and c-TEE should be used.
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Affiliation(s)
- Fangfang Liu
- Department of Cardiology, Shandong University Qilu Hospital, Jinan, China
| | - Qingyu Kong
- Department of Pediatrics, Shandong University Qilu Hospital, Jinan, China
| | - Xiaojun Zhang
- Department of Cardiology, Rongjun General Hospital of Shandong Province, Jinan, China
| | | | - Shimin Liang
- Department of Cardiology, The Fifth People's Hospital of Jinan, Jinan, China
| | - Shuang Han
- Department of Doppler Ultrasonic, The First Hospital of Shandong First Medical University, Jinan, China
| | - Guishuang Li
- Department of Cardiology, Shandong University Qilu Hospital, Jinan, China
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65
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Majumdar U, Yasuhara J, Garg V. In Vivo and In Vitro Genetic Models of Congenital Heart Disease. Cold Spring Harb Perspect Biol 2021; 13:cshperspect.a036764. [PMID: 31818859 DOI: 10.1101/cshperspect.a036764] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Congenital cardiovascular malformations represent the most common type of birth defect and encompass a spectrum of anomalies that range from mild to severe. The etiology of congenital heart disease (CHD) is becoming increasingly defined based on prior epidemiologic studies that supported the importance of genetic contributors and technological advances in human genome analysis. These have led to the discovery of a growing number of disease-contributing genetic abnormalities in individuals affected by CHD. The ever-growing population of adult CHD survivors, which are the result of reductions in mortality from CHD during childhood, and this newfound genetic knowledge have led to important questions regarding recurrence risks, the mechanisms by which these defects occur, the potential for novel approaches for prevention, and the prediction of long-term cardiovascular morbidity in adult CHD survivors. Here, we will review the current status of genetic models that accurately model human CHD as they provide an important tool to answer these questions and test novel therapeutic strategies.
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Affiliation(s)
- Uddalak Majumdar
- Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Jun Yasuhara
- Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Vidu Garg
- Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, Ohio 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio 43205, USA.,Department of Molecular Genetics, The Ohio State University, Columbus, Ohio 43205, USA
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66
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Shen Y, Nie Q, Zhang Y, Cao Q, Hou Z, Xu L. Treatment Strategies for Cryptogenic Stroke Patients with Patent Foramen Ovale: What Do We Choose? Neuropsychiatr Dis Treat 2021; 17:3205-3214. [PMID: 34712049 PMCID: PMC8548060 DOI: 10.2147/ndt.s333930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE The treatment of cryptogenic stroke patients with patent foramen ovale to prevent recurrence of stroke, especially when patients consider drug prevention alone, has caused serious treatment dilemmas in clinical practice. OBJECTIVE To study the safety and efficacy of different treatment strategies using a network meta-analysis of randomized controlled trials in this population with cryptogenic stroke and patent foramen ovale. STUDY SELECTION PUBMED, EMBASE, The Cochrane Library, WangFang, and China National Knowledge Infrastructure were searched to identify RCT comparing different treatment strategies. Eleven randomized studies were included (n = 5706). MAIN OUTCOMES The primary efficacy outcome was recurrence of ischemic stroke, including fatal and non-fatal ischemic strokes. The primary safety outcome was major hemorrhage, but closure surgery includes systemic thrombotic events, persistent atrial fibrillation, surgical deaths and other major events. RESULTS In terms of efficacy and safety events, compared with antiplatelet, the OR of vitamin K antagonists for stroke recurrence was 0.81 (95% CI, 0.41-1.6), the OR of surgical closure was 0.38 (95% CI, 0.16-0.63), and the OR of NOAC was 0.79 (95% CI, 0.27-2.3). Compared with antiplatelet, the safety event OR of vitamin K antagonists was 1.7 (95% CI, 0.65-4.8), the OR of surgical closure was 1.7 (95% CI, 0.68-3.8), and the OR of NOAC was 2.2 (95% CI, 0.67-7.6). CONCLUSION In terms of effectiveness, surgical occlusion has the best performance, while anticoagulation is the second best. Vitamin K antagonists and non-vitamin K antagonists are difficult to distinguish between the best in effectiveness. Antiplatelet drugs are considered the worst option. Regarding the safety results, it is generally believed that there are no obvious beneficial interventions, but antiplatelet drugs are considered to be relatively best, followed by surgical intervention and vitamin K antagonists, and non-vitamin K antagonists are considered to be the least safe.
