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Machowiec P, Przybylski P, Czekajska-Chehab E, Drop A. Patients with a Bicuspid Aortic Valve (BAV) Diagnosed with ECG-Gated Cardiac Multislice Computed Tomography-Analysis of the Reasons for Referral, Classification of Morphological Phenotypes, Co-Occurring Cardiovascular Abnormalities, and Coronary Artery Stenosis. J Clin Med 2024; 13:3790. [PMID: 38999356 PMCID: PMC11242148 DOI: 10.3390/jcm13133790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The aim of this study was to analyze a group of patients with a bicuspid aortic valve (BAV) examined with ECG-gated cardiac CT (ECG-CT), focusing on the assessment of the clinical reasons for cardiac CT, cardiovascular abnormalities coexisting with their BAV, and coronary artery stenosis. Methods: A detailed statistical analysis was conducted on 700 patients with a BAV from a group of 15,670 patients examined with ECG-CT. Results: The incidence of a BAV in ECG-CT was 4.6%. The most common reason for examination was suspicion of coronary heart disease-31.1%. Cardiovascular defects most frequently associated with a BAV were a VSD (4.3%) and coarctation of the aorta (3.6%), while among coronary anomalies, they were high-take-off coronary arteries (6.4%) and paracommissural orifice of coronary arteries (4.4%). The analysis of the coronary artery calcium index showed significantly lower values for type 2 BAV compared to other valve types (p < 0.001), with the lowest average age in this group of patients. Moreover, the presence of a raphe between the coronary and non-coronary cusps was associated with a higher rate of significant coronary stenosis compared to other types of BAVs (p < 0.001). Conclusions: The most common reason for referral for cardiac ECG-CT in the group ≤ 40-year-olds with a BAV was the suspicion of congenital cardiovascular defects, while in the group of over 40-year-olds, it was the suspicion of coronary artery disease. The incidence of cardiovascular abnormalities co-occurring with BAV and diagnosed with ECG-CT differs among specific patient subgroups. The presence of a raphe between the coronary and non-coronary cusps appears to be a potential risk factor for significant coronary stenosis in patients with BAVs.
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Affiliation(s)
- Piotr Machowiec
- Department of Radiology, Medical University of Lublin, 20-059 Lublin, Poland; (P.P.); (E.C.-C.); (A.D.)
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Knupp AJ, Smith DA. Increased Risk of Cryptogenic Stroke Associated with Patent Foramen Ovale in Young Adults. Cureus 2024; 16:e53502. [PMID: 38440035 PMCID: PMC10911391 DOI: 10.7759/cureus.53502] [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: 10/13/2023] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Ischemic stroke is defined as a reduction in blood flow to brain tissue that results in the deterioration and death of neurons in a matter of minutes. While often seen in older patients with a history of atherosclerosis of the major arteries, a subset of ischemic strokes occur in younger individuals with minimal to no prior risk factors. Further evaluation of these unknown, or cryptogenic, strokes has yielded positive findings of a patent foramen ovale (PFO) in a concerning number of cases. Cryptogenic strokes attributable to PFO present an important clinical occurrence because they do not fit the typical template regarding those most at risk for such acutely devastating outcomes, making their identification uniquely important for both immediate and long-term patient care. A 20-year-old Hispanic female presented to the emergency department for evaluation of neurological symptoms indicating obstruction of a major cerebral vessel. After being placed on stroke alert and found to have an embolus occluding the left middle cerebral artery (MCA) via non-contrast computed tomography (CT), tissue plasminogen activator (tPA) was administered, and mechanical thrombectomy was performed to restore blood flow. Following stabilization, further testing done on the patient revealed a substantial PFO that likely allowed for the crossing of an embolus from venous blood returning to the heart directly into the arterial circulation. The patient opted for cardiac monitor placement and has remained asymptomatic to this point while awaiting surgical repair. This case demonstrates an unusual presentation of ischemic stroke in a young individual with no reported risk factors and highlights the importance of screening for large PFO in patients prior to a serious cerebrovascular accident. It is our hope that highlighting this case may heighten awareness of this condition and allow for timely recognition from medical personnel who may encounter this same medical emergency in the future.
