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Zhai X, Jiao R, Ni A, Wang X. Case report: Anxiety and depression as initial symptoms in a patient with acute hypoxia and patent foramen ovale. Front Psychiatry 2023; 14:1229995. [PMID: 37674554 PMCID: PMC10478089 DOI: 10.3389/fpsyt.2023.1229995] [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: 05/27/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
The prevalence of patent foramen ovale (PFO) is 15-35% among adults. The role of right-to-left shunting through the PFO, anxiety, depression, and hypoxemia in the systemic circulation remains poorly understood. Herein, we present the case of a 52-year-old woman with no heart or lung disease, who was admitted due to anxiety for 5 months and had symptom exacerbation with dizziness for 4 days and presented with cyanosis. She was noted to have acute hypoxemia, with an oxygen saturation of 94.48% on room air, and arterial blood gas showed an oxygen tension of 65.64 mmHg. Agitated saline contrast echocardiography showed right-to-left shunting due to PFO. Arteriovenous fistula, pneumonia, pulmonary embolism, pulmonary hypertension, congestion peripheral cyanosis, ischemic peripheral cyanosis, and methemoglobin were excluded. Additionally, the patient improved by taking Paroxetine, Oxazepam, and Olanzapine. Her oxygen tension returned to 90.42 mmHg, and her symptoms resolved. In the case of severe anxiety and depression, right-to-left shunting through the PFO may cause acute systemic hypoxemia via a flow-driven mechanism, occasionally manifesting as cyanosis. When anxiety improved, hypoxia also improved. Thus, the treatment of anxiety and depression seems effective in improving hypoxemia. Notably, this is a rare report, and we hope to draw the attention of psychosomatic specialists, psychiatrists, and clinicians to seek the relationship between anxiety appearing as acute stress and PFO. This may be a new therapeutic method for treating severe anxiety disorder.
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Affiliation(s)
- Xiaoyan Zhai
- Department of Clinical Psychology, Hebei General Hospital, Shijiazhuang, China
| | - Ronghong Jiao
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Aihua Ni
- Department of Clinical Psychology, Hebei General Hospital, Shijiazhuang, China
| | - Xueyi Wang
- Psychiatric Department of The First Hospital of Hebei Medical University, Institute of Mental Health of Hebei Medical University, Shijiazhuang, Hebei, China
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Khalid N, Abdullah M, Ozgur SS, Elkattawy S, Shamoon F. Managing Patent Foramen Ovale (PFO) in Adults With Cryptogenic Stroke and Lymphoma: A Multidisciplinary Perspective. Cureus 2023; 15:e40316. [PMID: 37448395 PMCID: PMC10337876 DOI: 10.7759/cureus.40316] [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] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Cryptogenic strokes are strokes with no clear underlying cause. Patent foramen ovale (PFO) is believed to be one of the causes of cryptogenic strokes. To manage such cases, closing the PFO is usually considered an option. We report a case of a middle-aged male with lymphoma who presented with an altered mental status due to a stroke, which, on investigation, was found to be due to an underlying PFO. This report explores the factors that must be considered when making the decision to close the PFO and emphasizes the vital role of a multi-disciplinary team in determining the best course of action for patients with cryptogenic strokes.
