1
|
Bodilsen J, Madsen T, Brandt CT, Müllertz K, Wiese L, Demirci ST, Suhrs HE, Larsen L, Gill SUA, Hansen BR, Nilsson B, Omland LH, Fosbøl E, Kjeldsen AD, Nielsen H. Pulmonary arteriovenous malformations in patients with previous brain abscess: a cross-sectional population-based study. Eur J Neurol 2024; 31:e16176. [PMID: 38064178 DOI: 10.1111/ene.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND AND PURPOSE Pulmonary arteriovenous malformations (PAVMs) may cause recurrent brain abscess. The primary aim was to determine the prevalence of PAVM amongst survivors of brain abscess. The proportion with cardiac right-to-left shunts was also assessed post hoc. METHODS This was a cross-sectional population-based study of adult (≥18 years) survivors of cryptogenic bacterial brain abscess in Denmark from 2007 through 2016. Patients were invited for bubble-echocardiography to detect vascular right-to-left shunting and, if abnormal, subsequent computed tomography thorax for diagnosis of PAVM. Data are presented as n/N (%) or median with interquartile range (IQR). RESULTS Study participation was accepted by 47/157 (30%) eligible patients amongst whom two did not appear for scheduled bubble-echocardiography. The median age of participants was 54 years (IQR 45-62) and 19/57 (33%) were females compared with 59 years (IQR 48-68, p = 0.05) and 41/85 females (48%, p = 0.22) in non-participants. Bubble-echocardiography was suggestive of shunt in 10/45 (22%) participants and PAVM was subsequently confirmed by computed tomography in one patient with grade 1 shunting. The corresponding prevalence of PAVM was 2% (95% confidence interval 0.06-11.8) amongst all examined participants. Another 9/45 (20%) were diagnosed with patent in persistent foramen ovale (n = 8) or atrial septum defect (n = 1), which is comparable with the overall prevalence of 25% amongst adults in the Danish background population. CONCLUSIONS Undiagnosed PAVM amongst adult survivors of cryptogenic bacterial brain abscess is rare but may be considered in select patients. The prevalence of cardiac right-to-left shunts amongst brain abscess patients corresponds to the prevalence in the general population.
Collapse
Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Trine Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Thomas Brandt
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Katrine Müllertz
- Department of Cardiology, Nordsjaellands Hospital Hillerød, Hillerød, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | | | - Hannah Elena Suhrs
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | | | - Brian Nilsson
- Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Heart Centre, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Institute for Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
2
|
Meinel TR, Tsiplova K, Taylor A, Meseguer E, Haeusler KG, Hart RG, Arnold M, Perera KS. Chronic ischemic lesions and presence of patent foramen ovale in young adults with embolic stroke of undetermined source: Results of the young ESUS patient registry. Int J Stroke 2024; 19:470-477. [PMID: 37981572 DOI: 10.1177/17474930231217917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Chronic ischemic lesions (CILs) are frequent findings in patients with acute ischemic stroke, but their phenotypes and relevance in young adults with embolic stroke of undetermined source (Y-ESUS) remains uncertain. We aimed to compare Y-ESUS patients with CIL to those without CIL and assessed the association of CIL and its phenotypes with the presence of patent foramen ovale (PFO). METHODS This prospective longitudinal, multicenter cohort study enrolled consecutive patients 50 years and younger with ESUS from October 2017 to October 2019 in 41 stroke research centers in 13 countries. Local investigators adjudicated presence and phenotypes of CIL on routine brain imaging (either magnetic resonance imaging (MRI) or computed tomography (CT)). RESULTS Overall, 535 patients were enrolled (mean age = 40.4 (standard deviation (SD) = 7.3) years, 238 (44%) female). CILs were present in 76/534 (14.2%) patients with a median count CIL count of 1.0 (interquartile range (IQR) = 1-2), 42/76 (55%) had at least one cortical phenotype and 38/76 (50%) at least one non-cortical phenotype. Y-ESUS with CIL were less often female (32% vs 47% in non-CIL Y-ESUS), were older (mean 43 vs 40 years), had more often hypertension (42% vs 19%), diabetes (17% vs 7%), and hyperlipidemia (34% vs 18%). CIL Y-ESUS were independently associated with lower stroke recurrence (relative risk (RR) = 0.17 (0.05-0.61)). In Y-ESUS with PFO, CILs were less frequent in probable pathogenic PFO than with probable non-pathogenic PFO (6.1% vs 30% p< 0.001). CONCLUSION One in seven Y-ESUS patients has additional CIL. CILs were associated with several vascular risk factors, lower probability of a pathogenic PFO, and lower stroke recurrence.
Collapse
Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology, Inselspital (Bern University Hospital) and University of Bern, Bern, Switzerland
| | - Kate Tsiplova
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Amanda Taylor
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Elena Meseguer
- Department of Neurology and Stroke Center, APHP Bichat Hospital, Paris, France
| | | | - Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Marcel Arnold
- Department of Neurology, Inselspital (Bern University Hospital) and University of Bern, Bern, Switzerland
| | - Kanjana S Perera
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, Neurology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
3
|
Apostolos A, Drakopoulou M, Trantalis G, Ioakeimidis M, Koroboki E, Tsalamandris S, Aggeli C, Ntaios G, Tsioufis C, Tsivgoulis G, Toutouzas K. Management of patent foramen ovale; findings from a nationwide survey. J Stroke Cerebrovasc Dis 2024; 33:107551. [PMID: 38241951 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure. The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice. MATERIALS AND METHODS Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios. RESULTS A total of 51 physicians (56.9 % cardiologists, 25.5 % neurologists and 17.6 % internal medicine physicians) completed the survey, resulting in a response rate of 53 %. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020). CONCLUSIONS Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
Collapse
Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Michael Ioakeimidis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Eleni Koroboki
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| |
Collapse
|
4
|
Meucci F, Rapillo CM, Stolcova M, Scrima GD, Nardi G, Nistri R, Ristalli F, D'Ettore N, Mattesini A, Buonamici F, Piccardi B, Tudisco L, Cramaro A, Trapani S, Pracucci G, Nencini P, Di Mario C, Sarti C. Quality control in treating patients with patent foramen ovale: 7-year-experience of the Heart and Brain team of the Careggi University Hospital. Neurol Sci 2024; 45:671-678. [PMID: 37624543 DOI: 10.1007/s10072-023-07023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The right comprehension of ischemic stroke pathogenesis guarantees the best prevention therapy. The term "patent foramen ovale (PFO) related stroke" has been proposed for those events where PFO is supposed to be pathogenetic, but their definition is challenging. A multidisciplinary evaluation in a "Heart & Brain" team (HBteam) including stroke neurologists and interventional cardiologists was therefore highly recommended in the recent guidelines of secondary stroke prevention. OBJECTIVE We aimed at describing the organization of the HBteam of Careggi-University-Hospital of Florence (Italy), and the results of the first seven years of activity. METHODS In 2016 Interventional Cardiologists and Stroke Neurologists set up an outpatient clinic for the joined evaluation of patients with PFO and other cardio/neurological conditions. A specific diagnostic-therapeutic hospital plan was produced for PFO patients. Patient empowerment was guaranteed by a hospital explicative webpage, a booklet regarding risks/benefits of PFO closure and a 3D heartmodel to simulate the intervention. Data were collected in a dedicated registry. RESULTS We evaluated 594 patients for PFO, 40 for left atrial appendage closure and 38 for other conditions. In 20% of PFO-patients, HBteam diagnosis was discordant from that of referring physicians, 14% were stroke misdiagnoses. We advised against closure in 53% of patients. At follow-up 94% of closed patients had no/minimum residual shunt; 3 patients had a cerebral ischemic event. CONCLUSIONS A dedicated HBteam represents a unique opportunity to share decisions with patients after a thorough empowerment process. The joining of cardioneurological skills allows a better classification of PFO-patients, reducing futile interventions.
Collapse
Affiliation(s)
- Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Giulia Domna Scrima
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Giulia Nardi
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Rita Nistri
- Department of Heart and Vessel, Careggi University Hospital, Florence, Italy
| | - Francesca Ristalli
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Nicoletta D'Ettore
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Alessio Mattesini
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Buonamici
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | | | - Laura Tudisco
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | | | - Sara Trapani
- Neurosonology Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
- Department of Experimental & Clinical Medicine, University of Florence, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
5
|
Devos P, Guedeney P, Montalescot G. Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges. J Clin Med 2023; 13:54. [PMID: 38202061 PMCID: PMC10780039 DOI: 10.3390/jcm13010054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.
Collapse
Affiliation(s)
- Perrine Devos
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Paul Guedeney
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
| | - Gilles Montalescot
- ACTION Study Group, INSERM UMRS_1166 Institut de Cardiologie (AP-HP), Sorbonne Université, 75005 Paris, France; (P.D.); (P.G.)
- Institut de Cardiologie, Centre Hospitalier Universitaire, Pitié-Salpêtrière, 47 Boulevard de l’Hôpital, 75013 Paris, France
| |
Collapse
|
6
|
Cannata F, Stankowski K, Donia D, Figliozzi S, Fazzari F, Regazzoli D, Reimers B, Bragato RM, Pontone G, Trabattoni D, Colombo A, De Marco F, Mangieri A. Percutaneous suture-based patent foramen ovale closure: A state-of-the-art review. Trends Cardiovasc Med 2023:S1050-1738(23)00095-6. [PMID: 37931791 DOI: 10.1016/j.tcm.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
Percutaneous closure of a patent foramen ovale (PFO), a common variation of interatrial septum anatomy, is a commonly performed procedure in the catheterization laboratory to reduce the risk of recurrent stroke in selected patients and to treat other PFO-related syndromes. In the last twenty years, disc-based devices have represented the armamentarium of the interventional cardiologist; recently, suture-based devices have become an attractive alternative, despite limited data regarding their long-term performance. The present review gives an overview of the current evidence regarding suture-based PFO closure, the device's characteristics, the echocardiographic evaluation of the PFO anatomy, and recommendations for patient selection. A detailed procedural guide is then provided, and potential complications and future developments in the field are discussed.
