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Aoun J, Hatab T, Volpi J, Lin CH. Patent Foramen Ovale and Atrial Septal Defect. Cardiol Clin 2024; 42:417-431. [PMID: 38910025 DOI: 10.1016/j.ccl.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Patent foramen ovale (PFO) and atrial septal defects (ASDs) are two types of interatrial communications with unique clinical presentations and management strategies. The PFO is a normal part of fetal development that typically closes shortly after birth but may persist in as many as 25% to 30% of adults. The communication between atria may result in paradoxic embolism and embolic stroke. On the other hand, ASDs (anatomically defined as secundum, primum, sinus venosus, and coronary sinus in order of prevalence) typically result in right heart volume overload and are often associated with other congenital defects. The diagnostic methods, treatment options including surgical and percutaneous approaches, and potential complications are described. Both conditions underline the significance of precise diagnosis and appropriate management to mitigate risks and ensure optimal patient outcomes.
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Affiliation(s)
- Joe Aoun
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
| | - Taha Hatab
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - John Volpi
- Neurology Department, Houston Methodist Hospital, Houston, TX, USA
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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2
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Meng X, Song M, Zhang K, Lu W, Li Y, Zhang C, Zhang Y. Congenital heart disease: types, pathophysiology, diagnosis, and treatment options. MedComm (Beijing) 2024; 5:e631. [PMID: 38974713 PMCID: PMC11224996 DOI: 10.1002/mco2.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024] Open
Abstract
Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long-term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.
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Affiliation(s)
- Xiao Meng
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Ming Song
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Kai Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Weida Lu
- Shandong Key Laboratory of Cardiovascular Proteomics and Department of Geriatric MedicineQilu Hospital of Shandong UniversityJinanChina
| | - Yunyi Li
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Cheng Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
| | - Yun Zhang
- Department of CardiologyState Key Laboratory for Innovation and Transformation of Luobing TheoryQilu Hospital of Shandong UniversityJinanChina
- Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong UniversityJinanChina
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3
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Mirza AA, Saad MZ, Bittla P, Paidimarri SP, Ayuthu S, Chauhan YD, Khan S. A Detailed Systematic Review Comparing Patent Foramen Ovale Closure vs Medical Therapy for the Prevention of Recurrent Cryptogenic Stroke. Cureus 2024; 16:e65632. [PMID: 39205754 PMCID: PMC11357720 DOI: 10.7759/cureus.65632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Cryptogenic stroke refers to a type of ischemic stroke with no identifiable cause despite extensive diagnostic testing. Patent foramen ovale (PFO) treatment modality for the prevention of cryptogenic stroke has been controversial. We undertook this systematic review to compare the efficacy of PFO closure versus medical therapy in preventing recurrent cryptogenic stroke and to provide insight into the most effective treatment modality. Inclusion criteria included patients who had PFO, papers written in English language or had translation available, and papers focusing on medical therapy including drug and surgical treatment for PFO for the prevention of recurrent stroke. Exclusion criteria included articles in which full text could not be obtained and articles in which only one treatment modality was mentioned, either surgical closure or drug therapy. The databases used were PubMed, Cochrane, Embase, and ClinicalTrials.gov. We conducted a bias assessment through the modified Jadad scale for randomized controlled trials (RCTs) and AMSTAR.Ca for meta-analysis and systematic review. The literature search identified a total of 277 papers. After screening, 12 papers were selected for the review. Among these, five were RCTs, five were meta-analyses, one was a systematic review, and one was a systematic review with network meta-analysis. The RCTs included a total of 3,336 participants, while the meta-analyses included 21,813 participants. These finalized papers examined the outcomes of PFO closure compared to medical therapy in preventing recurrent strokes.
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Affiliation(s)
- Amna A Mirza
- Medicine, Ziauddin Medical College, Karachi, PAK
| | - Moyal Z Saad
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | | | | | - Shriya Ayuthu
- Medicine, Kamineni Institute of Medical Sciences, Nalgonda, IND
| | - Yashkumar D Chauhan
- Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, USA
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Ke Q, Weng G, Xie Q, Bao J, Zheng F, Huang J, Yan L, Chen H. Comparison of Long-Term Clinical Outcomes and Costs Between Transesophageal Echocardiography-Guided and X-ray-Guided Percutaneous Atrial Septal Defect Closure in Children. Pediatr Cardiol 2024:10.1007/s00246-024-03539-0. [PMID: 38880798 DOI: 10.1007/s00246-024-03539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
This study aimed to compare the long-term clinical outcomes and costs between using either transesophageal echocardiography (TEE) or X-ray fluoroscopy for Percutaneous atrial septal defect (ASD) closure in children. An analysis was conducted on clinical data from children undergoing TEE-guided (n = 168) and X-ray-guided (n = 139) percutaneous ASD closure. Demographic characteristics, technical indices, acute complications, follow-up outcomes, and costs were compared between the groups. The results are that TEE-guided closure demonstrated shorter surgical times (20.3 ± 7.6 min vs. 32.8 ± 7.9 min, P < 0.001) and lower procedural costs ($3093.3 ± 451.5 vs. $3589.1 ± 219.4, P < 0.001) compared to X-ray guidance. Initial successful closure rates were similar between the groups (TEE: 98.2%, XR: 97.1%, P = 0.691). TEE guidance also resulted in fewer acute complications and reduced radiation exposure. TEE-guided percutaneous ASD closure offers advantages in terms of shorter surgical times, lower procedural costs, and reduced radiation exposure compared to X-ray guidance. These findings support the preference for TEE guidance in pediatric ASD closure procedures, with potential implications for improving patient outcomes and reducing healthcare costs.
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Affiliation(s)
- Qiuqing Ke
- Department of Internal Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Guoxing Weng
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Qi Xie
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Jiayin Bao
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Fuzhen Zheng
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Jie Huang
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Licheng Yan
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China
| | - Haiyu Chen
- Department of Cardiovascular Surgery, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, Fujian Province, China.