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Affiliation(s)
- Noman Khalid
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Muhammad Abdullah
- Public Health & Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Shaikh Zayed Federal Postgraduate Medical Institute, Shaikh Zayed Medical Complex, Lahore, PAK
| | - Sacide S Ozgur
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | | | - Fayez Shamoon
- Cardiology, St. Joseph's Regional Medical Center, Paterson, USA
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DiMarco KG, Beasley KM, Shah K, Speros JP, Elliott JE, Laurie SS, Duke JW, Goodman RD, Futral JE, Hawn JA, Roach RC, Lovering AT. No effect of patent foramen ovale on acute mountain sickness and pulmonary pressure in normobaric hypoxia. Exp Physiol 2021; 107:122-132. [PMID: 34907608 DOI: 10.1113/ep089948] [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: 07/20/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022]
Abstract
What is the central question to this study? Is there a relationship between a patent foramen ovale and the development of acute mountain sickness and an exaggerated increase in pulmonary pressure in response to 7-10 hours of normobaric hypoxia? What is the main finding and its importance? Patent foramen ovale presence did not increase susceptibility to acute mountain sickness or result in an exaggerated increase in pulmonary artery systolic pressure with normobaric hypoxia. This data suggest hypobaric hypoxia is integral to the increased susceptibility to acute mountain sickness previously reported in those with patent foramen ovale, and patent foramen ovale presence alone does not contribute to the hypoxic pulmonary pressor response. ABSTRACT: Acute mountain sickness (AMS) develops following rapid ascent to altitude, but its exact causes remain unknown. A patent foramen ovale (PFO) is a right-to-left intracardiac shunt present in ∼30% of the population that has been shown to increase AMS susceptibility with high altitude hypoxia. Additionally, high altitude pulmonary edema (HAPE), is a severe type of altitude illness characterized by an exaggerated pulmonary pressure response, and there is a greater prevalence of PFO in those with a history of HAPE. However, whether hypoxia, per se, is causing the increased incidence of AMS in those with a PFO and whether a PFO is associated with an exaggerated increase in pulmonary pressure in those without a history of HAPE is unknown. Participants (n = 36) matched for biological sex (18 female) and the presence or absence of a PFO (18 PFO+) were exposed to 7-10 hours of normobaric hypoxia equivalent to 4755 m. Presence and severity of AMS was determined using the Lake Louise AMS scoring system. Pulmonary artery systolic pressure, cardiac output, and total pulmonary resistance were measured using ultrasound. We found no significant association of PFO with incidence or severity of AMS and no association of PFO with arterial oxygen saturation. Additionally, there was no effect of a PFO on pulmonary pressure, cardiac output, or total pulmonary resistance. These data suggest that hypobaric hypoxia is necessary for those with a PFO to have increased incidence of AMS and that presence of PFO is not associated with an exaggerated pulmonary pressor response. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kaitlyn G DiMarco
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Kara M Beasley
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Karina Shah
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Julia P Speros
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
| | - Jonathan E Elliott
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Department of Neurology, Portland, OR, USA
| | - Steven S Laurie
- KBR, Cardiovascular and Vision Laboratory, NASA Johnson Space Center, Houston, TX, USA
| | - Joseph W Duke
- Northern Arizona University, Department of Biological Sciences, Flagstaff, AZ, USA
| | | | | | - Jerold A Hawn
- Oregon Heart and Vascular Institute, Springfield, OR, USA
| | - Robert C Roach
- University of Colorado Anschutz Medical Campus, Altitude Research Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Aurora, CO, USA
| | - Andrew T Lovering
- University of Oregon, Department of Human Physiology, Eugene, OR, USA
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Houtzager T, Berg I, Urlings T, Grauss R. Concomitant pulmonary embolism and upper limb ischaemia as a first presentation of a patent foramen ovale. BMJ Case Rep 2021; 14:e242351. [PMID: 34598956 PMCID: PMC8488715 DOI: 10.1136/bcr-2021-242351] [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] [Accepted: 09/14/2021] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old female patient presented to the emergency department with syncope and dyspnoea. The left arm appeared to be cold and radial pulse was not palpable. A CT scan of the chest and left arm with intravenous contrast displayed bilateral central pulmonary embolisms in combination with a left subclavian artery embolism and an atrial septal aneurysm. Transthoracic echocardiography identified a patent foramen ovale with right-to-left shunting confirming the diagnosis of paradoxical embolism. The patient was treated with anticoagulants. In a patient presenting with a combination of a pulmonary embolism and a peripheral arterial embolism, the clinician should consider a right-to-left shunt with paradoxical embolism. In line with this, when diagnosing a peripheral arterial embolism, a central venous origin should be considered. Furthermore, when diagnosing a pulmonary embolism or other forms of venous thromboembolism, the clinician should be aware of signs of a peripheral arterial embolism.
