Characteristics of patients diagnosed for cardiological cause of ischemic neurological events and pre-screened with a transcranial doppler examination.

INTRODUCTION: The screening of patients with ischemic neurological events for patent foramen ovale (PFO) is increasing. OBJECTIVES: This study aimed to evaluate clinical characteristics and atrial septum anatomy in relation to age and presence of PFO as well as factors associated with a history of stroke in patients assessed for cardiological cause of ischemic neurological events. PATIENTS AND METHODS: A total of 817 patients with a history of neurological episodes (stroke / transient ischemic attack (TIA) or migraine) were pre-screened with transcranial doppler examination. Transesophageal contrast echocardiography (TOE) was used to confirm PFO and assess the anatomy of the atrial septum and right atrium. RESULTS: Among the patients 28% had ischemic stroke, 31% had TIA, and 49% suffered from migraines. PFO was confirmed in 79% of patients. Regardless of the analyzed age groups PFO was associated with higher prevalence of TIA, migraine and syncope history, atrial septum aneurysm (ASA) and Chiari network as well as lower female gender predominance, but only in the population ≤ 45 years old. Patient age, male gender, typical cardiovascular risk factors and the presence of ASA were associated with stroke history. CONCLUSIONS: In a selected population of patients with ischemic neurological events pre-screened for PFO presence, confirmation of PFO in TOE was associated with a higher frequency of TIA, migraine, syncope, Chiari network and ASA. Advanced age, typical cardiovascular risk factors and presence of ASA were associated with stroke history in analyzed study group.

Atrial septum anatomy as a predictor of ischemic neurological episodes in patients with a patent foramen ovale.

BACKGROUND: The correlation between atrial septum anatomy and the risk of ischemic neurological events remains underexplored. AIMS: This study aimed to examine both the functional and anatomical attributes of the atrial septum and identify predictors of stroke and/or transient ischemic attack (TIA) in patients diagnosed with patent foramen ovale (PFO). METHODS: A total of 155 patients diagnosed with PFO, with a cardiological cause of neurological events, were enrolled. Transesophageal echocardiography was utilized to assess the anatomy of the PFO canal, size of the right-to-left shunt, thickness of the primary and secondary atrial septum, presence of atrial septum aneurysm, and anatomical structures of the right atrium. RESULTS: Regression analysis showed that factors such as female sex, hypercholesterolemia, PFO canal width, and a large right-to-left shunt were significantly associated with stroke and/or TIA. Receiver operating characteristic analysis indicated that the width of the PFO canal holds a relatively weak, although significant predictive, value for ischemic neurological episodes (area under the curve = 0.7; P = 0.002). A PFO canal width of 4 mm was associated with 70% sensitivity and 55% specificity for predicting stroke and/or TIA. CONCLUSIONS: The atrial septum's anatomy, especially the dimensions of the PFO canal and the magnitude of the right-to-left shunt, combined with specific demographic and clinical factors, are linked to ischemic neurological incidents in PFO patients.

Experience in patent foramen ovale closure with the CERA Lifetech occluder in patients with cryptogenic stroke.

Introduction: Nowadays, percutaneous closure of patent foramen ovale (PFO) in patients after cryptogenic stroke is becoming a dominating strategy. The most commonly used and investigated device is the Amplatzer occluder. However, several other devices have been designed for transcatheter closure of PFO, which are not so well examined. Aim: To assess the effectiveness and safety of PFO closure with the Lifetech CERA occluder. Material and methods: A prospective, single-arm registry of patients with PFO treated with CERA occluder (Lifetech Scientific, Shenzhen, China) implantation was conducted. We assessed peri-procedural and 12-month follow-up. Patients were screened for the residual shunt in transcranial Doppler/transesophageal echocardiography. Results: Ninety-six patients entered the registry. Most patients were women (76%) and the analyzed group was relatively young (mean age of 42.3 ±13.6 years). Before closure, most patients had a large shunt through the PFO. Procedures of PFO closure were performed under TEE guidance. All procedures were made under local anesthesia and all patients had the PFO successfully closed. No device-related complications were reported in the peri-procedural period or during follow-up. No recurrent neurological ischemic events were reported at 12 months. During follow-up we observed a 9% rate of residual shunts, which were mostly small. Conclusions: The study confirmed excellent immediate and 12-month results of CERA occluder implantation in patients with PFO.