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Affiliation(s)
- Alec J Knupp
- Medical School, Lake Erie College of Osteopathic Medicine-Bradenton College of Osteopathic Medicine, Bradenton, USA
| | - Douglas A Smith
- Emergency Medicine, Nuvance Health, Danbury Hospital, Danbury, USA
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McCabe AM, Platek NM, Palmieri JR, Foerst JR. Stroke-Like Symptoms During Sexual Intercourse in a 25-Year-Old Female with a Patent Foramen Ovale. Cureus 2022; 14:e27332. [PMID: 36043015 PMCID: PMC9414168 DOI: 10.7759/cureus.27332] [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] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
A 25-year-old female who presented with stroke-like symptoms during sexual intercourse was found to have a patent foramen ovale (PFO). She was diagnosed with a cryptogenic transient ischemic attack (TIA) and underwent a successful catheter-based PFO closure. She had complete resolution of symptoms during both intercourse and physical activity.
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Nwosu I, Ibeson E, Singh S, Singh R, Gulati A, Zadushlivy D, Kupfer Y, Derman A, Clemen B, Basnet A, Nsofor G, Ogar AU. Paradoxical Thromboembolic Ischemic Stroke Following Tissue Plasminogen Activator Instillation for Clogged Central Venous Dialysis Catheter. Cureus 2021; 13:e20346. [PMID: 35036188 PMCID: PMC8752339 DOI: 10.7759/cureus.20346] [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] [Accepted: 12/11/2021] [Indexed: 11/20/2022] Open
Abstract
Central venous catheters including dialysis catheters are a potential source of venous thrombosis and pose a risk for paradoxical embolic events including ischemic stroke and systemic embolism in patients with a patent foramen ovale (PFO). The adult population with a PFO and patients with a central venous dialysis catheter (CVDC) are at increased risk of a paradoxical embolic event. Since bubble study is not routinely done during echocardiogram in a patient with CVDC, it is difficult to identify at-risk patients for paradoxical embolic events during catheter manipulation, especially for clogged CVDC. We report a rare case of a 79-year-old lady with end-stage renal disease on hemodialysis (HD) using a CVDC who developed a paradoxical embolic ischemic stroke following the use of tissue plasminogen activator (tPA) for unclogging a dialysis catheter. We aimed to highlight the existing risks of thromboembolism associated with the long-term use of central CVDC, especially the potential risk of paradoxical embolism and ischemic stroke with the use of tPA for management of clogged dialysis catheters. We emphasize the questionable need for a bubble study echocardiogram in all patients requiring long-term dialysis catheters.
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Lattanzi S, Brigo F, Cagnetti C, Di Napoli M, Silvestrini M. Patent Foramen Ovale and Cryptogenic Stroke or Transient Ischemic Attack: To Close or Not to Close? A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2018; 45:193-203. [PMID: 29649819 DOI: 10.1159/000488401] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The optimal strategy of secondary stroke prevention in patients with patent foramen ovale (PFO) is controversial. This study was performed to evaluate the efficacy and safety of the device closure (DC) versus the medical therapy (MT) in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO. SUMMARY Randomized controlled trials with active and control groups receiving the DC plus MT and MT alone in patients with history of cryptogenic stroke/TIA and diagnosis of PFO were systematically searched. The main efficacy outcome was stroke recurrence. Subgroup-analyses were performed according to age, shunt size, and presence of atrial septal aneurysm (ASA). Safety endpoints included any serious adverse event (SAE), atrial fibrillation (AF), and major bleeding complications. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were estimated. Five trials were included, involving 3,440 participants (DC = 1,829, MT = 1,611). There was a protective effect of closure in the risk of recurrent stroke (RR 0.43 [0.21-0.90]; p = 0.024; HR = 0.39 [0.19-0.83]; p = 0.014). The benefit of PFO closure was significant in patients with PFO associated with substantial right-to-left shunt or ASA. There were no differences in the risks of SAEs and major bleedings between the groups. The rate of new-onset AF was higher in the DC than in the MT arm (RR 4.46 [2.35-8.41]; p < 0.001). Successful device implantation and effective PFO closure were achieved in 96 and 91% of the patients respectively. Key Messages: In selected adult patients with PFO and history of cryptogenic stroke, the DC plus MT is more effective to prevent stroke recurrence and is associated with an increased risk of new-onset AF compared to the MT alone.
