Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 271
Filtrar
1.
Int J Cardiovasc Imaging ; 35(11): 2049-2056, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31325066

RESUMO

Left atrial (LA) enlargement is a marker of LA cardiopathy and, in patients with patent foramen ovale (PFO), is associated with an increased risk of ischemic stroke. The primary study outcome was the comparison of LA diameter between patients undergoing percutaneous PFO closure versus those treated conservatively. The secondary endpoints were the association of LA diameter with the Risk of Paradoxical Emboli (ROPE) score and the presence of Atrial septal aneurysm (ASA) and Right-To-Left Shunt (RLS). Retrospective analysis of clinical and instrumental data of 1040 subjects referred to a single tertiary center for PFO evaluation and treatment. Seven hundred and nineteen patients were enrolled: 495 patients (closure group, mean RoPE score 7.6 ± 0.8) underwent PFO closure while 224 patients (control group, mean RoPE score 4.1 ± 0.9. p < 0.001) were left to medical therapy. Preoperative LA diameter was significantly larger in closure group and reduced from 44.3 ± 9.1 to 37.3 ± 4.1 mm (p = 0.01) 1 year after the procedure to the size of controls. A larger LA diameter was associated with permanent RLS, RLS curtain pattern, ASA presence and multiple ischemic brain lesions pattern at neuroimaging. A LA diameter ≥ 43 mm was a predictor a RoPEscore > 7. In our patients' cohort, LA diameter was associated with the clinic severity of PFO and RLS. The reversal of LA enlargement after PFO closure suggests a role for RLS to induce LA cardiopathy. LA enlargement has the potential to be considered per se as an indication to transcatheter PFO repair.


Assuntos
Função do Átrio Esquerdo , Remodelamento Atrial , Cateterismo Cardíaco , Tratamento Conservador , Forame Oval Patente/terapia , Adulto , Cateterismo Cardíaco/efeitos adversos , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/etiologia , Tratamento Conservador/efeitos adversos , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
2.
J Stroke Cerebrovasc Dis ; 28(9): e135-e138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31253482

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thrombi in the pulmonary arteries, causing pulmonary hypertension and right heart failure. Early and accurate diagnosis are essential for successful treatment but are often difficult because clinical signs and symptoms can be nonspecific and risk factors, such as history of venous thromboembolism, may not always be present. Here, we report a case involving a 76-year-old woman who demonstrated paradoxical cerebral embolism as the initial manifestation of CTEPH. She developed right hemiplegia without dyspnea or edema. Brain magnetic resonance imaging revealed multiple fresh infarctions, while transesophageal echocardiography revealed a patent foramen ovale. Based on these findings, she was diagnosed as having paradoxical cerebral embolism. During the search for the embolic source, right heart catheterization showed significant pulmonary hypertension and pulmonary angiography revealed chronic thrombi in the peripheral pulmonary arteries, consistent with a diagnosis of CTEPH. To our knowledge, this is the first case of CTEPH to be diagnosed with the onset of paradoxical cerebral embolism. Because CTEPH is the only potentially curable form of pulmonary hypertension, clinicians should consider paradoxical cerebral embolism as a possible initial manifestation of CTEPH.


Assuntos
Arteriopatias Oclusivas/complicações , Embolia Paradoxal/etiologia , Hipertensão Pulmonar/etiologia , Embolia Intracraniana/etiologia , Trombose/complicações , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Doença Crônica , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Trombose/diagnóstico por imagem
3.
Tohoku J Exp Med ; 248(2): 137-141, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243182

RESUMO

Saddle pulmonary embolism (PE) and paradoxical embolism (PDE) are life-threatening disorders carrying a risk of sudden death, and their prompt diagnosis is extremely important. Saddle PE is a radiologic definition and refers to a thrombus that straddles the bifurcation of the pulmonary artery trunk, carrying a risk of sudden hemodynamic collapse. PDE is defined as a systemic arterial embolus due to the passage of a venous thrombus though a right-to-left shunt, such as patent foramen ovale (PFO). We herein present the rare case of asthma exacerbation coincident with saddle PE and PDE. A 69-year-old woman with asthma was suffering from dyspnea, pulse attenuation of the left radial artery and left upper limb pain. An arterial blood gas analysis revealed hypoxemia, and a pulmonary function test demonstrated an obstructive pattern. Enhanced computed tomography (CT) revealed saddle PE, right popliteal venous thrombosis, and left brachial artery occlusion. After the treatment with edoxaban, an anticoagulant, and aspirin, the PE was significantly alleviated, and the brachial artery occlusion was recanalized. Subsequently, the right-to-left shunt through PFO was confirmed, and PDE was suspected of inducting her brachial artery embolism. In the present case, the pulse attenuation of the radial artery and upper limb pain prompted us to consider peripheral vascular disease or coagulation disorders. Physicians should keep in mind that patients with asthma are at considerable risk of PE, and it is important to be aware of possible PFO in patients presenting with the coexistence of PE and systemic arterial embolism.


Assuntos
Asma/complicações , Asma/patologia , Progressão da Doença , Embolia Paradoxal/complicações , Embolia Pulmonar/complicações , Idoso , Asma/diagnóstico por imagem , Embolia Paradoxal/diagnóstico por imagem , Feminino , Humanos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/patologia , Tomografia Computadorizada por Raios X
4.
J Stroke Cerebrovasc Dis ; 28(7): e100-e101, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31006519

RESUMO

Pulmonary arteriovenous fistula (PAVF), a vessel malformation connecting the pulmonary circulation to the systemic circulation while bypassing the pulmonary capillaries, can cause paradoxical cerebral infarction. It is often associated with hereditary hemorrhagic telangiectasia (HHT), a genetic disease characterized by multiple dermal, mucosal, and visceral telangiectasia causing recurrent bleeding. Paradoxical cerebral embolism caused by PAVF without HHT is rare. Here, we report a patient with isolated PAVF who experienced an ischemic stroke caused by a paradoxical embolism from deep venous thrombosis; the patient was successfully treated with recombinant tissue plasminogen activator. She presented with a decrease in arterial oxygen saturation to 91%, and lung disease was suspected. A PAVF was subsequently found in the right S6 region using contrast computed tomography. Interventional radiologists successfully occluded the shunt using 6 microcoils. PAVF should be considered when determining the pathogenesis of cerebral ischemia in patients with hypoxia, which can be the only symptom of PAVF.