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Affiliation(s)
- Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qiurui Nie
- Department of Cardiovascular Medicine, People's Hospital Affiliated of Nanchang University, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Yibi Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhuo Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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67
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Specktor P, Yalonetsky S, Agmon Y, Sprecher E, Ali FH, Telman G. The effect of TEE on treatment change in patients with acute ischemic stroke. PLoS One 2020; 15:e0243142. [PMID: 33270736 PMCID: PMC7714247 DOI: 10.1371/journal.pone.0243142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Ischemic stroke is a widespread disease carrying high morbidity and mortality. Transesophageal echocardiography (TEE) is considered an important tool in the work-up of patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients; its utility is limited by a semi-invasive nature. The purpose of this study was to evaluate the probability of treatment change due to TEE findings (yield) in the work-up of AIS and TIA patients. Methods Retrospective data on patients with AIS or TIA who underwent TEE examination between 2000–2013 were collected from the institutional registry. Results The average age of 1284 patients who were included in the study was 57±10.4, 66% of patients were male. The most frequent TEE findings included aortic plaques in 54% and patent foramen ovale (PFO) in 15%. TEE findings led to treatment change in 135 (10.5%) patients; anticoagulant treatment was initiated in 110 of them (81%). Most common etiology for switch to anticoagulation was aortic plaques (71 patients); PFO was second most common reason (26 patients). Significant TEE findings (thrombus, endocarditis, tumor) were found in 1.9% of patients, they were more common in young patients (<55; 56% of the patients). Conclusions The beginning of anticoagulation treatment in patients with thick and complicated plaques was found frequently in our study. Significant TEE findings, were infrequent, constituted an absolute indication for treatment change and were more common in younger patients.
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Affiliation(s)
- Polina Specktor
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Department of Neurology, Carmel Hospital, Haifa, Israel
| | | | - Yoram Agmon
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Faten Haj Ali
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Gregory Telman
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion, Israel Institute of Technology, Haifa, Israel
- * E-mail:
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68
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Van der Giessen H, Wilson LC, Coffey S, Whalley GA. Review: Detection of patient foramen ovale using transcranial Doppler or standard echocardiography. Australas J Ultrasound Med 2020; 23:210-219. [PMID: 34765407 PMCID: PMC8411673 DOI: 10.1002/ajum.12232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/21/2020] [Accepted: 10/02/2020] [Indexed: 11/07/2022] Open
Abstract
A patent foramen ovale (PFO) is a common remnant of fetal circulation present in up to 25% of the worldwide adult population. Paradoxical embolism occurs when venous blood crosses the PFO into the arterial system, bypassing the pulmonary circulation. This allows for the direct passage of microemboli into cerebral blood vessels, increasing the risk of cryptogenic stroke. This review investigates the current diagnostic procedures used to detect and grade a PFO, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and transcranial Doppler (TCD). Only a few studies have directly compared the use of TTE with TCD for PFO detection but several have compared TTE and TCD independently against the clinical gold standard TOE. Known pitfalls of TTE and TCD are also discussed, including the difficulty of differentiating between intracardiac shunts and intrapulmonary shunts. This review also discusses methods to optimise imaging, such as performing an adequate Valsalva manoeuvre, the role of abdominal compression and the choice of the injection site for the contrast agent and how these may increase the diagnostic success of detecting a right-to-left shunt when prompted by a clinician.
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Affiliation(s)
- Hanna Van der Giessen
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Luke C Wilson
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Sean Coffey
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
| | - Gillian A Whalley
- The Department of Medicine, Otago Medical SchoolThe University of OtagoDunedinNew Zealand
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69
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Parrini I, Cecchi E, Forno D, Lyon AR, Asteggiano R. Device closure for patent foramen ovale in patients with cryptogenic stroke: which patients should get it? Eur Heart J Suppl 2020; 22:M43-M50. [PMID: 33664639 PMCID: PMC7916420 DOI: 10.1093/eurheartj/suaa163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old.