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Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy.,Division of Neurology, "Franz Tappeiner" Hospital, Merano, Italy
| | - Claudia Cagnetti
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Mario Di Napoli
- Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy.,Neurological Section, Neuro-Epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, L'Aquila, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
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Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J, Zhang C. Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack. Cochrane Database Syst Rev 2015; 2015:CD009938. [PMID: 26346232 PMCID: PMC7389291 DOI: 10.1002/14651858.cd009938.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The optimal therapy for preventing recurrent stroke in people with cryptogenic stroke and patent foramen ovale (PFO) has not been defined. The choice between medical therapy (antithrombotic treatment with antiplatelet agents or anticoagulants) and transcatheter device closure has been the subject of intense debate over the past several years. Despite the lack of scientific evidence, a substantial number of people undergo transcatheter device closure (TDC) for secondary stroke prevention. OBJECTIVES To: 1) compare the safety and efficacy of TDC with best medical therapy alone for preventing recurrent stroke (fatal or non-fatal) or transient ischemic attacks (TIAs) in people with PFO and a history of cryptogenic stroke or TIA; 2) identify specific subgroups of people most likely to benefit from closure for secondary prevention; and 3) assess the cost-effectiveness of this strategy, if possible. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (July 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2014), MEDLINE (1950 to July 2014) and EMBASE (1980 to July 2014). In an effort to identify unpublished and ongoing trials we searched seven trials registers and checked reference lists. SELECTION CRITERIA We included randomized controlled trials (RCTs), irrespective of blinding, publication status, and language, comparing the safety and efficacy of device closure with medical therapy for preventing recurrent stroke or TIA in people with PFO and a history of cryptogenic stroke or TIA. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed quality and risk of bias, and extracted data. The primary outcome measures of this analysis were the composite endpoint of ischemic stroke or TIA events as well as recurrent fatal or non-fatal ischemic stroke. Secondary endpoints included all-cause mortality, serious adverse events (atrial fibrillation, myocardial infarction, bleeding) and procedural success and effective closure. We used the Mantel-Haenszel method to obtain pooled risk ratios (RRs) using the random-effects model regardless of the level of heterogeneity. We pooled data for the primary outcome measure with the generic inverse variance method using the random-effects model, yielding risk estimates as pooled hazard ratio (HR), which accounts for time-to-event outcomes. MAIN RESULTS We included three RCTs involving a total of 2303 participants: 1150 participants were randomized to receive TDC and 1153 participants were randomized to receive medical therapy. Overall, the risk of bias was regarded as high. The mean follow-up period of all three included trials was less than five years. Baseline characteristics (age, sex, and vascular risk factors) were similar across trials. Intention-to-treat analyses did not show a statistically significant risk reduction in the composite endpoint of recurrent stroke or TIA in the TDC group when compared with medical therapy (RR 0.73, 95% CI 0.45 to 1.17). A time-to-event analysis combining the results of two RCTs also failed to show a significant risk reduction with TDC (HR 0.69, 95% CI 0.43 to 1.13). When assessing stroke prevention alone, TDC still did not show a statistically significant benefit (RR 0.61, 95% CI 0.29 to 1.27) (HR 0.55, 95% CI 0.26 to 1.18). In a sensitivity analysis including the two studies using the Amplatzer PFO occluder, TDC showed a possible protective effect on recurrent stroke compared with medical therapy (HR 0.38, 95% CI 0.14 to 1.02); however, it did not reach statistical significance. Safety analysis found that the overall risks for all-cause mortality and adverse events were similar in both the TDC and medical therapy groups. However, TDC increased the risk of new-onset atrial fibrillation (RR 3.50, 95% CI 1.47 to 8.35) and may be associated with the type of device used. AUTHORS' CONCLUSIONS The combined data from recent RCTs have shown no statistically significant differences between TDC and medical therapy in the prevention of recurrent ischemic stroke. TDC closure was associated with an increased risk of atrial fibrillation but not with serious adverse events.
