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1.
BMC Cardiovasc Disord ; 24(1): 293, 2024 Jun 06.
Article in English | MEDLINE | ID: mdl-38844866

ABSTRACT

Patients with previous interatrial shunt device (IASD) implantation may face greater challenges during future left atrial interventional procedures. Herein, we report the first case of left atrial appendage closure (LAAC) in a patient with previous IASD implantation. The patient successfully underwent LAAC using the LAmbre device without complications.


Subject(s)
Atrial Appendage , Atrial Fibrillation , Cardiac Catheterization , Humans , Atrial Appendage/physiopathology , Atrial Appendage/diagnostic imaging , Atrial Fibrillation/physiopathology , Atrial Fibrillation/diagnosis , Atrial Fibrillation/surgery , Treatment Outcome , Cardiac Catheterization/instrumentation , Male , Female , Echocardiography, Transesophageal , Aged , Atrial Function, Left , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/physiopathology , Foramen Ovale, Patent/surgery , Left Atrial Appendage Closure
2.
Curr Cardiol Rep ; 26(7): 735-746, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38913234

ABSTRACT

PURPOSE OF REVIEW: Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure. RECENT FINDINGS: PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.


Subject(s)
Foramen Ovale, Patent , Septal Occluder Device , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/surgery , Foramen Ovale, Patent/therapy , Humans , Cardiac Catheterization/methods , Stroke/prevention & control , Stroke/etiology , Treatment Outcome , Practice Guidelines as Topic
4.
J Am Heart Assoc ; 13(9): e034249, 2024 May 07.
Article in English | MEDLINE | ID: mdl-38639354

ABSTRACT

This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.


Subject(s)
Atrial Fibrillation , Foramen Ovale, Patent , Humans , Atrial Fibrillation/physiopathology , Atrial Fibrillation/epidemiology , Atrial Fibrillation/etiology , Atrial Fibrillation/therapy , Atrial Fibrillation/diagnosis , Foramen Ovale, Patent/epidemiology , Foramen Ovale, Patent/physiopathology , Foramen Ovale, Patent/therapy , Foramen Ovale, Patent/complications , Incidence , Cardiac Catheterization/adverse effects , Risk Factors , Septal Occluder Device/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/physiopathology
5.
BMC Cardiovasc Disord ; 24(1): 198, 2024 Apr 05.
Article in English | MEDLINE | ID: mdl-38580946

ABSTRACT

BACKGROUND: Migraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates. METHODS: The SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements. CONCLUSION: The SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).


Subject(s)
Foramen Ovale, Patent , Migraine Disorders , Humans , Retrospective Studies , Prospective Studies , Treatment Outcome , Migraine Disorders/diagnosis , Migraine Disorders/prevention & control , Migraine Disorders/etiology , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Foramen Ovale, Patent/complications , Cardiac Catheterization/adverse effects , Randomized Controlled Trials as Topic
8.
Clin Cardiol ; 47(3): e24251, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38445759

ABSTRACT

BACKGROUND: The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years. HYPOTHESIS: The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone. METHODS: We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure. RESULTS: The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow-up period (n = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), p = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), p = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow-up period. CONCLUSION: Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone.


Subject(s)
Atrial Fibrillation , Foramen Ovale, Patent , Stroke , Humans , Middle Aged , Follow-Up Studies , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Cerebral Infarction , Stroke/etiology , Stroke/prevention & control
9.
Semin Dial ; 37(3): 277-281, 2024.
Article in English | MEDLINE | ID: mdl-38459828

ABSTRACT

Paradoxical embolism is a medical condition characterized by the migration of an embolus from a venous source into the systemic circulation. This occurs through a specific cardiac abnormality known as a right-to-left shunt, ultimately resulting in the possibility of arterial embolism. Patent foramen ovale (PFO) is the most common cause of intracardiac shunting. We reported a rare case of a 56-year-old man on hemodialysis with PFO and arteriovenous fistula dysfunction who suffered a paradoxical embolic ischemic stroke after percutaneous transluminal angioplasty. This case emphasized the potential risk of paradoxical embolism in hemodialysis patients with vascular access problems. We aimed to highlight the importance of searching for PFO, as it may serve as a possible source of embolism in these patients.


