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Vizzari G, Pizzino F, Zwicke D, Tajik AJ, Carerj S, Di Bella G, Micari A, Khandheria BK, Zito C. Patent foramen ovale: anatomical complexity and long-tunnel morphology related issues. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:316-329. [PMID: 34322302 PMCID: PMC8303044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
Patent foramen ovale (PFO) is present in about one-quarter of the population and should be considered an anatomical variant rather than a malformation. The association of PFO with cryptogenic stroke, migraine, peripheral embolism and other pathologies is still controversial. The evaluation of anatomical complexity, and particularly the long-tunnel morphology, is crucial for the assessment of the risk profile and for a targeted therapeutic management. Long-tunnel PFOs seem to be more prone to clot formation and complications related to percutaneous closure procedures. Echocardiography is the most useful method to investigate anatomical complexity, confirm and reinforce the indication to treatment, select the appropriate device and guide the PFO closure towards a successful procedure.
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Affiliation(s)
- Giampiero Vizzari
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Fausto Pizzino
- Cardiology Unit, Conegliano Hospital, AULSS2 Marca TrevigianaConegliano (TV) 31015, Italy
| | - Dianne Zwicke
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - A Jamil Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Antonio Micari
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
| | - Bijoy K Khandheria
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health2801 W. Kinnickinnic River Parkway, #840, Milwaukee, WI 53215, USA
| | - Concetta Zito
- Department of Clinical and Experimental Medicine, University of Messina, A.O.U. Policlinic “G. Martino”Messina 98165, Italy
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D'Andrea A, Conte M, Riegler L, Scarafile R, Cocchia R, Pezzullo E, Cavallaro M, Di Maio M, Natale F, Santoro G, Russo MG, Scherillo M, Calabrò R. Transcranial Doppler Ultrasound: Incremental Diagnostic Role in Cryptogenic Stroke Part II. J Cardiovasc Echogr 2016; 26:71-77. [PMID: 28465966 PMCID: PMC5224669 DOI: 10.4103/2211-4122.187947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Transcranial Doppler (TCD) ultrasonography is a noninvasive ultrasound study, which has been extensively applied in both outpatient and inpatient settings. Its main use in current clinical practice is the research for “Paradoxical Embolism,” due to migration of thromboembolic material from systemic venous circulation to the left cardiac chambers and arterial circulation through cardiopulmonary shunts such as patent foramen ovale which represents an important cause of cryptogenic stroke, especially in patients under 55 years of age. In this review, we shall describe the incremental diagnostic role in cryptogenic stroke for this imaging modality. TCD not only can be used to detect right-left cardiopulmonary shunts but it also allows to classify the grade of severity of such shunts using the so-called “Microembolic Signals grading score.”
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Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Marianna Conte
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Raffaella Scarafile
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Rosangela Cocchia
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Enrica Pezzullo
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Massimo Cavallaro
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Marco Di Maio
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Francesco Natale
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Giuseppe Santoro
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
| | | | - Raffaele Calabrò
- Department of Cardiology, Second University of Naples, Monadi Hospital, Naples, Italy
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