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Affiliation(s)
- Jie Li
- People's Hospital of Deyang CityDepartment of NeurologyNo.173, Taishan North RoadDeyangSichuanChina618000
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Junfeng Liu
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Ming Liu
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Shihong Zhang
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Zilong Hao
- West China Hospital, Sichuan UniversityDepartment of NeurologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Jing Zhang
- Xuanwu Hospital, Capital Medical UniversityDepartment of NeurologyNo. 45, Changchun StreetBeijingBeijingChina100053
| | - Canfei Zhang
- The First Affiliated Hospital of Henan University of Science and TechnologyDepartment of NeurologyNo. 24, Jinghua RoadLuoyangHenan ProvinceChina471003
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Sabate Rotes A, Burkhart HM, Suri RM, Grogan M, Taggart NW, Li Z, Schaff HV, Dearani JA. Minimally invasive video-assisted surgical closure of atrial septal defects: a safe approach. World J Pediatr Congenit Heart Surg 2015; 5:527-33. [PMID: 25324249 DOI: 10.1177/2150135114542166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of video-assisted thoracic surgery (VATS) versus conventional median sternotomy (open) in the repair of secundum atrial septal defect (ASD) or patent foramen ovale (PFO). DESIGN Among 415 consecutive patients undergoing open or VATS ASD/PFO closure between 1993 and October 2012, 153 patients were compared using 2:1 frequency matching (n=102 open vs 51 VATS). Matching variables include age, gender, body surface area, past medical history of neurologic events, and need of patch closure. Median age was 43 years (3-71 years), and 67% were female. RESULTS There were no early deaths in either group. There were no conversions to open sternotomy. Although mean cross-clamp time (14.5±7.6 vs 26.3±13.2 minutes, P<.001) and bypass time (31.7±13.8 vs 60.9±20.9 minutes, P<.001) were longer in the VATS group, patients who underwent VATS had shorter postoperative ventilation time (7.5±6.4 vs 4.4±2.8 hours, P=.03) with 62.7% extubated in the operating room, along with shorter intensive care unit stay (26.7±10.8 vs 19.1±9.9 hours, P<.001) and hospital stay (5.2±1.9 vs 3.5±0.9 days, P<.001). At early follow-up (mean 1.5 years, maximum 4.2 years), there was no difference in need for reintervention. Of the 27 patients who underwent VATS ASD/PFO closure for a neurologic event, none had a recurrence. CONCLUSION The use of VATS provides a safe, equally effective alternative to conventional sternotomy for ASD/PFO closure, using a less invasive approach.