Subject(s)
Angioplasty , Embolism, Paradoxical , Renal Dialysis , Humans , Male , Middle Aged , Renal Dialysis/adverse effects , Embolism, Paradoxical/etiology , Embolism, Paradoxical/diagnosis , Embolic Stroke/etiology , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/complications , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/therapy , Arteriovenous Shunt, Surgical/adverse effects
12.
J Stroke Cerebrovasc Dis ; 33(3): 107551, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38241951

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.


Subject(s)
Foramen Ovale, Patent , Stroke , Thrombophilia , Humans , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Secondary Prevention/methods , Stroke/diagnosis , Stroke/etiology , Stroke/prevention & control , Risk Factors , Treatment Outcome , Recurrence
13.
BMC Womens Health ; 24(1): 70, 2024 01 25.
Article in English | MEDLINE | ID: mdl-38273311

ABSTRACT

BACKGROUND: Patent foramen ovale (PFO) is a known cause of ischemic stroke in young adults and combined oral contraceptives (COCs) are widely used by women of reproductive age. If young women with PFO are taking COCs, they may be subjected to a synergistic increase in the occurrence of stroke, though reports of ischemic stroke in this population are rare. We report a woman of reproductive age who was taking COC suffered repetitive ischemic strokes before a patent foramen ovale (PFO) was detected and closed, which may raise concerns in this field. CASE PRESENTATION: A 31-year-old woman presented to the emergency department with sudden-onset right upper- and lower-limb weakness and dysarthria for 1 hour, whose only risk factor of stroke was oral contraceptive use. On admission, she was alert with left gaze deviation, dysarthria, and right-sided hemiplegia. Her symptoms improved after receiving the revascularization therapy. About 24 hours later, her left eye experienced sudden painless vision loss. Then the PFO with a substantial right-to-left shunt was detected and then she received a trans-catheter closure of the defect. Over 3 months of follow-up, there were no signs of stroke, but visual loss persisted. CONCLUSION: This case of disabling stroke raises concerns regarding optimal management in primary and secondary prevention of stroke in young women on COCs with additional risk factors of stroke.


Subject(s)
Foramen Ovale, Patent , Ischemic Stroke , Stroke , Young Adult , Humans , Female , Adult , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/therapy , Dysarthria/complications , Stroke/etiology , Risk Factors , Ischemic Stroke/complications , Recurrence , Treatment Outcome
14.
Eur Heart J Cardiovasc Pharmacother ; 10(3): 184-189, 2024 May 04.
Article in English | MEDLINE | ID: mdl-38216511

ABSTRACT

INTRODUCTION: Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN: The Assessment of Flecainide to Lower the PFO closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release (SR) dose) for 6 months (Group 1), Flecainide (150 mg per day in a single SR dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30 s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analysed as a secondary objective of the study. CONCLUSION: AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. CLINICAL TRIAL REGISTRATION: NCT05213104 (clinicaltrials.gov).


Subject(s)
Anti-Arrhythmia Agents , Atrial Fibrillation , Flecainide , Foramen Ovale, Patent , Adult , Female , Humans , Male , Middle Aged , Anti-Arrhythmia Agents/therapeutic use , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/administration & dosage , Atrial Fibrillation/diagnosis , Atrial Fibrillation/prevention & control , Flecainide/adverse effects , Flecainide/administration & dosage , Flecainide/therapeutic use , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/therapy , Heart Rate/drug effects , Prospective Studies , Time Factors , Treatment Outcome
16.
Arch Cardiovasc Dis ; 116(12): 580-589, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37951755