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Wei Y, Su Y, Cao S, He Z, Wang R, Qin X, Feng Y, Yang C, Jiang H. Experimental study of the bilateral asymmetric single-rivet occluder device for transcatheter patent foramen ovale closure with reserved interatrial septal puncture area. Front Cardiovasc Med 2024; 10:1301412. [PMID: 38250032 PMCID: PMC10796624 DOI: 10.3389/fcvm.2023.1301412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To evaluate a noval bilateral asymmetric single-rivet occluder with reserved interatrial septal puncture area for treating patent foramen ovale (PFO). Materials and methods The study established a pig model of patent foramen ovale (PFO) by puncturing the oval fossa and then performing high-pressure balloon dilation. A specially designed bilateral asymmetric occluder for the reserved interatrial septal puncture area was then. used to close the PFO through catheter-based intervention. The pigs were kept for 3 months before undergoing a second catheter-based intervention, involving interatrial septal puncture using a newly developed occluder in the reserved interatrial septal puncture area. During 6 months, the experimental pigs underwent assessment using digital subtraction angiography (DSA), echocardiography, and histological evaluation. Results A patent foramen ovale (PFO) model was successfully established in 6 pigs using the puncture atrial septum high-pressure balloon dilation method. The diameter of the unclosed PFO was measured (3.56 ± 0.25 mm). Using the newly developed occluder device, all 6 pigs with unclosed PFO underwent successful catheter-based closure surgeries, with intraoperative and postoperative transesophageal echocardiography showing excellent device positioning and complete closure without residual shunting. After 3 months of implantation, the catheter-based interatrial septal puncture was performed through the reserved interatrial septal puncture area, and all procedures were successful. Immediately following euthanasia, a histological examination revealed intact and undamaged occluder devices with visible puncture holes in the reserved interatrial septal puncture area. No fracture of the nitinol wire was observed, and the surface of the occluder device showed coverage of endothelial and connective tissues. Utilizing a bilateral asymmetric single-rivet occluder device implanted through the reserved interatrial septal puncture area has proven effective in closing PFO. After implantation, the occluder device allows subsequent interatrial septal puncture procedures through the reserved area. Conclusion The novel occluder device demonstrated excellent closure performance, biocompatibility, and puncturability in the experiment. This indicates the feasibility of conducting further catheter-based interventions on the interatrial septum.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Haibin Jiang
- Department of Cardiology, Wuxi No.2 People's Hospital (Jiangnan University Medical Center), Wuxi, Jiangsu, China
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Patel U, Dengri C, Pielykh D, Baskar A, Tar MI, Patel G, Patel N, Kothari N, Selvam SA, Sharma AM, Venkata VS, Shah S, Mahmood SN, Peela AS. Secondary Prevention of Cryptogenic Stroke and Outcomes Following Surgical Patent Foramen Ovale Closure Plus Medical Therapy vs. Medical Therapy Alone: An Umbrella Meta-Analysis of Eight Meta-Analyses Covering Seventeen Countries. Cardiol Res 2023; 14:342-350. [PMID: 37936625 PMCID: PMC10627369 DOI: 10.14740/cr1526] [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: 06/19/2023] [Accepted: 08/09/2023] [Indexed: 11/09/2023] Open
Abstract
Background Cryptogenic stroke (CS) is an exclusion diagnosis that accounts for 10-40% of all ischemic strokes. Patent foramen ovale (PFO) is found in 66% of patients with CS, while having a prevalence of 25-30% in the general population. The primary aim was to evaluate the risk of recurrent stroke following surgical PFO closure plus medical therapy vs. medical therapy alone amongst CS, an embolic stroke of undetermined source (ESUS), or transient ischemic attack (TIA). The secondary aim was to evaluate new-onset non-valvular atrial fibrillation, mortality, and major bleeding. Methods We conducted an umbrella meta-analysis using PRISMA guidelines on English studies comparing surgical PFO closure plus medical therapy versus medical therapy alone for managing CS. We extracted data on interventions and outcomes and used random-effects models with generic inverse variance to calculate relative risks (RRs) with 95% confidence intervals for outcome calculations. Results A comprehensive search yielded 54,729 articles on CS and 65,001 on surgical PFO closure, with 1,591 studies focusing on PFO closure and medical therapy for secondary CS, ESUS, or TIA prevention. After excluding non-meta-analyses, 52 eligible meta-analyses were identified, and eight studies were selected for outcome evaluation, excluding non-English, non-human, and studies before January 2019 as of August 31, 2021. Among a total of 41,880 patients, 14,942 received PFO closure + medical therapy, while 26,938 patients received medical therapy alone. Our umbrella meta-analysis showed that PFO closure plus medical therapy had a 64% lower risk of recurrent strokes than medical therapy alone (pooled RR: 0.36). PFO closure plus medical therapy was associated with 4.94 times higher risk of atrial fibrillation. There was no difference in the risk of death or bleeding between both groups. Conclusion In patients with CS, PFO closure, in addition to medical therapy, reduces the risk of recurrence. More research is needed to assess the efficacy of early closure as well as specific risk profiles that would benefit from early intervention to reduce the burden of stroke.
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Affiliation(s)
- Urvish Patel
- Department of Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- These authors contributed equally to the article
| | - Chetna Dengri
- Department of Neurology, Cleveland Clinic Florida, Weston, FL 33331, USA
- These authors contributed equally to the article
| | - David Pielykh
- Odessa National Medical University, Valikhovskiy Lane 2, Odessa 65000, Ukraine
| | - Aakash Baskar
- K.A.P. Viswanatham Government Medical College, Musiri, Trichy, Tamilnadu 621006, India
| | - Muhammad Imtiaz Tar
- Touro University Nevada College of Osteopathic Medicine, Henderson, NV 89014, USA
| | | | - Neel Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Nishel Kothari
- Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Renu
- Department of Medicine, Sarojini Naidu Medical College, Agra, Uttar Pradesh 282003, India
| | - Sri Abirami Selvam
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Amit Munshi Sharma
- Department of Medicine, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA
| | | | - Shamik Shah
- Department of Neurology, Stormont Vail Health, Topeka, KS, USA
| | - Syed Nazeer Mahmood
- Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 5333, USA
| | - Appala Suman Peela
- Department of Family Medicine, UNC Health Southeastern, Lumberton, NC 28358, USA
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7
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Trabattoni D, Gili S, Calligaris G, Teruzzi G, Troiano S, Ravagnani P, Santagostino Baldi G, Montorsi P. Patent foramen ovale closure with the Occlutech Figulla flex II device: A long-term (up to 10-years) follow-up. Int J Cardiol 2023; 387:131116. [PMID: 37301447 DOI: 10.1016/j.ijcard.2023.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Percutaneous closure represents the first line of treatment in patients with cryptogenic stroke and documented patent foramen ovale (PFO). Scarce data report the long-term outcomes of patients undergoing PFO closure with the Figulla Flex II device (Occlutech, Germany). METHODS Consecutive patients undergoing PFO closure with a Figulla Flex II device at a single, high-volume Institution were included. Baseline clinical and procedural features were collected and patients were followed up for up to 10 years. The device's long-term safety was assessed, as well as mortality, recurrent cerebrovascular events, new-onset atrial fibrillation (AF) and residual shunt. RESULTS Overall, 442 patients were included. The main indication for PFO closure was cryptogenic stroke/transitory ischemic attack (65.5%), followed by migraine (21.7%), silent lesions at MRI (10.8%), and decompression disease (2.0%). Atrial septal aneurysm was present in 20.8% of cases, Eustachian valve in 9.0%, Chiari network in 19.9%. The most frequently implanted device was the 23/25 mm (49.5% of cases). One procedural failure due to device embolization; in-hospital complications occurred in 15 cases (3.4%; 4 minor access site complications, 11 transient supraventricular tachycardias (SVT)/AF). After a follow-up of 9.2 years, 2 patients suffered recurrent TIA (with no residual R-L shunt detected). A moderate or severe residual shunt was observed in 3 patients after discharge. CONCLUSIONS Figulla Flex II devices for PFO closure are associated with high procedural success and low incidence of adverse events even at long-term follow-up.
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Affiliation(s)
- Daniela Trabattoni
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy.
| | - Sebastiano Gili
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giuseppe Calligaris
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Sarah Troiano
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Paolo Ravagnani
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Giulia Santagostino Baldi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
| | - Piero Montorsi
- Centro Cardiologico "Monzino", IRCCS, Department of Cardiovascular Sciences, University of Milan, Italy
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Liu TT, Jiao RH, Chen T, Jiang ZA, Bai WL. A Systematic Review and Meta-Analysis of the Association between Residual Shunts after Patent Foramen Ovale Closure and Long-Term Cerebrovascular Events. Cerebrovasc Dis 2023; 52:387-392. [PMID: 36882039 DOI: 10.1159/000527457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/28/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The association between a patent foramen ovale (PFO) and cryptogenic stroke (CS) is well established, and the benefits of PFO closure are clearly recognized. This study aimed to investigate the presence of a residual shunt in patients who have experienced cryptogenic cerebrovascular events following a PFO closure. METHODS Two researchers systematically searched the PubMed and Embase online database for pertinent clinical studies published between January 2000 and July 2021 concerning the recurrence of cerebrovascular events after PFO closures. RESULTS Upon screening an initial list of 2,342 articles, six studies were identified, involving 2,083 patients. Overall, the analysis indicated a marked difference in the recurrence of cerebrovascular events in 8.89% of residual shunt (RS) cases compared to only 2.90% of non-RS cases. The summary odds ratio was 3.484 (95% confidence interval, 2.169-5.596), which suggested that RS may be a risk factor for recurrent cerebrovascular events in patients that experienced PFO-related cerebrovascular events within 6 months after PFO closure surgery. CONCLUSIONS The presence of RS significantly increases the risk of recurrent cerebrovascular events in patients with clinical PFO closure.