Collapse
Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy; Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Dario Donia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Damiano Regazzoli
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Bernhard Reimers
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Renato Maria Bragato
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Federico De Marco
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Mangieri
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy.
| |
Collapse
|
7
|
Kamel M, Malik A, Sarkar K, Narine B, Garcia-Bengochea Y, Makaryus JN, Singh A. Orthodeoxia Platypnea Syndrome in the Setting of Cholangiocarcinoma: A Case Report. Am J Cardiol 2023; 204:64-69. [PMID: 37536206 DOI: 10.1016/j.amjcard.2023.07.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
Platypnea-orthodeoxia syndrome is a rare cause of positional hypoxemia and dyspnea. We present the case of a 54-year-old man with right-to-left shunting through a patent foramen ovale in the setting of metastatic cholangiocarcinoma resulting in platypnea-orthodeoxia syndrome. The shunt was originally not visualized on cardiac magnetic resonance imaging but later detected with transesophageal echocardiography. This case highlights the importance of complimentary multimodality cardiac imaging in the diagnosis of both common and uncommon disorders.
Collapse
Affiliation(s)
- Maikel Kamel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York.
| | - Aysha Malik
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Kumar Sarkar
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Badewattie Narine
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Youssef Garcia-Bengochea
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - John N Makaryus
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| | - Avneet Singh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
9
|
Ke S, Lin L, Yang W, Zhang Y, Cui Q, Lou Z, Hou Y, Teng F, Hu Y. Understanding of the Intrinsic Difference between n- and p-Doping Propagation in Polymer Light-Emitting Electrochemical Cells: A Numerical Modeling Approach. ACS Appl Mater Interfaces 2023; 15:41680-41687. [PMID: 37615302 DOI: 10.1021/acsami.3c09203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Distinct doping propagation characteristics between p-doping and n-doping in light-emitting electrochemical cells (LECs) have been highlighted by intensive reports. Typically, there are significant differences in the doping speeds between p-doping and n-doping, with the former exhibiting a sawtooth frontier and the latter displaying a more uniform frontier profile. In addition, experimental observations demonstrate a uniform motion instead of the theoretically suggested accelerated electrochemical doping frontier propagation. Therefore, there is an urgent need to establish a quantitative model that delves into the underlying mechanisms responsible for doping propagation in LECs. In this study, four variables were selected to investigate the detailed mechanism of electrochemical doping propagation: temperature, voltage, and concentrations of salt and solid electrolyte. Fluorescence imaging revealed that the n-doping and p-doping propagations behaved contrarily with increasing temperature and voltage. By numerically fitting the doping propagation frontier, equations were derived to describe the relationship between the speed of electrochemical doping propagation and temperature/voltage. The underlying mechanisms were elucidated, indicating that anions undergo motion through the cooperative effects of electric field drift and concentration diffusion, while cation transport strongly relies on poly(ethylene oxide) (PEO) segmental motions. In other words, the movement of anions within the electrolyte is characterized by a greater degree of freedom, whereas the motion of cations is significantly dependent on the segmental motions of PEO. The resulting equations were well-fitted with experimental data, providing a solid foundation for further theoretical investigations into electrochemical doping in various devices.
Collapse
Affiliation(s)
- Shichuan Ke
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Lin Lin
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Weiao Yang
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Yu Zhang
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Qiuhong Cui
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Zhidong Lou
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Yanbing Hou
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Feng Teng
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| | - Yufeng Hu
- Key Laboratory of Luminescence and Optical Information, Ministry of Education, Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044, P. R. China
| |
Collapse
|
10
|
Park S, Kwon B, Oh JK, Song JK, Lee JS, Kwon SU. Risk of recurrent ischemic stroke in patients with patent foramen ovale: The role of D-dimer. J Stroke Cerebrovasc Dis 2023; 32:107246. [PMID: 37536016 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Paradoxical embolism under elevated thromboembolic conditions is known to be the primary mechanism of patent foramen ovale (PFO)-related stroke. We hypothesized that higher levels of D-dimer, a marker of thromboembolism, could increase the risk of stroke recurrence in patients with PFO. METHODS We conducted a retrospective analysis of data from 1226 consecutive patients with acute ischemic cryptogenic stroke (CS) who underwent transesophageal echocardiography (TEE). D-dimer was assessed during admission. We used a multivariate Cox proportional hazards model to evaluate the association of long-term outcomes between the presence of PFO and levels of D-dimer. RESULTS Of the 1226 patients, the study included 461 who underwent TEE. Among them, 242 (52.5%) had PFOs. Among PFO patients, those with a D-dimer level >1.0 mg/L had a significantly higher risk of stroke recurrence compared to those with <0.5mg/L (adjusted hazard ratio (aHR) 4.04, 95% confidence interval [CI] 1.63-10.02). A pattern of increased risk of event with increasing D-dimer levels was observed (Ptrend=0.008). However, there was no significant difference in the risk of stroke recurrence at any D-dimer level compared to D-dimer level <0.5 mg/L among patients without PFO. In these patients, there was little evidence of increased risk with increasing D-dimer levels (Ptrend=0.570). CONCLUSIONS This study demonstrated that the elevated D-dimer level increased the recurrence of stroke in CS patients with PFO, particularly showing a dose-dependent relationship between D-dimer levels and recurrence. However, no such effect was observed in patients without PFO. These findings provide valuable insights into the potential benefits of anticoagulation for strokes related to PFO.
Collapse
Affiliation(s)
- Seongho Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Boseong Kwon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Sejong Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jae-Kwan Song
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
11
|
Khan F, Derbas LA, Messé SR, Kavinsky C, Kasner SE, Favilla CG. Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists. J Am Heart Assoc 2023:e029451. [PMID: 37345798 DOI: 10.1161/jaha.123.029451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Background Results from multiple clinical trials support patent foramen ovale closure after cryptogenic stroke in select patients, but it remains unclear how new data and updated professional society guidelines have impacted clinical practice. Here, we aimed to compare how stroke neurologists and interventional cardiologists approach patients with cryptogenic stroke with patent foramen ovale and how critical anatomic and clinical factors influence decision making. Methods and Results An electronic survey was administered to 1556 vascular neurologists and 1057 interventional cardiologists throughout the United States. The survey addressed factors such as patient age, preclosure workup, and postclosure antithrombotics. Clinical vignettes highlighted critical variables and used a 5-point Likert scale to assess the providers' level of support for closure. There were 491 survey responses received from 301 (of 1556) vascular neurologists and 190 (of 1057) interventional cardiologists, with an overall response rate of 19%. Vascular neurologists were more likely to recommend against closure on the basis of older age (P<0.001). Interventional cardiologists are more supportive of closure across a range of clinical vignettes, including a very carefully selected patient with cryptogenic stroke (P<0.001), a patient with a high-risk alternative stroke cause (P<0.001), and a range of cases highlighting clinical variables where data are lacking. The majority of interventionalists (88%) seek neurology consultation before pursuing patent foramen ovale closure. Conclusions lnterventional cardiologists are more likely than vascular neurologists to support patent foramen ovale closure across a range of situations. This emphasizes the importance of collaboration and shared decision making, but also reveals an opportunity for professional society educational outreach.
Collapse
Affiliation(s)
- Farhan Khan
- Department of Neurology University of Chicago Chicago IL USA
| | - Laith A Derbas
- Division of Cardiovascular Medicine Rush University Medical Center Chicago IL USA
| | - Steven R Messé
- Department of Neurology University of Pennsylvania Philadelphia PA USA
| | - Clifford Kavinsky
- Division of Cardiovascular Medicine Rush University Medical Center Chicago IL USA
| | - Scott E Kasner
- Department of Neurology University of Pennsylvania Philadelphia PA USA
| | | |
Collapse
|
12
|
Tobis JM. PFO Device Closure Despite Thrombophilia: The Need for Good Observational Studies. JACC Cardiovasc Interv 2023; 16:1367-1368. [PMID: 37316147 DOI: 10.1016/j.jcin.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Jonathan M Tobis
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| |
Collapse
|
13
|
Canali E, Serani M, Tarzia P, Ciampi P, Canestrelli S, Calò L. Echocardiography in cardioembolic stroke prevention. Eur Heart J Suppl 2023; 25:C212-C217. [PMID: 37125319 PMCID: PMC10132583 DOI: 10.1093/eurheartjsupp/suad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Stroke is a leading cause of mortality and disability, and cardiac embolism accounts for one-third of all ischaemic strokes. Thirty per cent of strokes are cryptogenic. In this setting, echocardiography is essential in the diagnosis, treatment, and prevention of embolic stroke of undetermined source since it is a widely available, safe, and inexpensive tool. Transthoracic echocardiography and transoesophageal echocardiography, furthermore, are proven to change therapeutic management leading to initiation of anti-coagulation, anti-microbial therapy, patent foramen ovale (PFO) closure, or cardiac tumour resection. The most common cardioembolic sources include left atrial appendage thrombus, left ventricular thrombus, vegetations in endocarditis, paradoxical embolization in PFO, prosthesis thrombosis, and intracardiac tumours. Although the presence of a cardioembolic source only represents a risk factor for an ischaemic stroke, it could not assure the certain or the unique cause of the event. The purpose of this review is to underline the importance of echocardiography and overview the main sources of cardiac embolism and the echocardiographic features.
Collapse
Affiliation(s)
- Emanuele Canali
- Corresponding author. Tel: +39 3473067059, Fax: +39 0623188305,
| | - Marco Serani
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Pierpaolo Tarzia
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Pellegrino Ciampi
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Stefano Canestrelli
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| |
Collapse
|
14
|
Abazid RM, Tzemos N. Thrombus in Transit Entrapped Within a Patent Foramen Ovale: Role of Multimodality Imaging. CASE (Phila) 2023; 7:147-151. [PMID: 37123630 PMCID: PMC10147547 DOI: 10.1016/j.case.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
TIT is a thrombus attached to any right heart structure. Multimodality imaging is essential in patients with TIT to rule out intracardiac shunt. PFO is the most common access of paradoxical embolization in patients with TIT.
Collapse
Affiliation(s)
- Rami M. Abazid
- Correspondence: Rami M. Abazid, MD, Division of Cardiology, Department of Medicine, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, PO Box 5010, London, Ontario, N6A 5W9, Canada.
| | | |
Collapse
|
15
|
Berk TA, Kroeze S, Suttorp MJ, Heijmen RH. Open surgical retrieval of a migrated patent foramen ovale closure device from the descending aorta following failed percutaneous retrieval from the aortic arch: a case report with a word of caution. Eur Heart J Case Rep 2023; 7:ytad099. [PMID: 36926264 PMCID: PMC10012176 DOI: 10.1093/ehjcr/ytad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/13/2022] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
Background Percutaneous patent foramen ovale (PFO) closure is considered safe and has been used widely for over 25 years. A rare but potentially life-threatening complication is device migration, especially to the aorta. Case summary We present a 30-year-old male with a PFO occlusion device implanted for cryptogenic stroke, which asymptomatically migrated to the aortic arch. A percutaneous retrieval attempt failed at complete removal but relocated the device to the proximal descending aorta. It was then successfully removed by open surgery. Severe intimal damage necessitated resection and interposition grafting. Discussion Manipulation of migrated intravascular devices can cause intimal damage and subsequent complications, such as local dissections. We advocate caution with percutaneous removal of such large, migrated closure devices to avoid additional intimal damage, especially after endothelialization has occurred. The interventional cardiologist should be aware of the risk of intimal damage as a result, and surgical removal, though invasive, should always be considered.