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Affiliation(s)
- Tessa Houtzager
- Emergency Medicine, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Ingvar Berg
- Emergency Medicine, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Thijs Urlings
- Radiology, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
| | - Robert Grauss
- Cardiology, Haaglanden Medical Center, location Westeinde, Den Haag, The Netherlands
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Characteristics and prognosis of patients with cryptogenic stroke and suggestive of patent foramen ovale. Cardiovasc Ultrasound 2021; 19:20. [PMID: 34090472 PMCID: PMC8180014 DOI: 10.1186/s12947-021-00255-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/25/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS The purpose of this study were to identify the usefulness of screening for PFO using agitated saline echocardiography (ASE) and characteristics and prognosis of patients with suggestive of patent foramen ovale (PFO). METHODS Three hundred three patients (mean age, 53 ± 9 years; 199 [66%] men) admitted with acute stroke or suspicion of stroke were included. Patients were classified into those with and without right-to-left shunt (RLS) according to the ASE results (positive ASE [n = 92] vs. negative ASE [n = 211]). Fifty-one out of ninety-two patients with positive ASE and twenty-one out of two hundred eleven patients with negative ASE underwent TEE with ASE to confirm PFO. RESULTS Ninety-two were positive for ASE and thirty-six of the fifty-one patients who underwent TEE were confirmed as having PFO. Of the patients with RLS grade 1, 50% were diagnosed with PFO and all patients with RLS grade ≥ 2 were diagnosed with PFO. All patients with negative ASE had no PFO (sensitivity of 100% and specificity of 58%). Patients with positive ASE were younger, had a lower body mass, and a lower prevalence of hypertension. The positive ASE patients had a higher mean S' velocity and better diastolic function. Four of ninety-one patients with positive ASE and thirteen of one hundred seventy-seven showed recurrence of stroke and suspicion of stroke. CONCLUSION Transthoracic ASE is a good method to screen for PFO. Patients with suggestive of PFO had lower risk factors, less atherosclerosis, and better cardiac performance.
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Romano V, Gallinoro CM, Mottola R, Serio A, Di Meglio F, Castaldo C, Sirico F, Nurzynska D. Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults. J Cardiovasc Dev Dis 2021; 8:jcdd8060060. [PMID: 34070460 PMCID: PMC8228640 DOI: 10.3390/jcdd8060060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.
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Affiliation(s)
- Veronica Romano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Carlo Maria Gallinoro
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Rosita Mottola
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Alessandro Serio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Franca Di Meglio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Clotilde Castaldo
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Felice Sirico
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
- Correspondence: (F.S.); (D.N.)
| | - Daria Nurzynska
- Department of Medicine, Surgery and Dentistry “ScuolaMedicaSalernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence: (F.S.); (D.N.)