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Affiliation(s)
- Iris Parrini
- Division of Cardiology, Mauriziano Hospital Turin, Italy
| | - Enrico Cecchi
- Division of Cardiology, MariaVittoria Hospital Turin, Italy
| | - Davide Forno
- Division of Cardiology, MariaVittoria Hospital Turin, Italy
| | - Alexander R Lyon
- Department of Cardiology, Royal Brompton Hospital and Imperial College London, SW3 6NP, UK
| | - Riccardo Asteggiano
- LARC (Laboratorio Analisi e Ricerca Clinica) C.so Venezia 10—Turin – Italy and School of Medicine—, Insubria University, Varese, Italy
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70
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Belopasova AV, Dobrynina LA, Kalashnikova LA, Chechetkin AO, Karshieva AR, Abugov SA, Mardanyan GV, Puretsky MB, Shteklein AB. [Pulmonary arteriovenous shunt - a rare cause of recurrent stroke due to paradoxical embolism]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:107-113. [PMID: 33081455 DOI: 10.17116/jnevro2020120091107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Paradoxical embolism is one of the mechanisms of ischemic stroke in patients younger than 45 years of age, due to opening between the right and left chambers of the heart through a patent foramen ovale, an atrial or ventricular septal defect, pulmonary arteriovenous malformations (PAVMs), etc. The PAVMs are structurally abnormal vessels that provide direct capillary-free communication between the pulmonary and systemic circulations, and hence an anatomic "right-to-left" shunt. Most pulmonary malformations are congenital and associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). This publication highlights the issues of pathogenesis, clinical presentation, diagnosis and treatment of this pathology, and also describes a clinical case in which multiple PAVMs caused repeated ischemic strokes.
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Affiliation(s)
| | | | | | | | | | - S A Abugov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - G V Mardanyan
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - M B Puretsky
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A B Shteklein
- Peoples' Friendship University of Russia, Moscow, Russia
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71
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Jensen B, Christoffels VM, Moorman AFM. An Appreciation of Anatomy in the Molecular World. J Cardiovasc Dev Dis 2020; 7:E44. [PMID: 33076272 PMCID: PMC7712948 DOI: 10.3390/jcdd7040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Robert H. Anderson is one of the most important and accomplished cardiac anatomists of the last decades, having made major contributions to our understanding of the anatomy of normal hearts and the pathologies of acquired and congenital heart diseases. While cardiac anatomy as a research discipline has become largely subservient to molecular biology, anatomists like Professor Anderson demonstrate anatomy has much to offer. Here, we provide cases of early anatomical insights on the heart that were rediscovered, and expanded on, by molecular techniques: migration of neural crest cells to the heart was deduced from histological observations (1908) and independently shown again with experimental interventions; pharyngeal mesoderm is added to the embryonic heart (1973) in what is now defined as the molecularly distinguishable second heart field; chambers develop from the heart tube as regional pouches in what is now considered the ballooning model by the molecular identification of regional differentiation and proliferation. The anatomical discovery of the conduction system by Purkinje, His, Tawara, Keith, and Flack is a special case because the main findings were never neglected in later molecular studies. Professor Anderson has successfully demonstrated that sound knowledge of anatomy is indispensable for proper understanding of cardiac development.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 15, 1105AZ Amsterdam, The Netherlands; (V.M.C.); (A.F.M.M.)
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72
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Kahles T, Michel P, Hapfelmeier A, Eberli FR, Zedde M, Thijs V, Kraemer M, Engelter ST, Serena J, Weimar C, Mallmann A, Luft A, Hemelsoet D, Thaler DE, Müller-Eichelberg A, De Pauw A, Sztajzel R, Armon C, Kent DM, Meier B, Mattle HP, Fischer U, Arnold M, Mono ML, Nedeltchev K. Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors. Front Neurol 2020; 11:503. [PMID: 32582015 PMCID: PMC7289181 DOI: 10.3389/fneur.2020.00503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/07/2020] [Indexed: 01/10/2023] Open
Abstract
Background and Purpose: To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO). Methods: We studied cross-sectional data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design. Results: We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke. Conclusion: In patients with CS and PFO, the likelihood of prior stroke is associated with both, PFO-related and PFO-unrelated factors.