Collapse
Affiliation(s)
- Thirza A Berk
- Department of Cardiothoracic surgery, Sint Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Sven Kroeze
- Department of Cardiology, Sint Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Maarten Jan Suttorp
- Department of Cardiology, Sint Antonius Hospital, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| |
Collapse
|
16
|
Uecker NA, Rosenkranz S, Bunck A, Tichelbäcker T. Unexpected paradoxical embolization following catheter-directed thrombectomy with the FlowTriever™ system in a patient with pulmonary embolism: a case report. Eur Heart J Case Rep 2023; 7:ytad074. [PMID: 36895302 PMCID: PMC9991041 DOI: 10.1093/ehjcr/ytad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/09/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023]
Abstract
Background The optimal therapy for patients suffering from acute pulmonary embolism (PE) classified as intermediate-high risk still needs to be identified. Catheter-directed thrombectomy (CDTE) is a safe procedure to reduce thrombus burden immediately. The lack of randomized trials is one reason: catheter-directed thrombolysis (CDT) has not yet received a clear recommendation in our guidelines. Herein, we report an unexpected event in the course of a patient with PE treated with CDTE using the FlowTriever™ system, the only FDA-approved catheter system for percutaneous mechanical thrombectomy regarding this indication. Case Summary A 57-year-old male presented with dyspnoea at the emergency department of our university hospital. The computed tomography (CT) scan showed bilateral PE, and ultrasound of the left lower limb revealed deep venous thrombosis. According to the current ESC guidelines, he was classified intermediate-high risk. We performed bilateral CDTE. On the first and third day post-intervention, our patient presented neurological deficits. Whereas the first CT scan of the cerebrum remained normal, the CT scan at Day 3 showed demarcated embolic stroke. Further imaging diagnostic gave evidence to an ischemic lesion in the left kidney. Transesophageal echocardiography revealed a patent foramen ovale (PFO) as the origin of paradoxical embolism and thus mechanism of both ischemic lesions. Compliant to the current recommendations, percutaneous PFO closure was performed. Our patient recovered properly without any sequelae. Discussion Whether the deep venous thrombosis is the source of embolization or the catheter-directed retrieval of clots may have transported clot material to the right atrium which further on embolized systemically will remain unclear. Yet, we have to consider it as a potential complication in catheter-directed treatment of PE in patients with a PFO.
Collapse
Affiliation(s)
- Nicola Anne Uecker
- Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany
| | - Stephan Rosenkranz
- Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany
| | - Alexander Bunck
- Faculty of Medicine and University Hospital Cologne, Department of Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany
| | - Tobias Tichelbäcker
- Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany
| |
Collapse
|
17
|
Fakhra S, Sattar Y, Patel NN, Aziz S, Titus A, Almas T, Aamir M, Sulaiman S, Mishra NK, Elgendy IY, Raina S, Jagadeesan V, Daggubati R, Alraies MC. Comparison of Sex Based In-Hospital Procedural Outcomes and Hospital Readmission Frequency After Patent Foramen Ovale Occluder Device Placement: A Propensity Matched National Cohort. Curr Probl Cardiol 2023; 48:101662. [PMID: 36868331 DOI: 10.1016/j.cpcardiol.2023.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION PFO occluder device has been shown to reduce the chance of recurrent stroke in clinically indication per guidelines, stroke is higher in females but procedural efficacy and complications based on sex difference is not well studied in literature. METHODS The Nationwide Readmission Database (NRD) was used to create sex cohorts using ICD-10 Procedural code for elective PFO occluder device placement performed during the years 2016-2019. The two groups were compared using propensity score matching (PSM) and multivariate regression models that matched for confounders to report multivariate odd's ratio (mOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury (AKI), acute ischemic stroke, post-procedure bleeding, and cardiac tamponade. Statistical analysis was performed using STATA v. 17. RESULTS A total of 5,818 patients who underwent PFO occluder device placement were identified, of which 3,144 (54.0%) were females, and 2,673 (46.0%) were males. There was no difference in periprocedural in-hospital mortality, new onset acute ischemic stroke, post-procedural bleeding, or cardiac tamponade between both sexes undergoing occluder device placement. AKI onset was higher in males as compared to females after matching for CKD (mOR = 0.66; 95% CI [0.48-0.92]; p=0.016) this can be procedural or can be secondary to volume status or nephrotoxins. Males also had a higher length of stay (LOS) at their index hospitalization (2 days vs 1 day) which led to slightly higher total hospitalization cost ($26,585 vs $24,265). Our data did not show a statistically significant difference in the readmission LOS trends between the two groups at 30, 90, and 180 days. CONCLUSION PFO occluder is equally efficacious in both sex and no significant difference in sex-based complications noticed on national cohort analysis. AKI occurrence was high in males that can be limited due to unavailability of data about hydration status and nephrotoxic medications.
Collapse
Affiliation(s)
- Sadaf Fakhra
- Department of Medicine, University of Nevada, Las Vegas-Kirk Kerkorian School of Medicine, USA
| | - Yasar Sattar
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Neel N Patel
- Department of Medicine, New York Medical College/Landmark Medical Center, RI, USA
| | - Shazia Aziz
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA
| | - Anoop Titus
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Talal Almas
- Department of Internal Medicine, Mayo Clinic Ireland
| | - Muhammad Aamir
- Department of Cardiology, LeHigh Valley Hospital, Allentown, PA, USA
| | - Samian Sulaiman
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Nishant K Mishra
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Sameer Raina
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Vikrant Jagadeesan
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Ramesh Daggubati
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | | |
Collapse
|
18
|
Hitzeroth J, van der Bijl P, Michel F, Meel R, Cupido BJ, Klug E. SA Heart consensus statement on closure of patent foramen ovale 2021. Cardiovasc J Afr 2023; 34:35-39. [PMID: 35687070 PMCID: PMC10392800 DOI: 10.5830/cvja-2022-009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/07/2022] [Indexed: 06/07/2023] Open
Abstract
A patent foramen ovale (PFO) is associated with numerous clinical conditions. The most severe of these is cryptogenic stroke. This consensus statement aims to provide a clinical guideline on which patients should be offered PFO closure.
Collapse
Affiliation(s)
- J Hitzeroth
- Medical School, University of Cape Town, Cape Town, South Africa
| | | | - F Michel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - R Meel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - B J Cupido
- Medical School, University of Cape Town, Cape Town, South Africa
| | - E Klug
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
19
|
Senior MJT, Monico C, Weatherill EE, Gilbert RJ, Heuck AP, Wallace MI. Single-molecule tracking of perfringolysin O assembly and membrane insertion uncoupling. FEBS J 2023; 290:428-441. [PMID: 35989549 PMCID: PMC10086847 DOI: 10.1111/febs.16596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023]
Abstract
We exploit single-molecule tracking and optical single channel recording in droplet interface bilayers to resolve the assembly pathway and pore formation of the archetypical cholesterol-dependent cytolysin nanopore, Perfringolysin O. We follow the stoichiometry and diffusion of Perfringolysin O complexes during assembly with 60 ms temporal resolution and 20 nm spatial precision. Our results suggest individual nascent complexes can insert into the lipid membrane where they continue active assembly. Overall, these data support a model of stepwise irreversible assembly dominated by monomer addition, but with infrequent assembly from larger partial complexes.
Collapse
Affiliation(s)
- Michael J T Senior
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, UK
| | - Carina Monico
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, UK.,Department of Chemistry, King's College London, UK
| | - Eve E Weatherill
- Chemistry Research Laboratory, Department of Chemistry, University of Oxford, UK.,Department of Chemistry, King's College London, UK
| | - Robert J Gilbert
- Division of Structural Biology, Wellcome Centre for Human Genetics, University of Oxford, UK
| | - Alejandro P Heuck
- Departments of Biochemistry and Molecular Biology, University of Massachusetts, Amherst, MA, USA
| | | |
Collapse
|
20
|
Li Y, Shen Y, Cao Q, Cheng Y, Xu L, Tang Z. Effect of Interventional Therapy Unexplained Dizziness and Relationship Between Dizziness Handicap Inventory and Right-to-Left Shunt Grading. Int J Gen Med 2023; 16:803-811. [PMID: 36883122 PMCID: PMC9985875 DOI: 10.2147/ijgm.s401046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
Objective Unexplained dizziness remains a clinical challenge. Our previous studies have shown that unexplained dizziness may be related to patent foramen ovale (PFO). This study aims to explore whether the degree of shunt is correlated with the degree of unexplained dizziness and looking for the possible clinical intervention for patients with unexplained dizziness. Methods This study was a large single-center, prospective, controlled study. From March 2019 to March 2022, patients with unexplained dizziness and explained dizziness and healthy controls were recruited. Contrast-enhanced transcranial Doppler sonography (c-TCD) was performed to detect the existence of right-to-left shunt (RLS) and shunt grading. The dizziness handicap inventory (DHI) was completed to evaluate the dizziness. Unexplained dizziness patients with large amount of PFO were volunteered to receive medication treatment and transcatheter PFO closure and followed up six months. Results A total of 387 patients (132 unexplained, 123 explained and 132 controls) were enrolled. There was a statistical difference in the RLS grading with three groups (p < 0.001). The Spearman correlation coefficient of RLS grading and DHI scores in unexplained dizziness patients (r=0.122, p=0.163) and explained dizziness patients (r=0.067, p=0.460). In the unexplained group, there were 49 cases with massive grading RLS. Of which 25 patients received percutaneous PFO closure treatment and 24 cases received medication treatment. Followed up six months after treatment, the amount of DHI scores change in patients who received the percutaneous PFO closure was significantly higher than that in the medication treatment group (p < 0.001). Conclusion RLS may play an important role in unexplained dizziness. For unexplained dizziness patients, PFO closure may contribute to better outcomes. In the future, large-scale randomized controlled studies are still needed.