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Adamo D, Calabria E, Coppola N, Pecoraro G, Buono G, Mignogna MD. When orofacial pain needs a heart repair. Clin Exp Dent Res 2020; 7:263-267. [PMID: 33247554 PMCID: PMC8019759 DOI: 10.1002/cre2.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/15/2022] Open
Abstract
Objectives The association of chronic orofacial pain (COFP) and congenital heart disease has never previously been reported. We report the first case of COFP secondary to a right‐to‐left shunt (RLS) due to asymptomatic patent foramen ovale (PFO) in a patient with prothrombotic states. Materials and methods A 48‐year‐old female patient presented with a 10‐month history of left‐sided facial pain who was initially diagnosed with persistent idiopathic facial pain (PIFP) on account of its similar characteristics. Magnetic resonance imaging (MRI) of the brain revealed gliosis and carotid siphon tortuosity; in addition, hyperhomocysteinaemia due to the homozygosis mutation for 5,10 MethyleneTetraHydroFolate Reductase was identified. Transcranial doppler ultrasonography was requested from a neurology consultant which revealed a high degree of RLS. Subsequently, a cardiological evaluation was performed; the specialist requested a transesophageal echocardiography that detected an interatrial septum aneurysm with PFO. Results Based on the analysis of the patient's high degree of RLS, prothrombotic state and gliosis in relation to age, the cardiological consultant chose to perform a percutaneous closure of the PFO to avoid the risk of a cryptogenic stroke. After PFO closure, a complete remission of the pain was obtained. Conclusions The disappearance of the pain supports the possible association between RLS and COFP. PFO with RLS has been suggested as a risk factor for cryptogenic stroke, especially in association with other thromboembolic risk factors. Therefore, the early detection, in this case, could be considered a possible lifesaver. Communication between different care providers is essential when the patient presents symptoms of facial pain which are of an atypical nature.
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Affiliation(s)
- Daniela Adamo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Elena Calabria
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Noemi Coppola
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Buono
- Department of Morphological and Functional Imaging, Haematology and Oncology Sciences, University Federico II of Naples, Naples, Italy
| | - Michele Davide Mignogna
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
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Jensen B, Joyce W, Gregorovicova M, Sedmera D, Wang T, Christoffels VM. Low incidence of atrial septal defects in nonmammalian vertebrates. Evol Dev 2019; 22:241-256. [PMID: 31597012 PMCID: PMC9285691 DOI: 10.1111/ede.12322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The atrial septum enables efficient oxygen transport by separating the systemic and pulmonary venous blood returning to the heart. Only in placental mammals will the atrial septum form by the coming-together of the septum primum and the septum secundum. In up to one of four placental mammals, this complex morphogenesis is incomplete and yields patent foramen ovale. The incidence of incomplete atrial septum is unknown for groups with the septum primum only, such as birds and reptiles. We found a low incidence of incomplete atrial septum in 11 species of bird (0% of specimens) and 13 species of reptiles (3% of specimens). In reptiles, there was a trabecular interface between the atrial septum and the atrial epicardium which was without a clear boundary between left and right atrial cavities. In developing reptiles (four squamates and one crocodylian), the septum primum initiated as a sheet that acquired perforations and the trabecular interface developed late. We conclude that atrial septation from the septum primum only results in a low incidence of incompleteness. In reptiles, the atrial septum and atrial wall develop a trabecular interface, but previous studies on atrial hemodynamics suggest this interface has a very limited capacity for shunting.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - William Joyce
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Department of Bioscience, Zoophysiology, Aarhus University, Aarhus, Denmark
| | - Martina Gregorovicova
- Institute of Anatomy, First Medical Faculty, Czech Academy of Sciences, Charles University and Institute of Physiology, Prague, Czech Republic
| | - David Sedmera
- Institute of Anatomy, First Medical Faculty, Czech Academy of Sciences, Charles University and Institute of Physiology, Prague, Czech Republic
| | - Tobias Wang
- Department of Bioscience, Zoophysiology, Aarhus University, Aarhus, Denmark
| | - Vincent M Christoffels
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
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Vasse M, Francois D, Van Dreden P, de Mazancourt P. Different sensitivity of von Clauss reagents for the diagnosis of dysfibrinogenemia. Eur J Haematol 2019; 104:70-71. [PMID: 31583746 DOI: 10.1111/ejh.13333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/01/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Marc Vasse
- Service de Biologie Clinique, Hôpital Foch & UMR-S 1176, Suresnes et Kremlin-Bicêtre, France
| | | | | | - Philippe de Mazancourt
- Université de Versailles Saint-Quentin & Laboratoire de Biochimie, Hôpital Ambroise Paré, UMR1179, Boulogne Billancourt, France
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Binbin Z, Yutao W, Chengwei Z. Postoperative Cerebral Embolism After video-assisted thoracoscopic left upper lobectomy : A Case Report and Literature Review. J Stroke Cerebrovasc Dis 2019; 28:e139-e142. [PMID: 31239222 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/26/2019] [Accepted: 06/02/2019] [Indexed: 12/15/2022] Open
Abstract
Postoperative cerebral embolism after left upper or lower lobectomy caused by the thrombus in the pulmonary vein stump (PVS) is a rare complication. However, it is still unclear how the cerebral embolism develop after lobectomy, and how can we prevent further embolism after thrombus removal. We present a case of a 55-year-old man without cardiovascular disease history suffering cerebral embolism 2 days after left upper lobectomy. Patient underwent endovascular thrombectomy and discharged hospital 10 days later with proper recovery. No thrombus was detected in an enhanced pulmonary CT after 1 month of aspirin intake, but the length of PVS was measured.
