Instant percutaneous closure of patent foramen ovale in patients with acute myocardial infarction and normal coronary arteries

[Which patent foramen ovale needs to be closed, and how?]

Patent Foramen Ovale (PFO) is a normal fetal communication between right and left atria that persists after birth by about 30% in adults. It is discussed to be associated to potential clinical events, asking rational of such closure. Its correction throughout venous access can be attempted on four different indications: (1) secondary prevention of stroke or transient ischemic attack, (2) decompression illness, (3) migraine with aura, and (4) platypnea-orthodeoxia. The PFO closure procedure implies the double control of X-rays and ultrasound, and is relatively simple to perform, using various prostheses. In France, the place of percutaneous closure procedure is nowadays unclear since the Haute Autorité de santé currently suspended recommendations about the management after stroke.

A case of simultaneous pulmonary embolism and acute myocardial infarction secondary to a previously undiagnosed patent foramen ovale

We describe a 79-year-old male with recurrent high-grade liposarcoma who developed postoperative chest pain, dyspnea, and hypoxia suspicious for acute pulmonary embolism (PE). However, electrocardiogram (ECG) was suggestive of an acute ST-elevation myocardial infarction (MI). Heparin was initiated and emergent coronary angiography was performed, which demonstrated a "cutoff sign" in the distal left anterior descending artery (LAD) consistent with coronary embolism. A patent foramen ovale (PFO) and bilateral pulmonary emboli were subsequently identified. It was concluded that the patient had suffered an acute PE, with a portion of clot traversing the PFO and entering the LAD, resulting in a simultaneous acute ST-elevation MI. While the case described is rare, the underlying anatomical variant is common and may have practical significance. We discuss the literature regarding PFO with acute PE and paradoxical emboli.

Paradoxical emboli through the patent foramen ovale as the suspected cause of myocardial and renal infarction in a 48-year-old woman

We review the case of a 48-year-old woman who underwent elective percutaneous patent foramen ovale closure following successive renal and myocardial infarction with normal renal and coronary arteries, probably as a consequence of paradoxical emboli.

Transcatheter repair of iatrogenic left ventricular free-wall perforation

Left ventricular free-wall perforation can complicate catheter-based diagnostic or interventional procedures and may require immediate needle pericardiocentesis followed by surgical repair in about 20% of the cases. We describe the transcatheter closure of a left ventricular free-wall perforation as an option in the event of maintained access to the perforation site after defect creation.