Collapse
Affiliation(s)
- Yanping Li
- Department of Neuroelectrophysiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yu Shen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yingzhang Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhenyu Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| |
Collapse
|
21
|
Kolokathis K, Thomopoulos C, Tsioufis K. Net clinical benefit of PFO closure versus medical treatment in patients with cryptogenic stroke: A systematic review and meta-analysis. Hellenic J Cardiol 2022; 70:46-52. [PMID: 36584788 DOI: 10.1016/j.hjc.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/02/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The ideal treatment for patent foramen ovale (PFO) in patients with cryptogenic stroke remains controversial and is being evaluated. The objective of this study was to evaluate the net clinical benefit (NCB) between PFO closure and medical treatment. METHODS We searched three electronic databases from inception until January 2022. The primary outcomes were the NCB-1, defined as the cumulative incidence of stroke, major bleeding, atrial fibrillation/flutter, and serious procedural or device complications; the NCB-2 and NCB-3 were defined as NCB1 but using a weighted factor of 0.5 and 0.25 for atrial fibrillation/flutter events, respectively. We also evaluated each component outcome of NCB as a secondary outcome. Risk ratios (RR) and 95% confidence intervals (CI) of each outcome were calculated (random-effects model). RESULTS Our analysis included six RCTs (n = 3750 patients). The rates of NCB-1, NCB-2, and NCB-3 were not different between PFO closure and medical treatment. The heterogeneity between trials was low to moderate. Stroke showed a significant relative decrease of 44% (95% CI, 21-60%), favoring the PFO closure arm. Atrial fibrillation/flutter increased by 4.04 times (95% CI, 1.57-8.89) in the PFO closure compared with the medical treatment group. In a meta-regression analysis, the reduction in NCB-1 with PFO closure increased as the proportion of patients treated with the Amplatzer device increased (p = 0.02), and the reduction in NCB-1, NCB-2, and NCB-3 with PFO closure increased as the proportion of patients treated with substantial PFO size increased (p = 0.03). CONCLUSION The NCB between PFO closure and medical treatment was not different, suggesting individualized treatment to maximize benefit.
Collapse
Affiliation(s)
- Konstantinos Kolokathis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| |
Collapse
|
22
|
Wei N, Liu B, Ma M, Zhang X, Zhang W, Hou F, Liu F, Yu X. Patent foramen ovale closure vs. medical therapy alone after cryptogenic stroke in China: A cost-effectiveness analysis. Front Public Health 2022; 10:1016854. [PMID: 36407985 PMCID: PMC9669480 DOI: 10.3389/fpubh.2022.1016854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background In 2019, there were 28. 76 million patients with stroke in China, with ~25% of them suffering from cryptogenic stroke (CS). Patent foramen ovale (PFO) is related to CS, and PFO closure can reduce recurrent stroke. To date, no study has investigated the cost-effectiveness of PFO closure vs. medical therapy among such populations in China. Methods A Markov model with a cycle length of 3 months was established to compare the 30-year cost-effectiveness of PFO closure and medical therapy. The transition probability of recurrent stroke was derived from the RESPECT study, and the costs and utility were obtained from domestic data or studies conducted in China. The primary outcome of this study was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost per quality-adjusted life year (QALY). PFO closure was considered cost-effective if the ICER obtained was lower than the willingness-to-pay (WTP) threshold of 37,654 USD/QALY; otherwise, PFO closure was regarded as not being cost-effective. One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Results After a simulation of a 30-year horizon, a cryptogenic stroke patient with PFO was expected to have QALY of 13.15 (15.26 LY) if he received PFO closure and a corresponding value of 11.74 QALY (15.14 LY) after medical therapy. The corresponding costs in both cohorts are US $8,131 and US $4,186, respectively. Thus, an ICER of 2783 USD/QALY and 31264 USD/LY was obtained, which is lower than the WTP threshold. One-way and probabilistic sensitivity analyses showed that the results were robust. Conclusion With respect to the WTP threshold of three times per capita GDP in China in 2021, PFO closure is a cost-effective method for Chinese cryptogenic stroke patients with PFO, as shown in the 30-year simulation.
Collapse
Affiliation(s)
- Na Wei
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Bo Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Meijuan Ma
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xuejun Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Wei Zhang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Fangxia Hou
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Fuqiang Liu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiangyou Yu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, China
- Department of Endocrinology, Shaanxi Provincial People's Hospital, Xi'an, China
| |
Collapse
|
23
|
Tian J, Chen X. PFO morphology for evaluation of c-TCD and c-TTE RLS grades. Eur J Med Res 2022; 27:228. [PMID: 36329503 PMCID: PMC9635101 DOI: 10.1186/s40001-022-00855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose The purpose of this study was to observe the morphologic characteristics of patent foramen ovale (PFO) by transesophageal echocardiography (TEE), and to analyze its correlation with right-to-left shunt (RLS) of contrast-transthoracic echocardiography (c-TTE) and contrast-transcranial Doppler ultrasonography (c-TCD). Methods 124 patients with PFO were divided into four groups according to the morphological characteristics of PFO. RLS grade of each group PFO with c-TTE and c-TCD in resting and Valsalva manoeuvre was measured. Anatomical structures influencing RLS grade were analyzed statistically through multivariate logistic analyses and predictive models. Results The 124 cases of PFO were divided into four groups: 55 cases (44.4%) with smooth uniform tubular tunnel (SUT), 21 cases (16.9%) with granule uniform tubular tunnel (GUT), 23 cases (18.5%) of right funnelform, 25 cases (20.2%) of left funnelform. Between group comparisons and multivariate logistic analyses revealed that PFO morphotype and interatrial septum(IAS) mobility were influencing factors of RLS degree. During Valsalva, the probability of c-TCD RLS ≥ 2 for the right funnelform PFO was 13.428 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TCD RLS ≥ 2 by a factor of 2.029, model predicted c-TCD RLS ≥ 2 with 78.1% sensitivity and 94.7% specificity; During Valsalva, the probability of c-TCD RLS ≥ 2 for the SUT PFO was 4.244 times that of the GUT, one unit increase in IAS mobility increased the probability of c-TTE RLS ≥ 2 by a factor of 2.392, model predicted c-TTE RLS ≥ 2 with 80.2% sensitivity and 87.9% specificity. Conclusions Studies have shown that the morphological structure of PFO is an influencing factor of RLS, and TEE can observe the specific morphological characteristics of PFO, which can further predict the level of RLS, help predict the occurrence of Cryptogenic stroke (CS). The above provides more evidences and surgical options for Interventional device closure indications.
Collapse
Affiliation(s)
- Jiali Tian
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, China
| | - Xiaobo Chen
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, China.
| |
Collapse
|
24
|
Asghar A, Stefanescu Schmidt AC, Sahakyan Y, Horlick EM, Abrahamyan L. Sex differences in baseline profiles and short-term outcomes in patients undergoing closure of patent foramen ovale. Am Heart J Plus 2022; 21:100199. [PMID: 38559747 PMCID: PMC10978392 DOI: 10.1016/j.ahjo.2022.100199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/24/2022] [Indexed: 04/04/2024]
Abstract
Objectives Although sex differences have been emphasized in stroke and congenital heart disease, there has been limited investigation into their role in patent foramen ovale (PFO) closure for secondary prevention of stroke. We aimed to explore differences by sex in baseline profiles, procedural characteristics, and short-term outcomes of patients undergoing transcatheter PFO closure. Methods Data of adult patients undergoing transcatheter PFO closure at the Toronto General Hospital from 1997 to 2017 was retrospectively analyzed. Baseline information included demographic characteristics, medical history, diagnostic, and procedural information, and periprocedural complications. Post-closure outcomes were captured at index hospitalization and during the first follow-up. Results From 1031 patients in the cohort sample, 80.7 % underwent closure for cryptogenic stroke and 44.7 % (n = 461) were females. We observed significant sex-related differences in baseline characteristics; females were younger, less likely to have a history of smoking, and less likely to have several cardiovascular risk factors at baseline (p < 0.05). The median time to first follow-up was 89 days for both groups. Recurrent stroke was observed in 0.1 % and TIA observed in 0.4 % of in the 'cryptogenic stroke/TIA' group; in the 'other indications' group, 1.4 % stroke and no TIA were reported. No significant differences were present between sexes. Conclusions There were no differences in procedural and short-term outcomes between males and females undergoing transcatheter PFO closure, but significant baseline differences in risk factors were identified. There is a critical need for long-term, systematic studies to understand sex and gender differences in the PFO population.
Collapse
Affiliation(s)
- Areeba Asghar
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ada C. Stefanescu Schmidt
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada
| | - Yeva Sahakyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada
| | - Eric M. Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, UHN, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute, University Health Network (UHN), Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Fordyce AM, Whalley GA, Coffey S, Wilson LC. Adjunct Methods for the Detection of Patent Foramen Ovale: The Contribution of Transcranial Doppler and the Valsalva Manoeuvre. Heart Lung Circ 2022; 31:1471-1481. [PMID: 36038470 DOI: 10.1016/j.hlc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
A patent foramen ovale (PFO) is present in 25% of the population. In some patients, especially those without traditional stroke risk factors and with no immediately apparent cause, a cryptogenic stroke may be caused by an embolus passing through the PFO to the systemic circulation. The identification, or indeed exclusion, of a PFO is sought in these patients, most commonly using contrast-enhanced transthoracic or transoesophageal echocardiography. Another method for detecting a PFO is transcranial Doppler, which allows the detection of PFO possibly without the need for an echo laboratory, and with arguably improved sensitivity. This review will focus on transcranial Doppler detection of PFO, with a brief summary of echocardiographic techniques and the use of ultrasound contrast agents, and the role of provocations to increase diagnostic accuracy, specifically the Valsalva manoeuvre. We discuss the phases alongside the direct and indirect signs of an adequate Valsalva manoeuvre.