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Affiliation(s)
- Timo Kahles
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Patrik Michel
- Department of Neurology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University Munich, München, Germany
| | - Franz R Eberli
- Department of Cardiology, Municipal Hospital Triemli, Zurich, Switzerland
| | - Marialuisa Zedde
- Department of Neurology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Vincent Thijs
- Department of Neurology, University Hospitals of Leuven, Leuven, Belgium.,Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Markus Kraemer
- Department of Neurology, Alfried-Krupp Krankenhaus, Essen, Germany.,Department of Neurology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Stefan T Engelter
- Department of Neurology, University Hospital of Basel, Basel, Switzerland.,Felix-Platter Hospital, Basel, Switzerland
| | - Joaquin Serena
- Department of Neurology, University Hospital of Girona, Girona, Spain
| | - Christian Weimar
- Department of Neurology, University Hospital of Essen, Essen, Germany
| | | | - Andreas Luft
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Dimitri Hemelsoet
- Department of Neurology, University Hospital of Ghent, Ghent, Belgium
| | - David E Thaler
- Department of Neurology, Tufts Medical Center, Boston, MA, United States
| | | | - Adinda De Pauw
- Department of Neurology, AZ Sint Blasius, Dendermonde, Belgium
| | - Roman Sztajzel
- Department of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - Carmel Armon
- Department of Neurology, Baystate Health Center, Springfield, MA, United States.,Sackler School of Medicine and Department of Neurology, Yitzchak Shamir Medical Center, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - David M Kent
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Marie-Luise Mono
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland.,Department of Neurology, University Hospital of Bern, Bern, Switzerland
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73
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Platypnea-Orthodeoxia Syndrome: Rare or Under-Diagnosed Syndrome? 3 Case Reports and a Literature Review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 22:115-119. [PMID: 32527601 DOI: 10.1016/j.carrev.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022]
Abstract
Platypnea-Orthodeoxia Syndrome (POS) is dyspnea and hypoxemia in the upright position that improves in the supine position. Cardiac POS is predominantly caused by congenital interatrial communications (CIC) paired with changes in the thoracic anatomy, allowing orthostatic right to left cardiac shunting. High suspicion, especially with hypoxemia without significant pulmonary disease, that does not easily correct with supplemental oxygen, should lead the clinician to obtain echocardiographic imaging, documenting right to left shunting, typically through a patent foramen ovale (PFO). Transcatheter closure of the CIC is highly successful in relieving symptoms of dyspnea and resolving hypoxemia in the majority of patients.
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74
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Raut S, Singh U, Sarmah D, Datta A, Baidya F, Shah B, Bohra M, Jagtap P, Sarkar A, Kalia K, Borah A, Dave KR, Yavagal DR, Bhattacharya P. Migraine and Ischemic Stroke: Deciphering the Bidirectional Pathway. ACS Chem Neurosci 2020; 11:1525-1538. [PMID: 32348103 DOI: 10.1021/acschemneuro.0c00137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Migraine and stroke are common, disabling neurological conditions with several theories being proposed to explain this bidirectional relationship. Migraine is considered as a benign neurological disorder, but research has revealed a connection between migraine and stroke, predominantly those having migraine with aura (MA). Among migraineurs, females with MA are more susceptible to ischemic stroke and may have a migrainous infarction. Migrainous infarction mostly occurs in the posterior circulation of young women. Although there are several theories about the potential relationship between MA and stroke, the precise pathological process of migrainous infarction is not clear. It is assumed that cortical spreading depression (CSD) might be one of the essential factors for migrainous infarction. Other factors that may contribute to migrainous infarction may be genetic, hormonal fluctuation, hypercoagulation, and right to left cardiac shunts. Antimigraine drugs, such as ergot alkaloids and triptans, are widely used in migraine care. Still, they have been found to cause severe vasoconstriction, which may result in the development of ischemia. It is reported that patients with stroke develop migraines during the recovery phase. Both experimental and clinical data suggest that cerebral microembolism can act as a potential trigger for MA. Further studies are warranted for the treatment of migraine, which may lead to a decline in migraine-related stroke. In this present article, we have outlined various potential pathways that link migraine and stroke.