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Affiliation(s)
- Ting-Ting Liu
- Department of Heart Center, Hebei General Hospital, Shijiazhuang, China
| | - Rong-Hong Jiao
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Tao Chen
- Department of Cardiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-An Jiang
- Department of Cardiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Lou Bai
- Department of Heart Center, Hebei General Hospital, Shijiazhuang, China
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Lucà F, Pino PG, Parrini I, Di Fusco SA, Ceravolo R, Madeo A, Leone A, La Mair M, Benedetto FA, Riccio C, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management. J Clin Med 2023; 12:1952. [PMID: 36902748 PMCID: PMC10004032 DOI: 10.3390/jcm12051952] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. Remarkably, accurately evaluating patients to refer to the closure strategy is extremely important. However, the selection of patients for PFO closure is still not so clear. The aim of this review is to update and clarify which patients should be considered for closure treatment.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio di Calabria, Italy
| | - Paolo G. Pino
- Cardiology Department, San Camillo Forlanini Hospital, 00152 Rome, Italy
| | - Iris Parrini
- Cardiology Department, Mauriziano Hospital, 10128 Torino, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Angelo Leone
- Ospedale Santissima Annunziata, 87100 Cosenza, Italy
| | - Mark La Mair
- Cardiothoracic Department, Brussels University Hospital, 1090 Jette, Belgium
| | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio di Calabria, Italy
| | - Carmine Riccio
- Division of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milano, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
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10
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Xiang K, Zhuang H, Wu Q, Tang M, Yang J, Fan C. A Rare Ultra-Long-Term Complication of Occluder Recanalization Due to Spontaneous Perforation of Polyvinyl Alcohol Membrane of Atrial Septal Defect Occluder: A Case Report and Review of the Literature. Front Cardiovasc Med 2022; 9:926527. [PMID: 35935660 PMCID: PMC9354964 DOI: 10.3389/fcvm.2022.926527] [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: 04/22/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Percutaneous closure of atrial septal defect (ASD) has emerged as a feasible alternative strategy to surgical repair in many cardiac centers worldwide. Occluder recanalization due to device failure is a rare and severe complication that often occurs within weeks to years after ASD closure. We reported a rare ultra-long-term complication of occluder recanalization due to delayed spontaneous perforation of polyvinyl alcohol (PVA) membrane of ASD occluder after 18 years of ASD closure. Surgical removal of the faulty device and reconstruction of the atrial septum with a bovine pericardial patch was performed. The patient was discharged and recovered uneventfully without syncope or residual shunt. The cause of this rare complication of spontaneous PVA membrane perforation of the occluder has not been fully detected. To our knowledge, this is the first report about PVA membrane perforation of an occluder that occurred soon after ASD closure.
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Heaton JN, Okoh AK, Suh S, Ozturk E, Salemi A, Waxman S, Tayal R. Safety and Efficacy of the Amplatzer Septal Occluder: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 37:52-60. [PMID: 34183276 PMCID: PMC10909392 DOI: 10.1016/j.carrev.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. BACKGROUND The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile. METHODS We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events. RESULTS We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity. CONCLUSION A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure. CONDENSED ABSTRACT The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America; Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America.
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Seungmo Suh
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America
| | - Ebru Ozturk
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Arash Salemi
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Sergio Waxman
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Rajiv Tayal
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
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12
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Vazquez-Sosa C, Clegg SD, Blankenship JC. How Old is Too Old? Closure of Patent Foramen Ovale in Older Patients. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke specifically in younger patients. The three randomized controlled trials that led to the widespread adoption of PFO closure excluded patients over the age of 60 years. Older patients frequently have other cardiac and vascular conditions that are common risk factors for stroke, whereas paradoxical embolism through a PFO is relatively rare. Younger patients theoretically benefit the most from closure due to longer lifetime exposure risk and absence of other traditional risk factors. PFO in older patients with cryptogenic strokes is often encountered in clinical practice, making up an increasing number of cardiology referrals, yet cardiologists lack guidelines and evaluation tools for these patients. This review explores the history of PFO closure – emphasizing data in older adults – and discusses the evaluation and treatment of older people with cryptogenic stroke and PFO while further trials in this important population are awaited.
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Affiliation(s)
| | - Stacey D Clegg
- University of New Mexico Health Science Center, Albuquerque, NM; New Mexico Veterans Administration Medical Center, Albuquerque, NM
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13
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Cho KK, Khanna S, Lo P, Cheng D, Roy D. Persistent pathology of the patent foramen ovale: a review of the literature. Med J Aust 2021; 215:89-93. [PMID: 34218432 DOI: 10.5694/mja2.51141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
A patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20-34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea-orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identified stroke mechanisms. While PFOs can be associated with migraine with auras, with some patients reporting symptomatic improvement after closure, the evidence from randomised controlled trials is less clear in supporting the use of PFO closure for migraine treatment. PFO closure for other indications such as platypnoea-orthodeoxia syndrome, decompression illness and paradoxical embolism are based largely on case series with good clinical outcomes. PFO closure can be performed as a day surgical intervention with high procedural success and low risk of complications.
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Affiliation(s)
- Kenneth K Cho
- St Vincent's Hospital Sydney, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Shaun Khanna
- St Vincent's Hospital Sydney, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Phillip Lo
- St Vincent's Hospital Sydney, Sydney, NSW
| | | | - David Roy
- St Vincent's Hospital Sydney, Sydney, NSW.,University of New South Wales, Sydney, NSW
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14
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Kolte D, Palacios IF. Patent foramen ovale closure for secondary prevention of cryptogenic stroke. Expert Rev Cardiovasc Ther 2021; 19:211-220. [PMID: 33605829 DOI: 10.1080/14779072.2021.1878026] [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] [Indexed: 10/22/2022]
Abstract
Introduction: A patent foramen ovale (PFO) is highly prevalent among the adult population. It allows shunting of blood through the inter-atrial septum and has been associated with cryptogenic stroke, transient ischemic attack, platypnea-orthodeoxia syndrome, decompression sickness (e.g. deep-water divers), and migraines.Areas Covered: In this manuscript, we will review the anatomy of PFO with particular emphasis on the factors associated with increased risk of paradoxical embolization, as well as the different modalities for the diagnosis of PFO. We will discuss medical, surgical, and transcatheter therapy for secondary prevention in patients with PFO and cryptogenic stroke, and summarize the data from observational studies, randomized controlled trials (RCTs), and meta-analysis of RCTs that have established the beneficial effect of transcatheter PFO closure in this patient population. Finally, we will provide a brief overview of the role of transcatheter PFO closure in patients with migraine.Expert Opinion: Transcatheter closure is the preferred treatment option in young (<60 years) patients with PFO and cryptogenic stroke. A multi-disciplinary approach with input from clinical cardiologist, neurologist, hematologist, cardiac surgeon, and interventional cardiologist provides the best therapeutic plan for each patient taking into account the available data, but also medical, social, and occupational considerations.
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Affiliation(s)
- Dhaval Kolte
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Igor F Palacios
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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15
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Drakopoulou M, Soulaidopoulos S, Stathogiannis K, Oikonomou G, Papanikolaou A, Toutouzas K, Tousoulis D. Antiplatelet and Antithrombotic Therapy After Patent Foramen Oval and Atrial Septal Defect Closure. Curr Pharm Des 2021; 26:2769-2779. [PMID: 32338207 DOI: 10.2174/1385272824999200427083838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
Pathologies of the atrial septum include different interatrial communications varying from patent foramen ovale (PFO) to actual defects. Atrial septal defects (ASDs) may be localized within the fossa ovalis such as the secundum type ASD or outside the region of fossa ovalis, such as the ostium primum defect and sinus venosus defect. Over the last decades, the percutaneous closure of interatrial shunts has become a feasible and safe method. During these procedures, the delicate balance between thrombotic risk, device sealing process and bleeding risk is crucial. In this review, we sought to describe current available data on the antiplatelet and antithrombotic management of patients after percutaneous ASD or PFO closure.