Collapse
Affiliation(s)
- Andrew M Fordyce
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/AFordyceOtago
| | - Gillian A Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand. http://www.twitter.com/GWhalleyPhD
| | - Sean Coffey
- Department of Medicine, University of Otago, Dunedin, New Zealand; Southern District Health Board, New Zealand. http://www.twitter.com/DrSeanCoffey
| | - Luke C Wilson
- Department of Medicine, University of Otago, Dunedin, New Zealand.
| |
Collapse
|
26
|
Gama E Castro A, Luz A, Oliveira F, Brochado B, Santos R, Alexandre A, Campinas A, Couto DS, Silveira J, Torres S. Platypnea Orthodeoxia Syndrome and Patent Foramen Ovale Closure: Single-Centre Experience and Long-Term Follow-Up. Heart Lung Circ 2022; 31:1547-1552. [PMID: 35987719 DOI: 10.1016/j.hlc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Platypnea orthodeoxia syndrome (POS) is an uncommon condition characterised by dyspnoea and arterial desaturation induced by an upright position and relieved in the supine position, usually due to a patent foramen ovale (PFO). Percutaneous closure of a PFO is the preferred treatment to cure POS. This study aimed to evaluate the clinical and gasometrical characteristics and to describe the long-term outcomes of percutaneous PFO closure in a group of patients with POS. METHODS Patients with POS and a PFO treated by percutaneous intervention from 2010-2020 were reviewed. The primary efficacy outcome was the arterial oxygen pressure to fraction of inspired oxygen (PaO2/FiO2) ratio before and 24 hours after the procedure. Total clinical success was considered if the arterial oxygen saturation measured by pulse oximetry (SpO2) improved to >94% in the supine and sitting positions without supplemental oxygen, while partial success was considered if SpO2 improved from baseline but still required oxygen to achieve >94%. Secondary outcomes were an absolute improvement in SpO2 and sense of dyspnoea, without significant residual shunt on transthoracic echocardiography (TTE) at follow-up. RESULTS Of 168 patients undergoing PFO or atrial septal defect closure, 14 had POS (8.3%). Percutaneous PFO closure was successfully performed in all patients with a single device. Twelve of 14 patients had total clinical success (86%) and one patient had partial success. The PaO2/FiO2 ratio increased from 155.9±50.6 to 318.3±73.4 after PFO closure (p=0.002). All patients with total clinical success had a successful secondary efficacy outcome with an absolute improvement in SpO2 and complete resolution of dyspnoea, which was maintained at follow-up (37±20 months; range, 11 months to 6 years). None had a significant residual shunt between 12 and 24 months of follow-up. CONCLUSION The PFO percutaneous closure was a successful, durable and safe method for patients presenting with POS; it achieved major improvements in both gasometrical parameters and quality of life.
Collapse
Affiliation(s)
- Ana Gama E Castro
- ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - André Luz
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal; Cardiovascular Research Group - Unit of Multidisciplinary Investigation in Biomedicine, ICBAS, Porto University, Porto, Portugal.
| | - Filomena Oliveira
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Bruno Brochado
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Raquel Santos
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - André Alexandre
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Andreia Campinas
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - David Sá Couto
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - João Silveira
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| | - Severo Torres
- Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; ICBAS School of Medicine and Biomedical Sciences, Porto University, Porto, Portugal
| |
Collapse
|
27
|
Chiang M, Wang DD, O'Neill WW, Villablanca PA. Bilateral Transbrachial Intracardiac Echocardiography-Guided Patent Foramen Ovale Closure in Patient With Bilateral Deep Vein Thrombosis. J Invasive Cardiol 2022; 34:E643-E644. [PMID: 35920736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patent foramen ovale (PFO) closure is a very common procedure, and unfavorable femoral venous access is not uncommonly encountered. The ability to treat this common condition in a minimally invasive manner via a different access is important in our daily practice. The transjugular venous approach has been successfully reported, with 1 main difficulty when faced with the angulation of the PFO septum primum during the crossing, as well as less operator-friendly in terms of positioning. Hence, we adopted the bilateral transbrachial approach in this patient. We consider this to be the first reported case of intracardiac echocardiography-guided PFO closure via bilateral transbrachial approach. The authors believe their experience serves an important role in the following: (1) steps and equipment needed for bilateral transbrachial PFO closure; (2) tips and tricks for a successful procedure; and (3) safety and feasibility of bilateral transbrachial approach as an alternative approach for minimally invasive PFO closure.
Collapse
Affiliation(s)
- Michael Chiang
- Henry Ford Hospital, Center for Structural Heart Disease, CFP 4th floor, 2799 W Grand Blvd, Detroit, MI 48202 USA.
| | | | | | | |
Collapse
|
28
|
Apostolos A, Drakopoulou M, Trantalis G, Synetos Α, Oikonomou G, Karapanayiotides T, Tsioufis C, Toutouzas K. The management of patent foramen ovale in divers: where do we stand? Ther Adv Neurol Disord 2022; 15:17562864221103459. [PMID: 35837370 PMCID: PMC9274415 DOI: 10.1177/17562864221103459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.
Collapse
Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Αndreas Synetos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- Professor of Cardiology, First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Avenue, Athens 115 27, Greece
| |
Collapse
|
29
|
Liu F, Tong J, Xu Z, Ge K, Ruan J, Cui L, Zhai T. Electrically Tunable Polymer Whispering-Gallery-Mode Laser. Materials (Basel) 2022; 15:ma15144812. [PMID: 35888278 PMCID: PMC9317815 DOI: 10.3390/ma15144812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023]
Abstract
Microlasers hold great promise for the development of photonics and optoelectronics. At present, tunable microcavity lasers, especially regarding in situ dynamic tuning, are still the focus of research. In this study, we combined a 0.7Pb(Mg1/3Nb2/3)O3-0.3PbTiO3 (PMN-PT) piezoelectric crystal with a Poly [9,9-dioctylfluorenyl-2,7-diyl] (PFO) microring cavity to realize a high-quality, electrically tunable, whispering-gallery-mode (WGM) laser. The dependence of the laser properties on the diameter of the microrings, including the laser spectrum and quality (Q) value, was investigated. It was found that with an increase in microring diameter, the laser emission redshifted, and the Q value increased. In addition, the device effectively achieved a blueshift under an applied electric field, and the wavelength tuning range was 0.71 nm. This work provides a method for in situ dynamic spectral modulation of microcavity lasers, and is expected to provide inspiration for the application of integrated photonics technology.
Collapse
Affiliation(s)
- Fangyuan Liu
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
| | - Junhua Tong
- College of Mathematics and Physics, Beijing University of Chemical Technology, Beijing 100029, China;
| | - Zhiyang Xu
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
| | - Kun Ge
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
| | - Jun Ruan
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
| | - Libin Cui
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
- Correspondence: (L.C.); (T.Z.)
| | - Tianrui Zhai
- College of Physics and Optoelectronics, Faculty of Science, Beijing University of Technology, Beijing 100124, China; (F.L.); (Z.X.); (K.G.); (J.R.)
- Correspondence: (L.C.); (T.Z.)
| |
Collapse
|
30
|
Rigatelli G, Zuin M, Roncon L. Increased Blood Residence Time as Markers of High-Risk Patent Foramen Ovale. Transl Stroke Res 2022. [PMID: 35690709 DOI: 10.1007/s12975-022-01045-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
Previous investigations have suggested that patients with patent foramen ovale (PFO) often have an atrial dysfunction, like to that observed in patients with atrial fibrillation (AF) which may concur to an increased risk of cryptogenic stroke. The aim of the study is to compare the atrial resident time (Rt) of PFO patients to those with sinus rhythm (SR) and AF using patient-specific 3D computational fluid dynamics (CFD) analysis. Models of left atrium (LA) hemodynamics were obtained from time-resolved CT scans and transthoracic echocardiography (TTE). Enrolled patients were divided into three groups: 30 healthy subjects with SR, 30 with PFO, and 30 with AF without PFO. Blood stasis was evaluated by determining the blood residence time (Rt) distribution in the LA and left atrial appendage (LAA). Overall, 90 patients (mean age 47.4 ± 7.5 years, 51 males) were included into the analysis. PFO patients exhibit higher mean Rt values compared to healthy subjects (2.65 ± 0.2 vs 1.5 ± 0.2 s). Conversely, AF patients presented higher Rt when compared to PFO patients (2.9 ± 0.3 vs 2.3 ± 0.2 s). Moreover, PFO patients presenting cerebral lesions at magnetic resonance imaging have a higher Rt compared to those without (2.9 ± 0.3 vs 2.3 ± 0.2 s, respectively, p < 0.001). PFO patients have a higher degree of atrial Rt compared to healthy subjects similar to that observed in AF patients. The higher mean LA Rt values offer an insight into the pathophysiological mechanism linking PFO with cryptogenic stroke and might be a marker of high-risk PFOs.
Collapse
|
31
|
Hou Y, Elmashad A, Staff I, Alberts M, Nouh A. Potential Embolic Sources Differ in Patients With Embolic Stroke of Undetermined Source According to Age: A 15-Year Study. Front Neurol 2022; 13:860827. [PMID: 35655618 PMCID: PMC9152312 DOI: 10.3389/fneur.2022.860827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Understanding the potential embolic source in young patients with ESUS may improve the diagnosis and treatment of such patients. Hypothesis Potential embolic sources (PES) differ in young vs. older patients with ESUS, and, therefore, not all patients with ESUS have the same risk profile for stroke recurrence. Methods Young patients (age 18-49) with ESUS, who were admitted to our stroke center from 2006 to 2019, were identified retrospectively and matched with next consecutive older patients (age 50-99) with ESUS by admission date. PES were categorized as atrial cardiopathy, AFib diagnosed during follow-up, left ventricular disease (LVD), cardiac valvular disease (CVD), PFO or atrial septal aneurysm (ASA), and arterial disease. Patients, who had cancer or thrombophilia, were excluded. The type and number of PES and stroke recurrence rates were determined and compared between young and older patients. Results In young patients (55.3% women, median age 39 years), the most common PES was PFO/ASA, and the rate of other PES was low (2-7%). Half of the young patients (54.1%) had a single PES, only 10% had multiple PES, and 35.3% of young patients did not have any PES identified. In older patients (41.7% women, median age 74 years), the 3 most common PES were atrial cardiopathy (38.1%), LVD (35.7%), and arterial disease (23.8%). Nearly half of older patients (42.9%) had multiple PES. The rate of stroke recurrence tended to be lower in young patients as compared to older patients (4.9 vs. 11.4%, p = 0.29). During a median follow-up of 3 years, only 3 young patients (4.9%) had a recurrent stroke, and two of them had unclosed PFO. There were no recurrent strokes among young patients with no PES identified. Conclusions It was noted that PES differ in patients with ESUS according to age and differences in recurrence. PFO is the only common PES in young patients with ESUS. Future studies prospectively evaluating PES in both age groups are needed.