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Affiliation(s)
- Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam 788011, India
| | - Kunjan R. Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Dileep R. Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
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75
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Donghi SM, Sedda G, Guarize J, Spaggiari L. Platypnea-orthodeoxia syndrome after pulmonary wedge resection in a patient with severe scoliosis. Interact Cardiovasc Thorac Surg 2020; 30:790-791. [PMID: 32016369 DOI: 10.1093/icvts/ivaa003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 11/13/2022] Open
Abstract
Platypnea-orthodeoxia is a rare syndrome characterized by dyspnoea and arterial desaturation, exacerbated by an upright position and relieved when the subject is recumbent. We report on a unique case of a patient with severe scoliosis who presented with several episodes of arterial desaturation after right pulmonary wedge resection.
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Affiliation(s)
- Stefano Maria Donghi
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Sedda
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Juliana Guarize
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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76
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De Cuyper C, Pauwels T, Derom E, De Pauw M, De Wolf D, Vermeersch P, Van Berendoncks A, Paelinck B, Vermeersch G. Percutaneous Closure of PFO in Patients with Reduced Oxygen Saturation at Rest and during Exercise: Short- and Long-Term Results. J Interv Cardiol 2020; 2020:9813038. [PMID: 32265599 PMCID: PMC7109556 DOI: 10.1155/2020/9813038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A patent foramen ovale (PFO) is a rare cause of hypoxemia and clinical symptoms of dyspnea. Due to a right-to-left shunt, desaturated blood enters the systemic circulation in a subset of patients resulting in dyspnea and a subsequent reduction in quality of life (QoL). Percutaneous closure of PFO is the treatment of choice. OBJECTIVES This retrospective multicentre study evaluates short- and long-term results of percutaneous closure of PFO in patients with dyspnea and/or reduced oxygen saturation. METHODS Patients with respiratory symptoms were selected from databases containing all patients percutaneously closed between January 2000 and September 2018. Improvement in dyspnea, oxygenation, and QoL was investigated using pre- and postprocedural lung function parameters and two postprocedural questionnaires (SF-36 and PFSDQ-M). RESULTS The average follow-up period was 36 [12-43] months, ranging from 0 months to 14 years. Percutaneous closure was successful in 15 of the 16 patients. All patients reported subjective improvement in dyspnea immediately after device deployment, consistent with their improvement in oxygen saturation (from 90 ± 6% to 94 [92-97%] on room air and in upright position) (p < 0.05). Both questionnaires also indicated an improvement of dyspnea and QoL after closure. The two early and two late deaths were unrelated to the procedure. CONCLUSION PFO-related dyspnea and/or hypoxemia can be treated successfully with a percutaneous intervention with long-lasting benefits on oxygen saturation, dyspnea, and QoL.
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Affiliation(s)
- Céline De Cuyper
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Tristan Pauwels
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Eric Derom
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Daniël De Wolf
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Paul Vermeersch
- Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
| | | | - Bernard Paelinck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Gaëlle Vermeersch
- Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium
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77
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Xi LMD, Faqin LMD, Ji-Bin LMD. Reply to Dr. Rajendram’s Letter to Editor: “Point of Care Ultrasound During the Covid-19 Pandemic Should Screen for Inter-Atrial Shunt”. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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78
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Burggren W, Filogonio R, Wang T. Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses. Biol Rev Camb Philos Soc 2019; 95:449-471. [PMID: 31859458 DOI: 10.1111/brv.12572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022]
Abstract
This review explores the long-standing question: 'Why do cardiovascular shunts occur?' An historical perspective is provided on previous research into cardiac shunts in vertebrates that continues to shape current views. Cardiac shunts and when they occur is then described for vertebrates. Nearly 20 different functional reasons have been proposed as specific causes of shunts, ranging from energy conservation to improved gas exchange, and including a plethora of functions related to thermoregulation, digestion and haemodynamics. It has even been suggested that shunts are merely an evolutionary or developmental relic. Having considered the various hypotheses involving cardiovascular shunting in vertebrates, this review then takes a non-traditional approach. Rather than attempting to identify the single 'correct' reason for the occurrence of shunts, we advance a more holistic, integrative approach that embraces multiple, non-exclusive suites of proposed causes for shunts, and indicates how these varied functions might at least co-exist, if not actually support each other as shunts serve multiple, concurrent physiological functions. It is argued that deposing the 'monolithic' view of shunting leads to a more nuanced view of vertebrate cardiovascular systems. This review concludes by suggesting new paradigms for testing the function(s) of shunts, including experimentally placing organ systems into conflict in terms of their perfusion needs, reducing sources of variation in physiological experiments, measuring possible compensatory responses to shunt ablation, moving experiments from the laboratory to the field, and using cladistics-related approaches in the choice of experimental animals.