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Affiliation(s)
- Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Stathogiannis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Georgios Oikonomou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
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16
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Advances and ongoing controversies in PFO closure and cryptogenic stroke. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:43-56. [PMID: 33632456 DOI: 10.1016/b978-0-12-819814-8.00009-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Approximately one-third of strokes are cryptogenic in origin. These patients have a higher prevalence of patent foramen ovale (PFO) compared to individuals with stroke of known origin. It has been proposed that some cryptogenic strokes (CSs) can be caused by paradoxical embolism across a PFO. PFOs can be treated medically with antithrombotic agents and percutaneously with occluder devices. Large randomized clinical trials have found transcatheter PFO closure to be superior to medical treatment for the prevention of recurrent stroke in young patients with CS. However, the superiority of PFO closure over medical treatment in unselected populations has not been demonstrated. In this chapter, we review the evidence supporting PFO closure and the selection of patients for such intervention.
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17
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Doshi R, Adalja D, Kumar A, Dave M, Shariff M, Shah J, Gullapalli N, Desai R, Rupareliya C, Sattar Y, Vallabhajosyula S. Frequency, Trends, and Outcomes of Cerebrovascular Events Associated With Atrial Fibrillation Hospitalizations. Am J Cardiol 2021; 138:53-60. [PMID: 33058804 DOI: 10.1016/j.amjcard.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022]
Abstract
The main objective is to estimate the frequency, temporal trends, and outcomes of cerebrovascular events associated with atrial fibrillation (AF) hospitalization in the United States. The national inpatient sample data was utilized to identify hospitalizations with a primary or secondary diagnosis of AF from January 1, 2005 through September 31, 2015 for the present analysis. Jonckheere-Terpstra Trend was utilized to analyze trends from 2005 to 2015. Global Wald score was used to assess relative contributions of various covariates towards stroke among AF hospitalizations. Between the years 2005 and 2015, there were 36,457,323 (95.2%) AF hospitalizations without cerebrovascular events and 1,824,608 (4.8%) with cerebrovascular events included in the final analysis. There was a statistically significant increase in the proportion of overall stroke, AIS, and AHS (ptrend value <0.001) per 1,000 AF hospitalizations. The frequency of stroke per 1,000 AF hospitalizations was highest among patients with CHA2DS2VASc score ≥3 and Charlson's comorbidity index ≥3. The trend of in-hospital mortality decreased during the study period, however, it remained higher in those with cerebrovascular events compared to those without. Lastly, hypertension, advancing age, and chronic lung disease were major stroke predicting factors among AF hospitalizations. These cerebrovascular events were associated with longer length of stay and higher costs. In conclusion, the incidence of cerebrovascular events associated with AF hospitalizations remained significantly high and the trend continues to ascend despite technological advancements. Strategies should improve to reduce the risk of AF-related stroke in the United States.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
| | - Devina Adalja
- Department of Medicine, GMERS Gotri Medical College, Vadodara, Gujarat, India
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Mariam Shariff
- Department of Critical Care Medicine, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Jay Shah
- Department of Cardiology, Mercy St Vincent Medical Center, Toledo, Ohio
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada
| | - Rupak Desai
- Department of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | | | - Yasar Sattar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital, Queens, New York
| | - Saraschandra Vallabhajosyula
- Division of Cardiovascular Medicine, Section of Interventional Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Abstract
Up to a third of strokes are cryptogenic. The prevalence of patent foramen ovale (PFO) in patients with cryptogenic stroke is higher than in individuals with stroke of known origin. It has been proposed that some cryptogenic strokes can be caused by paradoxic embolism across a PFO. The treatment of PFO includes medical treatment with antithrombotic agents and percutaneous PFO closure. There is limited evidence to support PFO closure in unselected cases of cryptogenic stroke. However, large randomized clinical trials confirmed the superiority of transcatheter PFO closure compared with medical treatment in young patients with cryptogenic stroke.
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19
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Transcatheter closure of patent foramen ovale: Current evidence and future perspectives. J Cardiol 2020; 77:3-9. [PMID: 33144025 DOI: 10.1016/j.jjcc.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022]
Abstract
Recent prospective controlled studies have demonstrated that transcatheter closure of a patent foramen ovale (PFO) reduces recurrent stroke risk in select patients, especially in patients younger than 60 years with PFO and embolic-appearing infarct and where no other mechanism of stroke was identified. Detection of PFO depends on the intensity of the Valsalva maneuver, and not all PFOs can be diagnosed using transesophageal echocardiography. Transthoracic contrast echocardiography using abdominal compression during the Valsalva maneuver is an easy method that can increase the detection sensitivity of PFO shunt. PFO with two or more of the following factors is most likely considered a "high-risk PFO" and as such, has a significantly higher probability of cryptogenic stroke: (1) a long-tunnel PFO (≥10 mm in length), (2) atrial septal aneurysm and/or hypermobile interatrial septum, (3) prominent Eustachian valve or Chiari's network, (4) large right-to-left shunt at rest and during the Valsalva maneuver, and (5) low-angle PFO. In order to establish the benefit of catheter-based PFO closure as a safe and effective treatment in clinical practice, the degree of accuracy of PFO diagnosis and its long-term safety need to be confirmed.
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20
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Miton N, Godart F, Milani G, Jalal Z, Karsenty C, Baruteau AE, Gronier C, Aldebert P, Douchin S, Lucron H, Chalard A, Houeijeh A, Petit J, Hascoet S, Thambo JB, Dauphin C. Patent foramen ovale closure in children without cardiopathy: Child-PFO study. Arch Cardiovasc Dis 2020; 113:513-524. [PMID: 32680737 DOI: 10.1016/j.acvd.2020.03.021] [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] [Received: 07/09/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Closure of patent foramen ovale is well-managed in adults, but is performed less frequently in children. AIM To analyse all patent foramen ovale closures performed in the past 20 years in French paediatric centres. METHODS Retrospective study of patent foramen ovale closures in children without cardiopathy in nine centres between 2000 and 2019. RESULTS Forty-one procedures were carried out in children (median age: 14.9 years). Thirty-one patent foramen ovales were closed after a transient ischaemic attack or stroke, six for a left-to-right shunt and four for other reasons. Transthoracic echocardiography was used for 72.2% of the diagnoses and transoesophageal echocardiography for 27.8%. A substantial degree of shunting was found in 42.9% of patients and an atrial septal aneurysm in 56.2%. General anaesthesia with transoesophageal echocardiography guidance was performed in 68.3% of the procedures; local anaesthesia and transthoracic echocardiography or intracardiac echocardiography was performed in 31.7%. The success rate was 100%. The median fluoroscopy time was 4.14minutes: 3.55minutes with transoesophageal echocardiography; and 4.38minutes with transthoracic echocardiography (P=0.67). There was only one periprocedural complication (2.4%). Postoperatively, 80,5% of patients were treated with aspirin and 12,2% with an anticoagulant. The rate of complete occlusion was 56.8% immediately after the procedure, 68.6% at 1 year and 92.3% at the last follow-up. There were no delayed complications or cases of recurrent stroke during follow-up (median follow-up: 568 days). CONCLUSION Closure of patent foramen ovale in children appears to be safe and effective, as we noted a low rate of immediate complications, no delayed complications and no stroke recurrence in this indication.
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Affiliation(s)
- Noelie Miton
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France
| | - François Godart
- Paediatric Cardiology and Congenital Heart Disease, Institut Coeur Poumon, Lille University, 59000 Lille, France
| | - Guiti Milani
- Paediatric Cardiology Department, Necker-Enfants Malades Hospital, AP-HP, M3C National Reference CHD Centre, Paris Descartes University, Sorbonne Paris, 75015 Paris, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, 33600 Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, 33600 Pessac, France
| | - Clément Karsenty
- Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse University, 31432 Toulouse, France; Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse University, 31300 Toulouse, France
| | - Alban-Elouen Baruteau
- L'institut du Thorax, INSERM, CNRS, Nantes University, CHU Nantes, 44007 Nantes, France; Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
| | - Céline Gronier
- Groupe d'Exploration Cardiovasculaire, Clinique de l'Orangerie, 67000 Strasbourg, France
| | - Philippe Aldebert
- Paediatric and Congenital Medico-Surgical Cardiology Department, M3C Regional Reference CHD Centre, AP-HM, La Timone University Hospital, 13005 Marseille, France
| | - Stéphanie Douchin
- Department of Cardiology, M3C Regional Reference CHD Centre, CHU Grenoble, 38700 La Tronche, France
| | - Hugues Lucron
- Paediatric Cardiology, M3C Antilles-Guyane Centre, University Hospital (CHU de Martinique), 97200 Fort-de-France, France
| | - Aurélie Chalard
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France
| | - Ali Houeijeh
- Paediatric Cardiology and Congenital Heart Disease, Institut Coeur Poumon, Lille University, 59000 Lille, France
| | - Jérome Petit
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference CHD Centre, Paris-Sud University, Paris-Saclay University, 92350 Le Plessis-Robinson, France
| | - Sébastien Hascoet
- Paris-Sud Faculty of Medicine, INSERM U999, Marie-Lannelongue Hospital, M3C National Reference CHD Centre, Paris-Sud University, Paris-Saclay University, 92350 Le Plessis-Robinson, France
| | - Jean-Benoit Thambo
- Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33604 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, 33600 Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, 33600 Pessac, France
| | - Claire Dauphin
- Department of Cardiology, M3C Regional Reference CHD Centre, Gabriel Montpied University Hospital, 63000 Clermont-Ferrand, France.