Collapse
Affiliation(s)
- Yan Hou
- Department of Neurology, Hartford Hospital, Hartford, CT, United States.,Department of Neurology, University of Connecticut, Farmington, CT, United States
| | - Ahmed Elmashad
- Department of Neurology, University of Connecticut, Farmington, CT, United States
| | - Ilene Staff
- Department of Research, Hartford Hospital, Hartford, CT, United States
| | - Mark Alberts
- Department of Neurology, Hartford Hospital, Hartford, CT, United States.,Department of Neurology, University of Connecticut, Farmington, CT, United States
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, Hartford, CT, United States.,Department of Neurology, University of Connecticut, Farmington, CT, United States
| |
Collapse
|
32
|
Lovering AT, Kelly TS, DiMarco KG, Bradbury KE, Charkoudian N. Implications of a patent foramen ovale on environmental physiology and pathophysiology: Do we know the hole story? J Physiol 2022; 600:1541-1553. [PMID: 35043424 DOI: 10.1113/jp281108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/14/2022] [Indexed: 11/08/2022] Open
Abstract
The foramen ovale is an essential component of the foetal circulation contributing to oxygenation and carbon dioxide elimination that remains patent under certain circumstances, in ∼ 30% of the healthy adult population, without major negative sequelae in most. Adults with a patent foramen ovale (PFO) have a greater tendency to develop symptoms of acute mountain sickness and high-altitude pulmonary oedema upon ascent to high altitude, and PFO presence is associated with worse cardiopulmonary function in chronic mountain sickness. This increase in altitude illness prevalence may be related to dysregulated cerebral blood flow associated with altered respiratory chemoreflex sensitivity; however, the mechanisms remain to be elucidated. Interestingly, men with a PFO appear to have a shift in thermoregulatory control to higher internal temperatures, both at rest and during exercise, and they have blunted thermal tachypnea. The teleological "reason" for this thermoregulatory shift is unclear, but the shift of ∼0.5°C in core body temperature does not appear to be sufficient to have any significant negative consequences in terms of risk of heat illness. Further work in this area is needed, particularly in women, to evaluate mechanisms of heat storage and dissipation in these individuals as compared to people without a PFO. Consequences of a PFO in SCUBA divers include a greater incidence of unprovoked decompression sickness, but whether PFO is beneficial or detrimental to breath hold diving remains unexplored. Whether PFO presence will explain interindividual variability in responses to, and consequences from, other environmental stressors such as spaceflight remain entirely unknown. Abstract figure legend Associations between PFO and altitude illnesses, core body temperature and diving. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Tyler S Kelly
- University of Oregon, Department of Human Physiology, Eugene, OR
| | | | - Karleigh E Bradbury
- University of Oregon, Department of Human Physiology, Eugene, OR.,United States Army Research Institute of Environmental Medicine, Thermal & Mountain Medicine Division, Natick, MA
| | - Nisha Charkoudian
- United States Army Research Institute of Environmental Medicine, Thermal & Mountain Medicine Division, Natick, MA
| |
Collapse
|
33
|
Cao Q, Shen Y, Hou Z, Li D, Tang B, Xu L, Li Y. The Relationship Between Patent Foramen Ovale and Unexplained Dizziness: A Prospective Analysis in China. Neuropsychiatr Dis Treat 2022; 18:1495-1505. [PMID: 35923299 PMCID: PMC9341455 DOI: 10.2147/ndt.s367140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patent foramen ovale (PFO) is potentially associated with abnormal embolisms, and it results in mixing of arteriovenous blood when its right-to-left shunt (RLS) emerges. Present studies have found that PFO is a risk factor that can lead to many diseases. However, few studies have examined the relationship between PFO and dizziness. METHODS This study was a large single-center, prospective, controlled study. From March 2019 to March 2021, we recruited patients with dizziness were divided into two groups: "explained" and "unexplained". All patients were submitted to contrast-enhanced transcranial Doppler ultrasound and screened for PFO. Transesophageal heart ultrasound or right heart catheterization was used to confirm PFO. Additionally, multiple factors were collected and statistical analysis was performed between the two groups. RESULTS Among the 244 patients included, 123 were in the "explained" group and 121 were in the "unexplained" group. The prevalence of PFO in the "explained" group was 34 (27.4%) compared to 79 (64.7%) in the "unexplained" group. In the "explained" group, 7 were RLS level IV, 6 were level III, 7 were level II, and 14 were level I. For the "unexplained" group, the numbers of patients with levels IV, III, II and I were 27, 26, 12 and 14, respectively. Univariate analysis revealed that PFO (χ2= 34.77, P < 0.001) and age (t = -3.49, P < 0.001) seemed to be potential risk factor candidates for "unexplained" dizziness. In multiple regression analysis, age (OR = 0.97; 95% CI 0.95-0.99) and the prevalence of PFO (OR = 4.37; 95% CI 2.50-7.63) were statistically significant. Massively shunted PFO showed more pronounced risk factors (OR = 8.76; 95% CI 4.04-19.03). CONCLUSION There was a high prevalence of PFO and a greater RLS level in unexplained dizziness. PFO and age were independent risk factors for unexplained dizziness. When treating with unexplained dizziness, especially among young people, we must pay attention to the presence of PFO.
Collapse
Affiliation(s)
- Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhuo Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Defu Li
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University School of Public Health, Nanchang, Jiangxi, People's Republic of China
| | - Boji Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yanping Li
- Department of Neuroelectrophysiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| |
Collapse
|
34
|
Vanreusel I, Maes S, De Wolf D, Van Berendoncks A. Percutaneous closure of a secundum atrial septum defect performed under hypnosis: a case report. Acta Cardiol 2021; 76:1078-1082. [PMID: 32964783 DOI: 10.1080/00015385.2020.1822491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Atrial septal defects (ASDs) are the third most common type of congenital heart diseases with ostium secundum defects (ASDsII) being responsible for approximately 75% of these defects. The treatment consists of either a transcatheter closure or a surgical intervention. The transcatheter approach offers a less invasive alternative for patients who fulfill anatomical and size criteria and is therefore increasingly used as the preferred primary intervention. As general anaesthesia is sometimes contra-indicated for some patients needing ASD or PFO closure and intracardiac echocardiography (ICE) is not always readily available, alternative "supportive" techniques as hypnosis could be of interest. In our case, a relative contra-indication for general anaesthesia was pronounced due to the severely impaired pulmonary function caused by severe deformative torsional scoliosis. Over the years several reviews have been published on hypnotic analgesia used together with usual care suggesting that hypnotic analgesia is a promising non-pharmacologic adjunct treatment for ameliorating pain and surgical distress. Also, various cardiological procedures under hypnosis have already been described in literature, but this is the first time that percutaneous ASD closure under virtual reality (VR) hypnosis is mentioned in literature.
Collapse
Affiliation(s)
| | - S. Maes
- Department of Anesthesiology, University Hospital of Antwerp, Edegem, Belgium
| | - D. De Wolf
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - A. Van Berendoncks
- University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Patent foramen ovale (PFO) is widely prevalent and studies have suggested an association with ischemic stroke. In this review, we aim to highlight current management of patients with ischemic stroke in the setting of PFO and discuss some areas of controversy. RECENT FINDINGS Upon reviewing the literature, we have found that the evidence regarding the management of patients with cryptogenic stroke and PFO has come a long way in the past several years, and many uncertainties remain in clinical practice. The Risk of Paradoxical Embolism (RoPE) score helps to predict the probability of a pathogenic PFO, and recent trial data confirms the benefit of closure in carefully selected patients. The benefit of closure in older patients and in patients with alternate, competing mechanisms is still uncertain, and the long-term risks of closure are not known. Finally, the efficacy of direct oral anticoagulants (DOACs) in this patient population as compared to other medical therapy or mechanical closure has not yet been investigated. Randomized data is needed to help answer these questions. PFO closure is a safe and effective strategy in reducing stroke risk in carefully selected patients with cryptogenic stroke in the setting of a PFO. More studies are needed to test optimal medical treatment strategies and the safety and efficacy of PFO closure in patient subgroups not included in prior PFO closure trials.
Collapse
Affiliation(s)
- Alison Thaler
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Alexandra Kvernland
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sean Kelly
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Christopher Song
- Department of Internal Medicine, Brown University, Providence, RI, USA
| | - Hugo J Aparicio
- Department of Neurology, Boston University, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston, MA, USA
| | | | - Shadi Yaghi
- Department of Neurology, Brown University, 593 Eddy Street APC 5, Providence, RI, 02903, USA.
| |
Collapse
|
36
|
Zuin M, Rigatelli G. Thrombus straddling a patent foramen ovale: Also a myocardial infarction matter? Int J Cardiol 2021:S0167-5273(21)01206-7. [PMID: 34375708 DOI: 10.1016/j.ijcard.2021.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/22/2022]
|
37
|
Kass M, Grocott HP, Shah AH. Constellation of Stroke, Pulmonary Embolism, and Platypnea Orthodeoxia Syndrome: The Elusive Patent Foramen Ovale. JACC Cardiovasc Interv 2021; 14:e165-e167. [PMID: 34217629 DOI: 10.1016/j.jcin.2021.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Malek Kass
- Section of Cardiology, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hilary P Grocott
- Department of Anesthesiology, Perioperative and Pain Medicine, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H Shah
- Section of Cardiology, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
38
|
Punzengruber G, Kolb R, Meier B, Binder RK. Percutaneous closure of a patent foramen ovale causing exercise hypoxemia: Case report and a review of the literature. Catheter Cardiovasc Interv 2021; 98:733-737. [PMID: 34145952 DOI: 10.1002/ccd.29825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/13/2021] [Accepted: 06/05/2021] [Indexed: 11/11/2022]
Abstract
Provoked exercise desaturation is a rare presentation of patent foramen ovale (PFO), when vigorous exercise leads to desaturation of arterial blood and subsequent dyspnea. We present a case of provoked exercise desaturation and curative percutaneous closure and review the literature. A 54-year-old male patient presented with shortness of breath during exercise in the pneumology outpatient department. During exercise spirometry, a relevant drop in arterial oxygen saturation and partial pressure of oxygen was observed and a right-left shunt suspected. In a transesophageal echocardiogram, a PFO was observed. Cardiac catheterization documented a right-left-shunt causing desaturation during exercise. Following percutaneous closure of the PFO, exercise induced desaturation was no longer detectable during exercise spirometry and there was considerable improvement in exercise capacity and subjective dyspnea. To sum up, provoked exercise desaturation is a rare but curable presentation of PFO. Percutaneous closure is a safe and effective way to treat this entity.