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Affiliation(s)
- Warren Burggren
- Department of Biological Sciences, Developmental Integrative Biology Cluster, University of North Texas, Denton, TX, 76203-5220, U.S.A
| | - Renato Filogonio
- Department of Physiological Sciences, Federal University of São Carlos, São Carlos, SP, 13565-905, Brazil
| | - Tobias Wang
- Zoophysiology, Department of Bioscience, Aarhus University, Aarhus C, 8000, Denmark.,Aarhus Institute of Advanced Sciences (AIAS), Aarhus University, Aarhus C, 8000, Denmark
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79
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Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers. POLISH HYPERBARIC RESEARCH 2019. [DOI: 10.2478/phr-2019-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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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Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y. Intraoperative Visible Air Bubbling Recorded as a Sign of Massive Venous Air Embolism During Prone Position Surgery for Extensive Ossification of Spinal Ligaments: A Case Report with a Video Clip. World Neurosurg 2019; 131:38-42. [PMID: 31369880 DOI: 10.1016/j.wneu.2019.07.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Venous air embolism (VAE) is a rare but, frequently, fatal complication that can occur during surgery. Several reported studies have shown visible bubbling of air at the surgical site as the first clinical indication of VAE-induced cardiovascular collapse during prone-position spine surgery. However, to the best of our knowledge, video imaging of this phenomenon has not been previously reported. CASE DESCRIPTION A 41-year-old man had undergone cervical laminoplasty for ossification of the posterior longitudinal ligament and thoracic laminectomy for ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum in the prone position. The entire surgery was recorded with video imaging. Before cardiac arrest due to the massive VAE, visible air bubbling had been observed at the operated site of the thoracic laminectomy, and this phenomenon had been incidentally recorded with the video. The patient recovered with cardiopulmonary resuscitation and intensive treatment against severe acute respiratory distress syndrome due to pulmonary damage. CONCLUSIONS The present case report offers the first video imaging evidence of intraoperative visible air bubbling as a sign of a massive VAE during prone-position spine surgery. To the best of our knowledge, this is also the first report of intraoperative VAE in a patient with extensive ossification of the spinal ligaments.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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81
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Altamura C, Paolucci M, Brunelli N, Cascio Rizzo A, Cecchi G, Assenza F, Silvestrini M, Vernieri F. Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura. PLoS One 2019; 14:e0220637. [PMID: 31369637 PMCID: PMC6675040 DOI: 10.1371/journal.pone.0220637] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023] Open
Abstract
Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.
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Affiliation(s)
- Claudia Altamura
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
- * E-mail:
| | - Matteo Paolucci
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Nicoletta Brunelli
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Angelo Cascio Rizzo
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Gianluca Cecchi
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Federica Assenza
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Fabrizio Vernieri
- Clinical Neurology, Headache and Neurosonology Unit, Campus Bio-Medico University of Rome, Roma, Italy
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Rigatelli G, Zuin M, Adami A, Aggio S, Lanza D, d’Elia K, Braggion G, Russo M, Mazza A, Roncon L. Left atrial enlargement as a maker of significant high-risk patent foramen ovale. Int J Cardiovasc Imaging 2019; 35:2049-2056. [DOI: 10.1007/s10554-019-01666-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
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83
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Affiliation(s)
- David D Berg
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - James M Kirshenbaum
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Elizabeth Gay
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Amy L Miller
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Joseph Loscalzo
- From the Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
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84
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Hołda MK. Letter by Hołda Regarding Article, “Patent Foramen Ovale Closure Versus Medical Therapy for Cryptogenic Ischemic Stroke: A Topical Review”. Stroke 2018; 49:e335. [DOI: 10.1161/strokeaha.118.022550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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85
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The morphology, clinical significance and imaging methods of the atrial septal pouch: A critical review. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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86
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Gąsiorek PE, Banach M, Maciejewski M, Głąbiński A, Paduszyńska A, Rysz J, Bielecka-Dąbrowa A. Established and potential echocardiographic markers of embolism and their therapeutic implications in patients with ischemic stroke. Cardiol J 2018; 26:438-450. [PMID: 29718528 DOI: 10.5603/cj.a2018.0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Cardiogenic strokes comprised 11% of all strokes and 25% of ischemic strokes. An accurate identification of the cause of stroke is necessary in order to prepare an adequate preventive strategy. In this review the confirmed and potential causes of embolic strokes are presented, which can be detected in echocardiography in the context of present treatment guidelines and gaps in evidence. There remains a need for further studies assessing the meaning of potential cardiac sources of embolism and establishment of rules for optimal medical prevention (antiplatelet therapy [APT] vs. oral anticoagulation [OAC]) and interventional procedures to reduce the incidence of ischemic strokes. Currently available data does not provide definitive evidence on the comparative benefits of OAC vs. APT in patients with cryptogenic stroke or embolic stroke of undetermined source. There is a lack of antithrombotic treatment scheme in the time between stroke and the completed diagnosis of potential sources of thromboembolism.