ABSTRACT

BACKGROUND: The Amplatzer™ Trevisio™ Intravascular Delivery System (Trevisio DS; Abbott Laboratories, Chicago, IL, USA) facilitates the delivery of Amplatzer™ Occluders and features an ultraflexible tip, which improves assessment of occluder position before release. AIMS: To assess the safety and efficacy of the Trevisio DS for transcatheter closure of patent foramen ovale and atrial septal defect. METHODS: The Amplatzer™ Trevisio™ Intravascular Delivery System Post-Approval Study was a prospective, postmarket, single-arm, multicentre, observational study of the Trevisio DS. Enrolled patients were indicated for transcatheter closure of patent foramen ovale or atrial septal defect. In all procedures, the Trevisio DS was used to deliver Amplatzer™ Occluders. Technical success was defined as successful deployment and release of at least one occluder. Device- or procedure-related serious adverse events were tracked until discharge or day 7, whichever occurred earlier. RESULTS: The study enrolled 144 patients with patent foramen ovale and 107 patients with atrial septal defect at 22 European sites; 53 patients with atrial septal defect (49.6%) were aged<18years. The rate of technical success was 98.4% (97.2% for atrial septal defect, 99.3% for patent foramen ovale). There was one serious adverse event (0.4%), an acute periprocedural device embolization that occurred after occluder release in a patient with atrial septal defect; the device was retrieved percutaneously. This was determined by the implanter to be unrelated to the performance of the Trevisio DS. CONCLUSIONS: The Trevisio DS exhibited a high rate of technical success and an excellent safety profile during transcatheter closure of patent foramen ovale and atrial septal defect.


Subject(s)
Foramen Ovale, Patent , Heart Septal Defects, Atrial , Septal Occluder Device , Humans , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Prospective Studies , Cardiac Catheterization , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/therapy , Treatment Outcome
17.
Catheter Cardiovasc Interv ; 102(7): 1348-1356, 2023 12.
Article in English | MEDLINE | ID: mdl-37681474

ABSTRACT

INTRODUCTION: Certain patent foramen ovale (PFO) characteristics, such as a large right-to-left shunt (RLS) or atrial septal aneurysm, identify patients who may receive the highest clinical benefit from percutaneous PFO closure. This study aimed to compare intracardiac echocardiography (ICE) with standard echocardiographic imaging in the evaluation of high-risk PFO characteristics and RLS severity in patients with PFO-associated stroke. METHODS: We conducted a retrospective review of all patients aged ≥18 years who underwent percutaneous PFO closure for PFO-associated stroke and received all three ultrasound-based cardiac imaging modalities and had interpretable results (N = 51). We then compared RLS severity, high-risk PFO characteristics, and the proportion of patients with a higher likelihood of PFO-associated stroke by ICE versus transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). RESULTS: The final cohort had a mean (±SE) age of 48.4 (±1.8) years and was predominantly female (58.8%). ICE was more likely to identify a large RLS versus TTE/TEE combined (66.7% vs. 45.1%; p = 0.03). The use of ICE resulted in significantly more patients being reclassified as having a higher likelihood of PFO-associated stroke (TTE vs. TEE vs. ICE: 10.4% vs. 14.6% vs. 25%; p = 0.03). A high-quality bubble study was found to be the single most important factor associated with identifying a larger RLS across all modalities (ρ [p]; TTE: 0.49 [<0.001], TEE: 0.60 [<0.001], ICE: 0.32 [0.02]). The presence of a hypermobile septum was associated with significantly greater RLS on ICE (ρ [p]: 0.3 [0.03]), especially with poor quality bubble studies (ρ [p]: 0.49 [0.02]). CONCLUSION: In this observational study of patients with PFO-associated stroke, ICE detected a large RLS more frequently than TTE and TEE; and reclassified some patients as having a higher likelihood of PFO-associated stroke.


Subject(s)
Foramen Ovale, Patent , Stroke , Humans , Female , Adolescent , Adult , Middle Aged , Male , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Retrospective Studies , Treatment Outcome , Echocardiography , Echocardiography, Transesophageal , Stroke/etiology
18.
BMC Cardiovasc Disord ; 23(1): 390, 2023 08 09.
Article in English | MEDLINE | ID: mdl-37558988