Collapse
Affiliation(s)
- Georg Punzengruber
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Rainer Kolb
- Department of Pneumology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Bernhard Meier
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Ronald K Binder
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
| |
Collapse
|
39
|
Qintar M, Villablanca P, Lee J, Wang DD, Frisoli T, O’Neill B, O’Neill WW, Eng MH. Patent foramen ovale closure with vena cava thrombus: You need an arm and a neck! Clin Case Rep 2021; 9:e03884. [PMID: 34026124 PMCID: PMC8123747 DOI: 10.1002/ccr3.3884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 12/01/2022] Open
Abstract
In patients with challenging femoral vein anatomy, transcatheter patent foramen ovale (PFO) closure can be safely and effectively be done through the jugular veins guided by ICE from the arm. This novel technique can potentially save resources (anesthesia and TEE) and provide an option for patients without a femoral option.
Collapse
Affiliation(s)
- Mohammed Qintar
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - Pedro Villablanca
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - James Lee
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - Dee Dee Wang
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - Tiberio Frisoli
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - Brian O’Neill
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - William W O’Neill
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| | - Marvin H Eng
- Center for Structural Heart DiseaseDivision of CardiologyHenry Ford Health SystemDetroitMIUSA
| |
Collapse
|
40
|
Affiliation(s)
- Malek Kass
- Section of Cardiology, Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Virendra K Arya
- Section of Anaesthesia, Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H Shah
- Section of Cardiology, Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
41
|
Elzanaty AM, Patel N, Sabbagh E, Eltahawy EA. Patent foramen ovale closure in the management of cryptogenic stroke: a review of current literature and guideline statements. Curr Med Res Opin 2021; 37:377-384. [PMID: 33460329 DOI: 10.1080/03007995.2021.1876648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The management recommendations for patent foramen ovale (PFO) closure in cryptogenic stroke are rapidly evolving. The data has expanded recently with four major trials demonstrating superiority of percutaneous device closure over medical management in preventing cryptogenic stroke recurrence. This paper aims to review the current literature for referring physicians who may encounter patients with patent foramen ovale before referring these patients to stroke specialists and/or interventional cardiologists. METHOD For this Narrative review, we conducted a broad literature search with expert selection of relevant data. Our search included a review of the currently available trials, guideline statements, position papers, cost-effectiveness of device closure data, as well as the impact of device closure on quality of life. RESULTS Most European societies are now in favor of evaluating all patients aged 60 years or younger with recent cryptogenic stroke in the setting of a PFO after careful consideration of the patient's echocardiographic and clinical risk factors. On the other hand, American societies, except for the American Academy of Neurology, have not yet passed official updated recommendations. CONCLUSION PFO closure can be considered for the prevention of recurrent cryptogenic stroke in patients aged ≤60 years after a thorough evaluation and discussion about benefits and potential risks (including but not limited to atrial fibrillation) of the procedure. Accumulating evidence supports prognostic, quality of life, and economic benefit from percutaneous PFO closure with newer generation closure devices in the right subset of patients. HIGHLIGHTS Data from 4 major trials (RESPECT, CLOSE, DEFENSE-PFO, REDUCE) demonstrates the superiority of PFO closure over medical management alone in preventing cryptogenic stroke recurrence. Trials investigated mostly patients ≤60 years old, and therefore results may not be generalizable to the entire population. Further randomized trials evaluating the safety and efficacy of PFO closure in patients older than 60 years are warranted.Atrial fibrillation is one of the most common "occult" causes of cryptogenic stroke and should be excluded by ambulatory electrocardiographic monitoring. It is important to also rule out other causes of stroke, including hypercoagulable states, atherosclerotic lesions, other cardioembolic sources, and arterial dissection.Complications of PFO procedure include new-onset AF, development of scar tissue, risk of aortic root dilation and subsequent erosions, and potential thrombi formation on the device.PFO closure with medical therapy is more cost-effective than medical therapy alone.Patients who underwent PFO closure had lower rates of depression, anxiety, and stress compared to those who did undergo closure.Development of the RoPE score has helped clinicians identify patients with cryptogenic stroke and PFO who might be a candidate for PFO closure. A score of 7, 8, and 9-10 corresponds to a causal risk of 72%, 84%, and 88%, respectively, and defines a subset of patients who may benefit from PFO closure.Current guidelines recommend determining the need for PFO closure on a case-by-case basis, depending on risk factors, in patients age 60 or less with recent cryptogenic stroke in the setting of PFO.
Collapse
Affiliation(s)
- Ahmed M Elzanaty
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Neha Patel
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ebrahim Sabbagh
- Department of Cardiology, University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiology, University of Toledo, Toledo, OH, USA
| |
Collapse
|
42
|
Boukhris M, Masson JB, Potvin J. Challenging Diagnosis of Patent Foramen Ovale in Presence of a Large Eustachian Valve. J Saudi Heart Assoc 2021; 33:135-137. [PMID: 34183910 PMCID: PMC8143726 DOI: 10.37616/2212-5043.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 39-year-old woman who presented with cryptogenic stroke. Conventional and contrast echocardiography modalities noticed a large Eustachian valve (EV) but failed to identify any right-to-left shunt. Conversely, contrast-transcranial Doppler revealed a grade 3 right-to-left shunt. Contrast echocardiography was repeated with bubble injections through both an upper extremity and a femoral vein, 10 min apart from each other. While no shunt was observed following upper extremity injection, >20 bubbles crossed the inter-atrial septum when contrast was injected via femoral vein confirming the diagnosis of patent foramen ovale.
Collapse
Affiliation(s)
- Marouane Boukhris
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Bernard Masson
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jeannot Potvin
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
43
|
Ito S, Dhesi S, Miranda WR, Geske JB, Anavekar NS, Morant K, Rihal CS, Eleid MF, Oh JK. Assessment of left ventricular filling pressure with Doppler velocities across the patent foramen ovale. J Echocardiogr 2021; 19:158-165. [PMID: 33438170 DOI: 10.1007/s12574-020-00509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/12/2020] [Accepted: 12/24/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The utility of Doppler velocities across the patent foramen ovale (PFO) to estimate left ventricular (LV) filling pressure is not well known. METHODS The best cut-off value of peak interatrial septal velocity across a transeptal puncture site measured by transesophageal echocardiography for estimating high mean left atrial (LA) pressure (≥ 15 mmHg) was determined in 17 patients. This cut-off value was subsequently applied to 67 patients with a PFO undergoing transthoracic echocardiography (TTE) for assessing the value of PFO velocity in determining LV filling pressure. RESULTS The peak systolic interatrial septal velocities significantly correlated with directly measured mean LA pressures during transcatheter mitral valve procedure (r = 0.77, P < 0.001). The best cut-off value was 1.7 m/s for predicting high LA pressure (AUC 0.91; sensitivity 90%, specificity 86%). When this cut-off was applied to patients undergoing TTE, peak PFO velocity ≥ 1.7 m/s correlated with reduced e', higher E/e', and higher tricuspid regurgitation velocity (P < 0.01). LV filling pressure according to the 2016 diastolic guideline was compared with peak PFO velocity in 51 patients. Among patients with high filling pressure according to the guidelines (n = 20), peak PFO velocity ≥ 1.7 m/s was present in 60% of patients. In patients with normal filling pressure per the guidelines (n = 31), PFO velocity < 1.7 m/s was present 84%. Sensitivity and specificity were 75% and 92%, respectively, in patients with sinus rhythm, but were only 50% and 57%, respectively, among patients with atrial fibrillation. CONCLUSIONS Doppler-derived peak PFO velocities could be valuable in the assessment of increased LV filling pressure using 1.7 m/s as the cut-off value.
Collapse
Affiliation(s)
- Saki Ito
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Sumandeep Dhesi
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
- Department of Medicine, Faculty of Medicine, Division of Cardiology at the University of British Columbia, Vancouver, BC, Canada
| | - William R Miranda
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA.
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Kareem Morant
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA
| |
Collapse
|
44
|
Shen Y, Nie Q, Zhang Y, Cao Q, Hou Z, Xu L. Treatment Strategies for Cryptogenic Stroke Patients with Patent Foramen Ovale: What Do We Choose? Neuropsychiatr Dis Treat 2021; 17:3205-3214. [PMID: 34712049 PMCID: PMC8548060 DOI: 10.2147/ndt.s333930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE The treatment of cryptogenic stroke patients with patent foramen ovale to prevent recurrence of stroke, especially when patients consider drug prevention alone, has caused serious treatment dilemmas in clinical practice. OBJECTIVE To study the safety and efficacy of different treatment strategies using a network meta-analysis of randomized controlled trials in this population with cryptogenic stroke and patent foramen ovale. STUDY SELECTION PUBMED, EMBASE, The Cochrane Library, WangFang, and China National Knowledge Infrastructure were searched to identify RCT comparing different treatment strategies. Eleven randomized studies were included (n = 5706). MAIN OUTCOMES The primary efficacy outcome was recurrence of ischemic stroke, including fatal and non-fatal ischemic strokes. The primary safety outcome was major hemorrhage, but closure surgery includes systemic thrombotic events, persistent atrial fibrillation, surgical deaths and other major events. RESULTS In terms of efficacy and safety events, compared with antiplatelet, the OR of vitamin K antagonists for stroke recurrence was 0.81 (95% CI, 0.41-1.6), the OR of surgical closure was 0.38 (95% CI, 0.16-0.63), and the OR of NOAC was 0.79 (95% CI, 0.27-2.3). Compared with antiplatelet, the safety event OR of vitamin K antagonists was 1.7 (95% CI, 0.65-4.8), the OR of surgical closure was 1.7 (95% CI, 0.68-3.8), and the OR of NOAC was 2.2 (95% CI, 0.67-7.6). CONCLUSION In terms of effectiveness, surgical occlusion has the best performance, while anticoagulation is the second best. Vitamin K antagonists and non-vitamin K antagonists are difficult to distinguish between the best in effectiveness. Antiplatelet drugs are considered the worst option. Regarding the safety results, it is generally believed that there are no obvious beneficial interventions, but antiplatelet drugs are considered to be relatively best, followed by surgical intervention and vitamin K antagonists, and non-vitamin K antagonists are considered to be the least safe.