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Affiliation(s)
| | | | - Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Martha Grogan
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA
| | | | - Zhuo Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph A Dearani
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Cerebellar infarction in a patient with cerebral vein thrombosis and patent foramen ovale: brain-to-brain embolism? Neurol Sci 2012; 33:1415-7. [PMID: 22210158 DOI: 10.1007/s10072-011-0908-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
Although the association between PFO and cryptogenic stroke is well shown in young adults, the causality is still unclear. The pathogenetic mechanism of ischemic stroke related to PFO is not entirely understood. Indeed, besides the well-known paradoxical embolism, formations of thrombi in situ, especially in the presence of ASA, a higher incidence of atrial fibrillation have been often observed. Cerebral sinus venous thrombosis may be due to local inflammation or to acquired or genetic thrombophilia including hyperhomocysteinemia. We report a case of a young man presenting with a cerebellar infarction probably secondary to a paradoxical brain-to-brain embolism, in which the only detectable embolic source was a cerebral vein thrombosis.
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Agustin SJU, Yumul MP, Kalaw AJL, Teo BC, Eng J, Phua Z, Singh R, Gan RN, Venketasubramanian N. Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler. Stroke 2011; 42:2201-5. [DOI: 10.1161/strokeaha.110.609875] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sherwin Joy U. Agustin
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Maricar P. Yumul
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Angelito Jonas L. Kalaw
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Boon Choon Teo
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Johnny Eng
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Ziqun Phua
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Rajinder Singh
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Robert N. Gan
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
| | - Narayanaswamy Venketasubramanian
- From the Research Department (S.J.U.A., A.J.L.K.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry (M.P.Y.), University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory (B.C.T., J.E., Z.P.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology (R.S.), National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research (R
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Pellaton C, Heinzer R, Michel P, Eeckhout E. Patent foramen ovale and obstructive sleep apnoea: from pathophysiology to diagnosis of a potentially dangerous association. Arch Cardiovasc Dis 2011; 104:242-51. [PMID: 21624791 DOI: 10.1016/j.acvd.2010.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Patent foramen ovale and obstructive sleep apnoea are frequently encountered in the general population. Owing to their prevalence, they may coexist fortuitously; however, the prevalence of patent foramen ovale seems to be higher in patients with obstructive sleep apnoea. We have reviewed the epidemiological data, pathophysiology, and the diagnostic and therapeutic options for both patent foramen ovale and obstructive sleep apnoea. We focus on the interesting pathophysiological links that could explain a potential association between both pathologies and their implications, especially on the risk of stroke.
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Affiliation(s)
- Cyril Pellaton
- Service of cardiology, CHU Vaudois (CHUV), University of Lausanne, 46, rue du Bugnon, 1011 Lausanne, Switzerland
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99mTc-MAA lung scan can be an alternative in detection and follow-up of patent foramen ovale. Int J Cardiol 2011; 147:296-8. [DOI: 10.1016/j.ijcard.2010.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 12/04/2010] [Indexed: 11/19/2022]
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Abstract
Thromboembolic complications are the second leading cause of death in cancer patients. In contrast to the large body of literature on venous thromboembolism (VTE), relatively few reports have focused on the pathogenesis, incidence, management and outcomes of arterial thromboembolic events in patients with malignancy. The purpose of this article is to review the current literature on the etiology, mechanisms, and prognosis of arterial thromboembolic events in cancer patients and outline appropriate screening and management guidelines that may help lower the rates of morbidity and mortality related to these events.
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Affiliation(s)
- Saurabh Sanon
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel J Lenihan
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | - Elie Mouhayar
- Division of Internal Medicine, Department of Cardiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA,
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Providencia RA. Headache and cardiovascular disease: old symptoms, new proposals. Future Cardiol 2010; 6:703-23. [DOI: 10.2217/fca.10.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Evidence of a link between headache symptoms and cardiovascular disease has rapidly grown in recent years and it is of utmost importance for the cardiologist and neurologist to be aware of this intimate connection. A brief overview of different cardiovascular diseases (namely hypertension, stroke, coronary heart disease, patent foramen ovale, atrial septal defects, atrial septal aneurisms, mitral valve prolapse, and aortic and carotid disease) that may be related to headache is presented in this article. Proposed pathophysiological mechanisms for this association and landmark studies are reviewed and discussed.
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