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Affiliation(s)
- Paulina E Gąsiorek
- Department of Neurology and Ischemic Strokes, Medical University of Lodz, Poland.
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Marek Maciejewski
- Department of Cardiology and Congenital Diseases of Adults, ICMP, Lodz, Poland
| | - Andrzej Głąbiński
- Department of Neurology and Ischemic Strokes, Medical University of Lodz, Poland
| | - Aleksandra Paduszyńska
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Agata Bielecka-Dąbrowa
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
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Zhang XL, Kang LN, Wang L, Xu B. Percutaneous closure versus medical therapy for stroke with patent foramen Ovale: a systematic review and meta-analysis. BMC Cardiovasc Disord 2018; 18:45. [PMID: 29499641 PMCID: PMC5834900 DOI: 10.1186/s12872-018-0780-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/22/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) closure has emerged as a secondary prevention option in patients with PFO and cryptogenic stroke. However, the comparative efficacy and safety of percutaneous closure and medical therapy in patients with cryptogenic stroke and PFO remain unclear. METHODS Randomized controlled trials (RCTs) and comparative observational studies that compared PFO closure against medical therapy, each with a minimal of 20 patients in the closure arm and 1-year follow-up were included. RESULTS We analyzed 6961 patients from 20 studies (5 RCTs and 15 observational studies) with a median follow-up of 3.1 years. Moderate-quality evidence showed that PFO closure was associated with a significantly lower incidence of the composite outcome of ischemic stroke, transient ischemic attack (TIA), or all-cause death (odds ratio [OR]: 0.57; 95% confidence interval [CI]: 0.38 to 0.85; P = 0.006), mainly driven by lower incidence of stroke (OR: 0.39; 95% CI: 0.24 to 0.63; P < 0.001). The numbers needed to treat were 43 and 39 for the composite outcome and recurrent ischemic stroke respectively. PFO closure increased the risks for atrial fibrillation or atrial flutter (OR: 5.74; 95% CI: 3.08 to 10.70; P < 0.001; high-quality evidence) and pulmonary embolism (OR: 3.03; 95% CI: 1.06 to 8.63; P = 0.038; moderate-quality evidence), with the numbers needed to harm being 30 and 143 respectively. The risks for TIA, all-cause death, and major bleeding were not statistically different. Analyses limited to RCTs showed similar findings, as did a series of other subgroup analyses. CONCLUSION In conclusion, PFO closure reduced the incidences of stroke and the composite outcome of ischemic stroke, TIA, or all-cause death, but increased risks for atrial fibrillation or atrial flutter and pulmonary embolism compared with medical therapy.
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Affiliation(s)
- Xin-Lin Zhang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Li-Na Kang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Lian Wang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, 321 Zhongshan Road, Nanjing, 210008, China
| | - Biao Xu
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, 321 Zhongshan Road, Nanjing, 210008, China.
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Reply. JACC Cardiovasc Interv 2017; 10:307-308. [DOI: 10.1016/j.jcin.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 11/15/2022]
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