Collapse
Affiliation(s)
- Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qiurui Nie
- Department of Cardiovascular Medicine, People's Hospital Affiliated of Nanchang University, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, People's Republic of China
| | - Yibi Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhuo Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| |
Collapse
|
45
|
Hammer JD, Khurshid SG. PFOh No: Spontaneous Globe Rupture During Injection of Perfluoro- n-Octane (PFO) During Retinal Detachment Repair. Front Med (Lausanne) 2020; 7:582596. [PMID: 33195330 PMCID: PMC7645235 DOI: 10.3389/fmed.2020.582596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022] Open
Abstract
The authors describe a case of spontaneous globe rupture during instillation of perfluoro-n-octane (PFO) during retinal surgery. A 71-year-old male with a macular-involving rhegmatogenous retinal detachment underwent pars plana vitrectomy. During instillation of PFO manually on a single-bore cannula by the assisting resident, spontaneous globe rupture occurred superotemporally in an area with no visible underlying structural abnormalities. Factors that led to this complication include the use of single-bore cannula, error in judgment of resistance during PFO injection, and inexperience. This is the first report of this complication without an identifiable structural abnormality predisposing patient to perforation.
Collapse
Affiliation(s)
- Jon David Hammer
- Department of Ophthalmology, University of Florida, Gainesville, FL, United States
| | - Syed Gibran Khurshid
- Department of Ophthalmology, University of Florida, Gainesville, FL, United States
| |
Collapse
|
46
|
Sievert K, Yu J, Bertog S, Hornung M, von Bardeleben RS, Gafoor S, Reinartz M, Matic P, Hofmann I, Grunwald I, Schnelle N, Sievert H. Post-Market Clinical Follow-Up With the Patent Foramen Ovale Closure Device IrisFIT (Lifetech) in Patients With Stroke, Transient Ischemic Attack, or Other Thromboembolic Events. Cardiovasc Revasc Med 2020; 30:72-75. [PMID: 33097460 DOI: 10.1016/j.carrev.2020.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND A patent foramen ovale (PFO) has been associated with embolic strokes and transient ischemic attacks (TIAs). Catheter closure of PFO is effective in preventing recurrent events. Residual shunts and procedure or device related complications can occur, including atrial fibrillation and thrombus formation. This study examines the initial experience with a new PFO closure device, the IrisFIT PFO-Occluder (Lifetech Scientific, Shenzhen, China). METHODS 95 patients with indications for PFO closure underwent percutaneous closure with the IrisFIT PFO-Occluder. The primary endpoint was the rate of accurate device placement with no/small residual shunt at 3 or 6 months follow-up. All patients underwent transoesophageal echocardiography (TEE) after 1 to 6 months. In case of a residual shunt, an additional TEE was performed after 12 months. Clinical follow-up was performed up to a mean of 33.1 ± 3.6 months. RESULTS The device was successfully implanted in 95 (100%) patients with no relevant procedural complications. At final TEE follow-up (7.6 ± 3.9 months) the effective closure rate was 96.8% with 1 moderate and 2 large residual shunts. There were 8 cases of new onset atrial fibrillation and 2 TIAs. There were no cases of device embolization or erosion. CONCLUSION The IrisFIT occluder is a new PFO closure device with several advantages compared to other devices. In this small study cohort, technical success rate, closure rate and adverse event rate were comparable to other devices. The rate of new onset atrial fibrillation was higher in comparison to other studies and warrants further investigation.
Collapse
Affiliation(s)
| | - Jiangtao Yu
- Helmut-G.-Walther-Klinikum, Lichtenfels, Germany
| | | | | | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | | | | | | | | | - Iris Grunwald
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nalan Schnelle
- CardioVascular Center Frankfurt, Frankfurt, Germany; Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany; Anglia Ruskin University, Chelmsford, United Kingdom.
| |
Collapse
|
47
|
Pagola J, Pagola C, Juega J, González-Alujas T, Alvarez-Sabin J, Molina CA. The Role of Echocardiography Screening at the Stroke Unit. Front Neurol 2020; 11:1003. [PMID: 33013663 PMCID: PMC7516041 DOI: 10.3389/fneur.2020.01003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/30/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jorge Pagola
- Stroke Unit, Neurology Department, Vall D'Hebron Hospital, Vall D'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Carlos Pagola
- Cardiology Department, Ciudad de Jaén University Hospital, Jaén, Spain
| | - Jesús Juega
- Stroke Unit, Neurology Department, Vall D'Hebron Hospital, Vall D'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Teresa González-Alujas
- Echocardiography Lab Cardiology Department, Vall D'Hebrón Hospital, CIBER-CV, Barcelona, Spain
| | - José Alvarez-Sabin
- Stroke Unit, Neurology Department, Vall D'Hebron Hospital, Vall D'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Neurology Department, Vall D'Hebron Hospital, Vall D'Hebron Research Institute, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma Barcelona, Barcelona, Spain
| |
Collapse
|
48
|
Fleissner F, Frank P, Haverich A, Ismail I. Echocardiographic guided, transatrial closure of a patent foramen ovale. J Cardiothorac Surg 2020; 15:255. [PMID: 32928262 PMCID: PMC7491112 DOI: 10.1186/s13019-020-01289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The management of an incidental patent foramen ovale found during planned cardiac surgery remains a challenge, and current guidelines are not helpful. Although evidence is accumulating, that closure of an incidental found patent foramen ovale might be beneficial, especially in planned off-pump procedures, the diagnosis of a formerly unknown patent foramen ovale with the patient on the operation table has vast consequences by making it necessary to switch to on pump, bi-caval cannulation for patent foramen ovale closure. We therefore developed a technique for transatrial closure of a patent foramen ovale, guided by transesophageal echocardiography. Results We have performed this surgery in 9 patients. None of them had a previously diagnosed patent foramen ovale. Mean age was 74 (±5) years, Operation time was 175 min (± 34 min), Clamp time 35 min (± 16 min) and Cardiopulmonary bypass time 80 (±17 min). Mortality was 0%. Periprocedural transesophageal echocardiography revealed closure of the patent foramen ovale in all cases. Conclusion We report a new surgical method for transoesophageal echocardiography controlled closure of a patent foramen ovale without the need for an atriotomy. This new technique is especially useful for the closure of patent foramen ovale in the setting of on-pump and off-pump coronary artery bypass graft surgeries alike.
Collapse
Affiliation(s)
- Felix Fleissner
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany.
| | - Paul Frank
- Clinic for Anesthesia and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany
| | - Issam Ismail
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany
| |
Collapse
|
49
|
Angelini F, Fortuni F, Tsivgoulis G, Agnelli G, Bocchino PP, Franchin L, De Filippo O, Bellettini M, D'Ascenzo F, Crimi G, Leonardi S, De Ferrari GM, Paciaroni M. Comparison of antithrombotic strategies in patients with cryptogenic stroke and patent foramen ovale: an updated meta-analysis. Cardiovasc Drugs Ther 2021; 35:987-93. [PMID: 32918655 DOI: 10.1007/s10557-020-07068-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Patients with patent foramen ovale (PFO) and cryptogenic ischemic stroke (CS) are at risk for stroke recurrence. The optimal antithrombotic strategy in patients who undergo medical management is still debated. METHODS We systematically searched the literature for studies that reported on cerebrovascular event recurrences and/or death in patients with PFO treated with oral anticoagulation (OAC) or antiplatelet therapy (APT) for secondary prevention of CS. The efficacy endpoints were stroke recurrence and the composite of stroke, transient ischemic attack or all-cause death. Major bleedings represented the safety endpoint. RESULTS A total of 16 studies with 3953 patients (OAC = 1527, APT = 2426) were included. Weighted mean follow-up was 2.9 years. OAC was associated with a significant reduction in the risk of stroke compared with APT (RR 0.65; 95% CI 0.44-0.95; ARR 2%, NNT 49), while no difference was found regarding the composite outcome (RR 0.78; 95% CI 0.57-1.07) and the safety outcome (RR 1.57; 95% CI 0.85-2.90; p = 0.15). CONCLUSIONS OAC was more effective than APT in reducing the risk of stroke recurrence in patients with PFO and CS, without a significant increase in the risk of major bleedings. Our findings support the need for further randomized data focused on the comparison of antithrombotic strategies in this setting.
Collapse
|
50
|
Hartig F, Reider N, Sojer M, Hammer A, Ploner T, Muth CM, Tilg H, Köhler A. Livedo Racemosa - The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt. Front Physiol 2020; 11:994. [PMID: 33013436 PMCID: PMC7497564 DOI: 10.3389/fphys.2020.00994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata (CM). Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis (LR), and livedo racemosa (LRC) are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. Unlike in diving medicine, in clinical medicine/dermatology the pathology of livedo racemosa is well described as a thrombotic/embolic occlusion of arteries. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. Recent studies have shown a high correlation of cardiac right/left (R/L) shunts with arterial gas embolism and skin bends in divers with unexplained DCI. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. The R/L shunt screening results of 18 divers who suffered from an unexplained decompression illness (DCI) and presented with livedo racemosa were retrospectively analyzed. All of the divers were diagnosed with a R/L shunt, 83% with a cardiac shunt [patent foramen ovale (PFO)/atrium septum defect (ASD)], and 17% with a non-cardiac shunt. We therefore not only confirm this hypothesis but when using appropriate echocardiographic techniques even found a 100% match between skin lesions and R/L shunt. In conclusion, in diving medicine the term cutis marmorata/livedo reticularis is used incorrectly for describing the actual pathology of livedo racemosa. Moreover, this pathology could be a good explanation for the high correlation of livedo racemosa with cardiac and non-cardiac right/left shunts in divers without omission of decompression procedures.
Collapse
Affiliation(s)
- Frank Hartig
- Department of Internal Medicine, University Clinic Innsbruck, Innsbruck, Austria
| | - Norbert Reider
- Department of Dermatology, University Clinic Innsbruck, Innsbruck, Austria
| | - Martin Sojer
- Department of Neurology, University Clinic Innsbruck, Innsbruck, Austria
| | - Alexander Hammer
- Department of Internal Medicine, University Clinic Innsbruck, Innsbruck, Austria
| | - Thomas Ploner
- Department of Internal Medicine, University Clinic Innsbruck, Innsbruck, Austria
| | | | - Herbert Tilg
- Department of Internal Medicine, University Clinic Innsbruck, Innsbruck, Austria
| | - Andrea Köhler
- Department of Internal Medicine, University Clinic Innsbruck, Innsbruck, Austria
| |
Collapse
|