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Affiliation(s)
- Zhu Binbin
- Anesthesiology department, The affiliated hospital of medical school of Ningbo University, Ningbo, China.
| | - Wang Yutao
- Imaging department, The affiliated hospital of medical school of Ningbo University, Ningbo, China
| | - Zhou Chengwei
- Thoracic surgery department, The affiliated hospital of medical school of Ningbo University, Ningbo, China
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Jensen B, Wang T, Moorman AFM. Evolution and Development of the Atrial Septum. Anat Rec (Hoboken) 2018; 302:32-48. [PMID: 30338646 PMCID: PMC6588001 DOI: 10.1002/ar.23914] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 12/27/2017] [Accepted: 01/09/2018] [Indexed: 02/05/2023]
Abstract
The complete division of the atrial cavity by a septum, resulting in a left and right atrium, is found in many amphibians and all amniotes (reptiles, birds, and mammals). Surprisingly, it is only in eutherian, or placental, mammals that full atrial septation necessitates addition from a second septum. The high incidence of incomplete closure of the atrial septum in human, so-called probe patency, suggests this manner of closure is inefficient. We review the evolution and development of the atrial septum to understand the peculiar means of forming the atrial septum in eutherian mammals. The most primitive atrial septum is found in lungfishes and comprises a myocardial component with a mesenchymal cap on its leading edge, reminiscent to the primary atrial septum of embryonic mammals before closure of the primary foramen. In reptiles, birds, and mammals, the primary foramen is closed by the mesenchymal tissues of the atrioventricular cushions, the dorsal mesenchymal protrusion, and the mesenchymal cap. These tissues are also found in lungfishes. The closure of the primary foramen is preceded by the development of secondary perforations in the septal myocardium. In all amniotes, with the exception of eutherian mammals, the secondary perforations do not coalesce to a secondary foramen. Instead, the secondary perforations persist and are sealed by myocardial and endocardial growth after birth or hatching. We suggest that the error-prone secondary foramen allows large volumes of oxygen-rich blood to reach the cardiac left side, needed to sustain the growth of the extraordinary large offspring that characterizes eutherian mammals. Anat Rec, 302:32-48, 2019. © 2018 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.
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Affiliation(s)
- Bjarke Jensen
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Tobias Wang
- Department of Bioscience, Zoophysiology, Aarhus University, Aarhus, Denmark
| | - Antoon F M Moorman
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, The Netherlands
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13
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Patent Foramen Ovale and Elective Posterior Fossa Craniotomy in the Park-bench Position: How Should We Proceed? J Neurosurg Anesthesiol 2017; 31:263-264. [PMID: 29252688 DOI: 10.1097/ana.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Meier B, Nietlispach F. Editorial Commentary: Closure of the patent foramen ovale viewed from a different angle. Trends Cardiovasc Med 2017; 27:582-584. [DOI: 10.1016/j.tcm.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/08/2017] [Indexed: 11/30/2022]
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