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Khan R. Examining the evidence for PFO closure and novel oral anticoagulants for treatment of cryptogenic stroke. Expert Rev Cardiovasc Ther 2020; 18:139-148. [PMID: 32085690 DOI: 10.1080/14779072.2020.1733977] [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] [Indexed: 10/24/2022]
Abstract
Introduction: There has been considerable study assessing the treatment of cryptogenic stroke (CS) recently. This review examines the role of patent foramen ovale (PFO) closure in CS, while also discussing the evidence for alternative medical therapies in disease treatment.Areas covered: PFO closure for treatment of CS has been assessed in 6 randomized controlled trials (RCTs). This review summarizes the background, results and limitations of these trials. Methodological and treatment-related differences in RCTs provide potential explanations for the discordance in outcomes observed between older (CLOSURE, PC, RESPECT-Early) and newer PFO closure trials (RESPECT-Late, CLOSE, REDUCE, DEFENSE-PFO). With regards to medical therapy for CS, two RCTs (NAVIGATE ESUS and RE-SPECT ESUS) did not show any benefit in recurrent stroke prevention with the use of novel oral anticoagulants (NOAC) compared with aspirin. Marked differences in baseline characteristics and rates of recurrent stroke between PFO closure and NOAC trials underlie the heterogeneous nature of CS.Expert commentary: In young patients with CS, PFO closure reduces the risk of recurrent stroke, with newer RCTs emphasizing the importance of identifying those with 'high-risk' PFO and the need for continued antiplatelet therapy. Additionally, treatment for CS should not be uniform but directed at disease-specific pathologies.
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Affiliation(s)
- Razi Khan
- Department of Cardiology, Royal Columbian Hospital, New Westminster, Canada
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22
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Gevorgyan Fleming R, Kumar P, West B, Noureddin N, Rusheen J, Aboulhosn J, Tobis JM. Comparison of residual shunt rate and complications across 6 different closure devices for patent foramen ovale. Catheter Cardiovasc Interv 2019; 95:365-372. [DOI: 10.1002/ccd.28527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Rubine Gevorgyan Fleming
- Division of Cardiology, Department of MedicineUniversity of California, Los Angeles Los Angeles California
| | - Preetham Kumar
- Division of Cardiology, Department of MedicineUniversity of California, Los Angeles Los Angeles California
| | - Brian West
- Division of Cardiology, Department of MedicineUniversity of California, Los Angeles Los Angeles California
| | - Nabil Noureddin
- Department of Internal MedicineUniversity of Nevada, Las Vegas Las Vegas Nevada
| | - Joshua Rusheen
- David Geffen School of MedicineUniversity of California, Los Angeles Los Angeles California
| | - Jamil Aboulhosn
- Division of Cardiology, Department of MedicineUniversity of California, Los Angeles Los Angeles California
| | - Jonathan M. Tobis
- Division of Cardiology, Department of MedicineUniversity of California, Los Angeles Los Angeles California
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23
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Garg A, Thawabi M, Rout A, Sossou C, Cohen M, Kostis JB. Recurrent Stroke Reduction with Patent Foramen Ovale Closure versus Medical Therapy Based on Patent Foramen Ovale Characteristics: A Meta-Analysis of Randomized Controlled Trials. Cardiology 2019; 144:40-49. [PMID: 31574522 DOI: 10.1159/000500501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/19/2019] [Indexed: 11/19/2022]
Abstract
Efficacy of patent foramen ovale (PFO) closure in patients with cryptogenic stroke remains a matter of debate. We performed a comprehensive meta-analysis of available randomized controlled trials (RCTs) to evaluate the efficacy and safety of PFO closure versus medical therapy (MT) based on PFO characteristics. Random-effects meta-analysis was conducted to estimate risk ratio (RR) with 95% confidence intervals (CI) for the primary end points of stroke. After systematic search, six RCTs (3,747 patients) with 1,889 patients randomized to PFO closure and 1,858 patients randomized to the MT group were included in the meta-analysis. Overall, PFO closure was associated with a significant reduction in recurrent stroke compared to MT [RR 0.41; 95% CI 0.20-0.83]. While there were no differences in mortality or major bleeding between the two groups, risk of newly diagnosed atrial fibrillation was higher in the PFO closure group compared to MT [RR 5.29; 95% CI 2.32-12.06]. Further, risk reduction in stroke with PFO closure was significant in patients with high-risk PFO characteristics [RR 0.37; 95% CI 0.16-0.87] but not in low-risk patients [RR 0.73; 95% CI 0.29-1.84]. In conclusion, among patients with cryptogenic stroke, PFO closure is associated with a significantly reduced risk of recurrent stroke compared to MT. Additionally, the benefit of PFO closure might be dependent on certain PFO characteristics.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA, .,Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA,
| | - Mohammed Thawabi
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Amit Rout
- Department of Medicine, Sinai Hospital, Baltimore, Maryland, USA
| | - Chris Sossou
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| | - John B Kostis
- Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Arfaras-Melainis A, Palaiodimos L, Mojadidi MK. Transcatheter Closure of Patent Foramen Ovale: Randomized Trial Update. Interv Cardiol Clin 2019; 8:341-356. [PMID: 31445719 DOI: 10.1016/j.iccl.2019.05.002] [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: 01/10/2023]
Abstract
A patent foramen ovale (PFO) is found in about one-quarter of all adults, but the prevalence increases to approximately half of those with a history of a so-called cryptogenic stroke. The true efficacy of PFO closure for prevention of recurrent paradoxical embolism has been debated for years, as the early 3 randomized trials did not show a statistically significant benefit of PFO closure over standard-of-care medical therapy. However, 3 recent randomized trials along with the long-term follow-up data from the largest early trial demonstrated superiority of device closure for secondary stroke prevention.
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Affiliation(s)
- Angelos Arfaras-Melainis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Street, Haidari, Athens 12462, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, 1101 East Marshall Street, Richmond, VA 23298, USA
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Gerstein NS, Clegg SD, Levin DB, Fish AC, Tolstrup K, Nakanishi K, Yoshida Y, Homma S. A Case-Based Discussion on the Management of Cryptogenic Stroke and Patent Foramen Ovale in the Patient With a Hypercoagulable Disorder. J Cardiothorac Vasc Anesth 2019; 33:3476-3485. [PMID: 31473116 DOI: 10.1053/j.jvca.2019.07.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/21/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico - School of Medicine, Albuquerque, NM.
| | - Stacey D Clegg
- Department of Medicine, Division of Cardiology, University of New Mexico - School of Medicine, Albuquerque, NM
| | - Daniel B Levin
- Department of Medicine, Division of Cardiology, University of New Mexico - School of Medicine, Albuquerque, NM
| | - Adam C Fish
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico - School of Medicine, Albuquerque, NM
| | - Kirsten Tolstrup
- Department of Medicine, University of California, San Francisco, CA
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
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Percutaneous Closure of Patent Foramen Ovale in Patients with Cryptogenic Stroke — An Updated Comprehensive Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:687-694. [DOI: 10.1016/j.carrev.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
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Mojadidi MK, Zaman MO, Elgendy IY, Mahmoud AN, Patel NK, Agarwal N, Tobis JM, Meier B. Cryptogenic Stroke and Patent Foramen Ovale. J Am Coll Cardiol 2019; 71:1035-1043. [PMID: 29495983 DOI: 10.1016/j.jacc.2017.12.059] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 02/09/2023]
Abstract
Nearly one-half of patients with cryptogenic stroke have a patent foramen ovale (PFO). The dilemma of whether to close these PFOs percutaneously, in an effort to reduce the risk of recurrent paradoxical embolism, has been a matter of ongoing debate for more than a decade. Early randomized clinical trials failed to demonstrate a significant benefit of percutaneous PFO closure for secondary prevention of cryptogenic stroke in an intention-to-treat analysis. The long-term follow-up data from the RESPECT trial and 2 new randomized trials (CLOSE and REDUCE) have clarified these findings. They showed that with good patient selection, transcatheter PFO closure significantly reduces the risk of recurrent stroke compared with medical therapy in patients with cryptogenic stroke, with no increased risk of serious adverse events or influence on major bleeding.