ABSTRACT

OBJECTIVES: To investigate the clinical values of right heart contrast transthoracic echocardiography (cTTE) combined with migraine rating scale in evaluating the efficacy of patent foramen ovale (PFO) closure. METHODS: From January 2018 to December 2021, a total of 68 hospitalized patients, 21 males and 47 females, who were treated with transcatheter closure of PFO-induced migraine in the Heart Center of the First Affiliated Hospital of Tsinghua University were selected, with the age of 38.4 ± 11.9 years old. The changes of right heart contrast transthoracic echocardiography (cTTE), visual analogue pain score(VAS), headache impact test-6(HIT-6) and migraine disability assessment questionnaire(MIDAS) before and 6 months after PFO occlusion were compared. RESULTS: Pre-operative cTTE data show that 36 patients (52.9%) had moderate right-to-left shunt (RLS), and 32 patients (47.1%) had massive RLS. cTTE was reexamined 6 months after operation and 1 case in the moderate RLS group had minimal RLS, 2 cases in the large RLS group had minimal RLS, and no shunts were seen for the rest. The VAS, HIT-6 and MIDAS scores before and 6 months after the operation were 7.65 ± 1.39 vs. 1.28 ± 1.53, 70.78 ± 6.82 vs. 41.53 ± 6.07, and 30.60 ± 13.24 vs. 1.93 ± 3.87, respectively. All the indexes 6 months after the operation significantly improved compared with the preoperative baseline (P < 0.05). CONCLUSIONS: cTTE combined with migraine evaluation scale could be used as an objective index to evaluate the clinical effect of PFO occlusion.


Subject(s)
Foramen Ovale, Patent , Migraine Disorders , Male , Female , Humans , Adult , Middle Aged , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnostic imaging , Foramen Ovale, Patent/therapy , Echocardiography , Migraine Disorders/therapy , Contrast Media , Treatment Outcome , Cardiac Catheterization/adverse effects
20.
Dtsch Med Wochenschr ; 148(14): 908-914, 2023 07.
Article in German | MEDLINE | ID: mdl-37493952

ABSTRACT

Thromboembolic disease is associated with a high mortality. It can be divided into two groups: embolism from a venous and embolism from an arterial side. This article gives an overview on thromboembolic disease (with a focus on pulmonary embolism and ischemic stroke) from a cardiologist's perspective.The therapeutic options for acute pulmonary embolism range from anticoagulation to fibrinolysis to interventional recanalization and surgery. The deciding factor for choice of therapy is the risk of early death. Besides clinical parameters, laboratory markers like cardiac troponin and right ventricular function on echocardiography or CTPA (computed tomography pulmonary angiography) are used to determine the early mortality risk. In hemodynamically instable patients, immediate thrombolysis is required, whereas patients with intermediate and low risk can be treated with anticoagulation. Interventional recanalization is currently being studied in patients at risk for development of CTEPH (chronic thromboembolic pulmonary hypertension) or an intermediate risk of early mortality.In ischemic stroke, early interdisciplinary workup involving a cardiologist is paramount. Post stroke screening should include monitoring for arrythmias (especially atrial fibrillation) and transthoracic echocardiography as well as sonography of extra- and intracranial arteries. If no embolic source can be detected (embolic stroke of undetermined source), transesophageal echo can be helpful to detect intracardiac shunts like patent foramen ovale (PFO) or intracardiac tumors. Post stroke care includes secondary prevention measures like risk factor modification and lipid lowering therapy as well as anticoagulation. In high risk for paradoxical embolization, interventional PFO closure can be performed. Interventional closure of the left atrial appendage (LAA) can be discussed in patients with both high thromboembolic and bleeding risk.


Subject(s)
Embolism, Paradoxical , Foramen Ovale, Patent , Ischemic Stroke , Pulmonary Embolism , Stroke , Thromboembolism , Humans , Stroke/prevention & control , Thromboembolism/diagnosis , Thromboembolism/therapy , Thromboembolism/complications , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnosis , Foramen Ovale, Patent/therapy , Risk Factors , Pulmonary Embolism/diagnosis , Pulmonary Embolism/therapy , Ischemic Stroke/complications , Anticoagulants/therapeutic use , Embolism, Paradoxical/complications , Embolism, Paradoxical/diagnosis , Echocardiography, Transesophageal , Cardiac Catheterization/methods
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