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Affiliation(s)
- Mohammad K Mojadidi
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Muhammad O Zaman
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Islam Y Elgendy
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Ahmed N Mahmoud
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - Nimesh K Patel
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Nayan Agarwal
- Interventional Cardiology, Cardiovascular Institute of the South, Houma, Louisiana
| | - Jonathan M Tobis
- Program in Interventional Cardiology, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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Abdelghani M, El-Shedoudy SAO, Nassif M, Bouma BJ, de Winter RJ. Management of Patients with Patent Foramen Ovale and Cryptogenic Stroke: An Update. Cardiology 2019; 143:62-72. [PMID: 31307049 DOI: 10.1159/000501028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/14/2019] [Indexed: 11/19/2022]
Abstract
Patent foramen ovale (PFO) is a common benign finding in healthy subjects, but its prevalence is higher in patients with stroke of unclear cause (cryptogenic stroke). PFO is believed to be associated with stroke through paradoxical embolism, and certain clinical and anatomical criteria seem to increase the likelihood of a PFO to be pathological. Recent trials have shown that closure of PFO, especially if associated with an atrial septal aneurysm and/or a large interatrial shunt, may reduce the risk of recurrent stroke as compared to medical treatment. However, it remains challenging to risk stratify patients with suspected PFO-related stroke and to decide if device closure is indicated. We sought to review contemporary evidence and to conclude an evidence-based strategy to prevent recurrence of PFO-related stroke.
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Affiliation(s)
- Mohammad Abdelghani
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany, .,Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands, .,Department of Cardiology, Al-Azhar University, Cairo, Egypt,
| | | | - Martina Nassif
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Madhkour R, Meier B. Ictus criptogénico con un foramen oval permeable: ¿cuándo se debe cerrar? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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30
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Alkhouli M, Sievert H, Holmes DR. Patent foramen ovale closure for secondary stroke prevention. Eur Heart J 2019; 40:2339-2350. [PMID: 30957864 DOI: 10.1093/eurheartj/ehz157] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/30/2018] [Accepted: 03/05/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke is gaining momentum after the recent publication of four randomized clinical trials suggesting its benefit. This article provides a contemporary overview of the anatomy and pathophysiology of PFO, the available diagnostic tools for the assessment and risk stratification of PFO, and the current and future landscape of PFO closure devices and their optimal utilization. It also summarizes the current data on PFO closure for stroke prevention, and discusses the remaining open issues in the field of PFO closure.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV, USA
| | - Horst Sievert
- Department of Medicine, CardioVascular Center Frankfurt, Seckbacher Landstraße 65, Frankfurt am Main, Germany
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge, UK
- Yunnan Hospital Fuwai, Intersection of Shahe Beilu and Jinchuan Lu, Kunming, China
- University of California, 550 16th Street, San Francisco, CA, USA
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, USA
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Wang TKM, Wang MTM, Ruygrok P. Patent Foramen Ovale Closure Versus Medical Therapy for Cryptogenic Stroke: Meta-Analysis of Randomised Trials. Heart Lung Circ 2019; 28:623-631. [DOI: 10.1016/j.hlc.2018.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/12/2018] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
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Meier B. [Patent foramen ovale with a license to kill]. Med Klin Intensivmed Notfmed 2019; 115:94-100. [PMID: 30859250 DOI: 10.1007/s00063-019-0561-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
Abstract
A patent foramen ovale (PFO) is present in about one of four, and one of its dangerous forms (large or associated with atrial septal aneurysm, Eustachian valve, or Chiari network) in one of twenty people. About 140 years ago, the PFO was shown to have the potential to result in death due to stroke and also myocardial infarction. The described decrease of the prevalence of a PFO with age may be a consequence of this. Therefore, it comes somewhat as a surprise that the PFO is taken rather lightly by the medical community. Percutaneous PFO closure with implantable devices has been around for over two decades and since then has proven to be the simplest and safest technique in interventional cardiology. Nonetheless, it is rarely applied and not recommended in current guidelines except for a few situations. Countless nonrandomised comparisons have invariably pointed to a clinical benefit of PFO closure in the secondary prevention of paradoxical cerebral events in patients with or without competitive reasons for stroke. Even a survival benefit of PFO closure was shown in a comparison over 10 years. However, the first three publications of randomised trials were not significant in the protocolled sense. PFO closure did reduce recurrent events compared to medical therapy by up to 80% but the statistical significance postulated was only reached in one of the three trials when the results were analyzed as treated or per predefined subgroups, like patients with atrial septal aneurysm, large PFO, or all PFO closure patients compared to treatment with acetylsalicylic acid only. Recently, a preplanned longer-term analysis of this trial and two additional randomised trials including higher risk PFOs reached the hypothesised statistical significance. This may be a turning point in the attitude towards PFO closure. In addition, PFO closure improves migraine and dyspnoea in certain patients. It appears, though, that it will take time until the full potential of PFO closure will be reflected in respective guidelines and reimbursement algorithms and adequately exploited by referring physicians (mostly neurologists) and interventional cardiologists. This reluctance will continue to cost innumerable preventable strokes, myocardial infarctions, and deaths around the world. The low risk of PFO closure must be weighed against even death if a PFO is left open; it is much more likely that one regrets not having closed a PFO than having closed it.
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Affiliation(s)
- B Meier
- Universitätsklinik für Kardiologie, Departement Herz und Gefässe, Inselspital, 3010, Bern, Schweiz.
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33
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Updated meta-analysis of closure of patent foramen ovale versus medical therapy after cryptogenic stroke. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:187-193. [DOI: 10.1016/j.carrev.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/27/2022]
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34
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Madhkour R, Wahl A, Praz F, Meier B. Amplatzer patent foramen ovale occluder: safety and efficacy. Expert Rev Med Devices 2019; 16:173-182. [DOI: 10.1080/17434440.2019.1581060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Raouf Madhkour
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Andreas Wahl
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
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Köhrmann M, Schellinger PD, Tsivgoulis G, Steiner T. Patent Foramen Ovale: Story Closed? J Stroke 2019; 21:23-30. [PMID: 30732440 PMCID: PMC6372901 DOI: 10.5853/jos.2018.03097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022] Open
Abstract
The optimal treatment strategy for secondary prevention in patients with cryptogenic stroke and patent foramen ovale (PFO) has been a matter of controversy for decades. After three randomized trials failed to show a benefit of closure with an excess of complications in the interventional arm, two large recent trials suggest a benefit with regard of preventing further ischemic strokes. With this discrepancy in results it is important to discuss recent trials in detail and evolve an informed clinical approach for daily practice.
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Affiliation(s)
- Martin Köhrmann
- Department of Neurology, Essen University Hospital, Essen, Germany
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Thorsten Steiner
- Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt, Germany.,Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Pristipino C, Sievert H, D'Ascenzo F, Mas JL, Meier B, Scacciatella P, Hildick-Smith D, Gaita F, Toni D, Kyrle P, Thomson J, Derumeaux G, Onorato E, Sibbing D, Germonpré P, Berti S, Chessa M, Bedogni F, Dudek D, Hornung M, Zamorano J. European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EUROINTERVENTION 2019; 14:1389-1402. [PMID: 30141306 DOI: 10.4244/eij-d-18-00622] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
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37
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Madhkour R, Meier B. PFO and Cryptogenic Stroke: When Should It Be Closed? ACTA ACUST UNITED AC 2018; 72:369-372. [PMID: 30553802 DOI: 10.1016/j.rec.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Raouf Madhkour
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland.
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38
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Optimal stroke prevention in patients with patent foramen ovale. Lancet Neurol 2018; 17:1027-1028. [DOI: 10.1016/s1474-4422(18)30369-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
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39
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Fiorelli EM, Carandini T, Gagliardi D, Bozzano V, Bonzi M, Tobaldini E, Comi GP, Scarpini EA, Montano N, Solbiati M. Secondary prevention of cryptogenic stroke in patients with patent foramen ovale: a systematic review and meta-analysis. Intern Emerg Med 2018; 13:1287-1303. [PMID: 30032341 DOI: 10.1007/s11739-018-1909-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/12/2018] [Indexed: 01/27/2023]
Abstract
The aim of our study is to compare patent foramen ovale (PFO) closure versus medical treatment and antiplatelet versus anticoagulant therapy in patients with cryptogenic stroke (CS) and PFO. We conducted a systematic review and meta-analysis with trial sequential analysis (TSA) of randomized trials. Primary outcomes are stroke or transient ischemic attack (TIA) and all-cause mortality. Secondary outcomes are peripheral embolism, bleeding, serious adverse events, myocardial infarction and atrial dysrhythmias. We performed an intention to treat meta-analysis with a random-effects model. We include six trials (3677 patients, mean age 47.3 years, 55.8% men). PFO closure is associated with a lower recurrence of stroke or TIA at a mean follow-up of 3.88 years compared to medical therapy [risk ratio (RR) 0.55, 95% CI 0.38-0.81; I2 = 40%]. The TSA confirms this result. No difference is found in mortality (RR 0.74, 95% CI 0.35-1.60; I2 = 0%), while PFO closure is associated with a higher incidence of atrial dysrhythmias (RR 4.55, 95% CI 2.16-9.60; I2 = 25%). The rate of the other outcomes is not different among the two groups. The comparison between anticoagulant and antiplatelet therapy shows no difference in terms of stroke recurrence, mortality and bleeding. There is conclusive evidence that PFO closure reduces the recurrence of stroke or TIA in patients younger than 60 years of age with CS. More data are warranted to assess the consequences of the increase in atrial dysrhythmias and the advantage of PFO closure over anticoagulants.
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Affiliation(s)
- Elisa Maria Fiorelli
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Tiziana Carandini
- Neurodegenerative Disease Unit, University of Milan, Dino Ferrari Centre, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Delia Gagliardi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Viviana Bozzano
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mattia Bonzi
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Neurology Unit, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elio Angelo Scarpini
- Neurodegenerative Disease Unit, University of Milan, Dino Ferrari Centre, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Monica Solbiati
- Department of Internal Medicine, IRCCS Foundation Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Closure versus Medical Therapy for Patent Foramen Ovale in Patients with Cryptogenic Stroke: An Updated Meta-Analysis of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2018; 27:3463-3472. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/25/2018] [Accepted: 08/05/2018] [Indexed: 11/18/2022] Open
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Morais LA, Sousa LD, Fiarresga A, Martins JD, Timóteo AT, Monteiro AV, Soares C, Agapito A, Pinto F, Ferreira RC. RoPE Score as a Predictor of Recurrent Ischemic Events After Percutaneous Patent Foramen Ovale Closure. Int Heart J 2018; 59:1327-1332. [DOI: 10.1536/ihj.17-489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Luís Almeida Morais
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Lídia de Sousa
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Antonio Fiarresga
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - José Diogo Martins
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Ana Teresa Timóteo
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | | | - Cristina Soares
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Ana Agapito
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Fátima Pinto
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
| | - Rui Cruz Ferreira
- Cardiology University Centre, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central
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Net clinical benefit of patent foramen ovale closure in patients with cryptogenic stroke: Meta-analysis and meta-regression of randomized trials. Int J Cardiol 2018; 266:75-80. [DOI: 10.1016/j.ijcard.2018.02.106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 02/07/2023]
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Sadrameli SS, Gadhia RR, Kabir R, Volpi JJ. Patent Foramen Ovale in Cryptogenic Stroke and Migraine with Aura: Does Size Matter? Cureus 2018; 10:e3213. [PMID: 30405989 PMCID: PMC6205877 DOI: 10.7759/cureus.3213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: There is an association between cryptogenic strokes and patent foramen ovale (PFO), as well as between migraines with aura and PFO. The purpose of the current study was to compare shunt characteristics in the stroke and migraine populations. Methods: We retrospectively evaluated the degree of the shunt in 68 consecutive patients with cryptogenic stroke (n=33) or migraines with aura (n=35) evaluated in a single transcranial Doppler laboratory. All patients underwent an intravenous injection of agitated saline, followed by the insonation of the middle cerebral artery to determine the degree of the right-to-left shunt. We graded the shunt size according to the number of emboli: Grade I, none; Grade II, 1-10; Grade III, 11-100; and Grade IV, >100. Grades I and II were considered low-grade shunts, and Grades III and IV were considered high-grade. Results: In the 14-month study period, we found 31 high-grade shunts and 37 low-grade shunts. Among migraines with aura patients, 27 (77%) had high-grade shunts, whereas only 4 patients (12%) with cryptogenic stroke had high-grade shunts. These percentages were significantly different between groups (Fisher’s exact test, p<0.0001). Conclusions: In a standardized laboratory using uniform methods, we found a significant difference in shunt size associated with PFO between cryptogenic stroke and migraine with aura patients. We hypothesize that in migraines with aura, venous admixture with arterial blood is the main mechanism by which PFO contributes to the condition. In contrast, cryptogenic strokes associated with PFO are more likely to arise from an atrial septal clot within the PFO space.
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Affiliation(s)
- Saeed S Sadrameli
- Neurosurgery, Houston Methodist Neurological Institute, Houston, USA
| | - Rajan R Gadhia
- Neurology, Houston Methodist Neurological Institute, Houston, USA
| | - Rasadul Kabir
- Radiology, Houston Methodist Neurological Institute, Houston, USA
| | - John J Volpi
- Neurology, Houston Methodist Neurological Institute, Houston, USA
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44
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Sidia B, Saleh C, El Issa M, Mono ML. Management of patent foramen ovale in patients with cryptogenic stroke: Is device closure superior to medical treatment? A brief review. Surg Neurol Int 2018; 9:132. [PMID: 30105130 PMCID: PMC6044138 DOI: 10.4103/sni.sni_111_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/04/2018] [Indexed: 11/04/2022] Open
Abstract
Background Recent randomized controlled trial (RCTs) comparing percutaneous closure with antithrombotic treatment in patients with patent foramen ovale (PFO) and cryptogenic stroke revealed inconsistent results. Indeed, there is still no consensus on the management of these patients, namely closure or medical therapy treatment. Methods To take stock of the PFO management after cryptogenic stroke, we conducted a literature review that included 16 articles dealing with different therapeutic strategies and long-term outcomes of these results. Results The reviewed studies showed great methodological diversity rendering an exhaustive and balanced comparison between studies difficult. Low recurrence rates under prevention regimens, crossovers, procedure- and device-related complications, as well as inappropriate patient selection might explain the inconsistency of trials. However, despite the methodological heterogeneity certain patterns could be detected. It appears that device closure as secondary prevention measure is an effective and safe procedure reducing the recurrence of neurological events in cryptogenic stroke patients <60 years with large PFOs. Standardization of procedures and larger trials are needed to arrive to definitive conclusions. Conclusion In cryptogenic stroke patients <60 years with large PFOs, PFO closure seems to be safe and more effective compared to medical treatment alone. For all other patients group, for example, patients >60 years further trials are needed to clarify the role of PFO closure.
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Affiliation(s)
- Besma Sidia
- Cardiovascular Prevention Center Ellasanté (Centre de Santé Ellasanté), Paris, France
| | - Christian Saleh
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Meidi El Issa
- Cardiovascular Prevention Center Ellasanté (Centre de Santé Ellasanté), Paris, France
| | - Marie-Luise Mono
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ma Y, Li D, Bai F, Qin F, Li J, Li Y, Liu N, Xie H, Zhou S, Liu Q. Patent foramen ovale closure or medical therapy for secondary prevention of cryptogenic stroke: An update meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e11965. [PMID: 30142823 PMCID: PMC6112940 DOI: 10.1097/md.0000000000011965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It was under debate whether cryptogenic stroke patients benefited from patent foramen ovale (PFO) closure. We sought to determine secondary prevention strategy in these patients. METHODS Scientific databases were searched for randomized controlled trials enrolling cryptogenic stroke patients with PFO who underwent PFO closure or medical therapy. The random-effect model was used to analyze the outcomes. RESULTS We identified 6 trials enrolling 3630 participants in this meta-analysis. When compared with medical therapy, PFO closure reduced risks of recurrent stroke (risk ratio [RR] 0.52, 95% confidence interval [CI] 0.29-0.93) and composite of stroke and transient ischemic attack (TIA) (RR 0.60, 95% CI 0.46-0.80). And no differences in all-cause death (RR 0.80, 95% CI 0.37-1.72) and cardiovascular death (RR 1.47, 95% CI 0.36-5.94) between 2 groups were observed. The risks of major bleeding (RR 0.96, 95% CI 0.47-1.96) and any serious adverse event (RR 1.03, 95% CI 0.92-1.16) did not differ between 2 groups. Yet, PFO closure increased risk of atrial fibrillation (RR 4.25, 95% CI 2.10-8.60). CONCLUSION PFO closure, as compared with medical therapy, was associated with decreased risk of recurrent stroke and increased risk of atrial fibrillation in cryptogenic stroke patients with PFO.
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Affiliation(s)
| | - Dongping Li
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | | | | | | | | | - Hui Xie
- Department of Cardiothoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Patent foramen ovale closure versus medical therapy for cryptogenic stroke: An updated meta-analysis. J Neurol Sci 2018; 390:139-149. [DOI: 10.1016/j.jns.2018.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 11/19/2022]
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Shah AH, Osten M, Benson L, Alnasser S, Bach Y, Vishwanath R, Van De Bruaene A, Shulman H, Navaranjan J, Khan R, Horlick E. Incidence and Outcomes of Positive Bubble Contrast Study Results After Transcatheter Closure of a Patent Foramen Ovale. JACC Cardiovasc Interv 2018; 11:1095-1104. [DOI: 10.1016/j.jcin.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 10/14/2022]
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Device Closure of Patent Foramen Ovale in Patients With Cryptogenic Stroke: The Tide Has Turned. J Am Coll Cardiol 2018; 71:2343-2345. [PMID: 29773161 DOI: 10.1016/j.jacc.2018.03.460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/16/2023]
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49
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Abdelaziz HK, Saad M, Abuomara HZ, Nairooz R, Pothineni NVK, Madmani ME, Roberts DH, Mahmud E. Long-term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta-analysis of randomized trials. Catheter Cardiovasc Interv 2018; 92:176-186. [PMID: 29726616 DOI: 10.1002/ccd.27636] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/09/2018] [Accepted: 03/25/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine long-term clinical outcomes with transcatheter patent foramen ovale (PFO) closure versus medical therapy alone in patients with cryptogenic stroke. BACKGROUND A long-standing debate regarding the optimal approach for the management of patients with PFO after a cryptogenic stroke exists. METHODS An electronic search was performed for randomized clinical trials (RCTs) reporting clinical outcomes with PFO closure vs. medical therapy alone after stroke. Random effects DerSimonian-Laird risk ratios (RR) were calculated. The main outcome was recurrence of stroke. Other outcomes included transient ischemic attack (TIA), new-onset atrial fibrillation/flutter (AF/AFL), major bleeding, serious adverse events, and device-related complications. All-cause mortality was also examined. RESULTS Five RCTs with a total of 3,440 patients were included. At a mean follow-up of 4.02 ± 1.57 years, PFO closure was associated with less recurrence of stroke (RR = 0.43; 95% CI 0.19-0.91; P = .027) compared with medical therapy alone. No difference was observed between both strategies for TIA (P = .21), major bleeding (P = .69), serious adverse events (P = .35), and all-cause death (P = .48). However, PFO closure, was associated with increased new-onset AF/AFL (P < .001), risk of pulmonary embolism (P = .04), and device-related complications (P < .001). On a subgroup analysis, stroke recurrence rate remained lower in PFO closure arm regardless of the type of closure device used (Pinteraction = .50), or the presence of substantial shunt in the majority of study population (Pinteraction = .13). CONCLUSIONS Transcatheter PFO closure reduces the recurrence of stroke compared with medical therapy alone, with no significant safety concerns. Close follow-up of patients after PFO closure is recommended to detect new-onset atrial arrhythmias.
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Affiliation(s)
- Hesham K Abdelaziz
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Marwan Saad
- Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.,Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Hossamaldin Z Abuomara
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom.,Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Ramez Nairooz
- Division of Cardiovascular Medicine, University of Southern California, California
| | - Naga Venkata K Pothineni
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohamed E Madmani
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David H Roberts
- Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California, San Diego Sulpizio Cardiovascular Center, La Jolla, California
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Alvarez C, Siddiqui WJ, Aggarwal S, Hasni SF, Hankins S, Eisen H. Reduced Stroke After Transcatheter Patent Foramen Ovale Closure: A Systematic Review and Meta-analysis. Am J Med Sci 2018; 356:103-113. [PMID: 30219151 DOI: 10.1016/j.amjms.2018.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/28/2018] [Accepted: 04/05/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recent randomized control trials (RCTs) have suggested benefit with transcatheter patent foramen ovale (PFO) closure plus antiplatelet therapy over medical treatment alone for secondary stroke prevention. MATERIAL AND METHODS Data sources: we searched PubMed and Ovid MEDLINE from the inception until November 10, 2017 for RCTs comparing TPFO closure to medical therapy in patients with a PFO and a history of cryptogenic stroke. RESULTS Five RCTs with 3,627 patients (TPFO closure = 1,829 versus medical therapy =1,798) were included. There was a decreased number of post-TPFO closure strokes compared to the medical therapy arm; 53 versus 80 strokes (odds ratio [OR] = 0.61, CI: 0.39-0.94, P = 0.03, I2 = 17%). Transient ischemic attacks occurred in 43 patients after TPFO closure versus 60 patients in the medical therapy group (OR = 0.80, CI: 0.53-1.19, P = 0.26, I2 = 0%). There was a higher incidence of atrial fibrillation in the TPFO closure group, which occurred in 75 patients, compared to 12 patients in the medical therapy group (OR = 5.23, CI: 2.17-12.59, P = 0.0002, I2 = 43%). There was a trend toward a decreased number of neuropsychiatric events in the TPFO closure closure group compared to the medical therapy group; 42 versus 67 neuropsychiatric events (OR = 0.71, CI: 0.48-1.06, P = 0.09, I2 = 0%). CONCLUSIONS TPFO closure plus antiplatelet therapy is superior to medical therapy in patients with a PFO and cryptogenic stroke. PFO closure is associated with new-onset atrial fibrillation and a trend toward reduced neuropsychiatric events.
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Affiliation(s)
- Chikezie Alvarez
- Internal Medical Department, Seton Hall University, St. Francis Medical Center, Trenton, New Jersey.
| | - Waqas Javed Siddiqui
- Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Sandeep Aggarwal
- Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Syed Farhan Hasni
- Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Shelly Hankins
- Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Howard Eisen
- Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Cardiology, Hahnemann University Hospital, Philadelphia, Pennsylvania
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