Assuntos
Fístula Arteriovenosa/complicações , Embolia Paradoxal/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Embolia Intracraniana/tratamento farmacológico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Trombose Venosa/complicações , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Embolização Terapêutica/instrumentação , Inibidores do Fator Xa/uso terapêutico , Feminino , Humanos , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Piridinas/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Tiazóis/uso terapêutico , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
8.
Eur Rev Med Pharmacol Sci ; 22(24): 8885-8890, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30575931

RESUMO

OBJECTIVE: Paradoxical embolism represents a rare condition occurring when a thrombus originating from venous system produces pulmonary embolism and systemic embolization through an intracardiac or pulmonary shunt. The evidence of a thrombus entrapped in a patent foramen ovale (PFO) is an even more rare condition. There is uncertainty about the optimal treatment strategy. PATIENTS AND METHODS: A 58-year-old male patient was admitted to our Internal Medicine Unit with the diagnosis of bilateral bronchopneumonia. During hospitalization, the co-occurrence of chest pain and amaurosis led us to hypothesize a paradoxical embolism. RESULTS: Transthoracic echocardiography showed the presence of a thrombus stuck over the interatrial septum. A contrast-enhanced chest CT scan showed multiple pulmonary embolisms and brain CT scan documented a hypodense area, of ischemic significance, in the left occipital lobe near tentorium. In order to prevent further embolization, emergency cardiac surgery (right atriotomy, removal of thrombus and closure of the PFO, pulmonary thrombectomy) was performed without complications. CONCLUSIONS: Although rare, the evidence of a thrombus stuck in a patent foramen ovale represents a clinical emergency. The optimal therapeutic approach is still debated. The surgical correction seems to be a safe and effective option for these patients.


Assuntos
Embolia Paradoxal/cirurgia , Forame Oval Patente/complicações , Trombose/cirurgia , Ecocardiografia , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , Trombose/etiologia , Tomografia Computadorizada por Raios X
10.
Ann Vasc Surg ; 53: 274.e7-274.e10, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30081165

RESUMO

Although patent foramen ovale (PFO) is a relatively common condition, the risk of paradoxical embolism is less than 2% of all arterial ischemia. We present the case of a 52-year-old man diagnosed with pulmonary thromboembolism complicated with 2 events of paradoxical emboli in the left upper and right lower limbs secondary to PFO. We also discuss some uncertainties behind the management of PFO patients after an episode of venous thromboembolism.


Assuntos
Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/etiologia , Extremidade Superior/irrigação sanguínea , Trombose Venosa/etiologia , Doença Aguda , Anticoagulantes/uso terapêutico , Cateterismo Cardíaco/instrumentação , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/tratamento farmacológico , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
11.
Int J Cardiovasc Imaging ; 34(12): 1849-1861, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29956022

RESUMO

Patent foramen ovale (PFO) is a residual, oblique, slit or tunnel like communication in the atrial septum that persists into adulthood. It is usually an incidental finding with no clinical repercussions. Nevertheless, recent evidence supports the association between the presence of a PFO and a number of clinical conditions, most notably cryptogenic stroke (CS). There is enough evidence that paradoxical embolism is a mechanism which can explain this association. Patient characteristics and certain echocardiography-derived anatomical and hemodynamic features of PFO provide great assistance in estimating the probability of paradoxical embolism. In this review, we initially describe PFO embryology and anatomy. We extensively present the available data on clinical, anatomical and hemodynamic features of PFOs which have been correlated with increased likelihood of paradoxical embolism and recent evidence of therapeutic management.


Assuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Forame Oval/diagnóstico por imagem , Embolia Paradoxal/etiologia , Embolia Paradoxal/fisiopatologia , Embolia Paradoxal/prevenção & controle , Forame Oval/embriologia , Forame Oval/fisiopatologia , Forame Oval Patente/complicações , Forame Oval Patente/fisiopatologia , Forame Oval Patente/terapia , Hemodinâmica , Humanos , Achados Incidentais , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia
12.
BMJ Case Rep ; 20182018 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848540

RESUMO

A 59-year-old woman presented with a sudden onset of breathlessness and chest pain. An echocardiography and CT scan showed pulmonary embolism and infarction with a paradoxical thrombus visualised in both atria. For haemodynamically stable patients, the optimal management strategy is poorly defined. Three main strategies were considered: surgical thrombectomy, thrombolysis and anticoagulation. Surgery with reversal of anticoagulation may lead to further coagulation and increased risk of bleeding complications. The significant pulmonary hypertension and right ventricular infarction raised the prospect of difficult weaning from cardiopulmonary bypass following thrombectomy. Thrombolysis, which has significant mortality rate, and systemic embolisation including pulmonary infarction with haemorrhagic transformation were also contraindications. A multidisciplinary approach was adopted and anticoagulation was therefore believed to be the safest and effective approach. Here, the use of anticoagulation alone was fortunately successful but could as easily end in disaster. This approach should be considered the ideal paradigm to yield optimum outcomes.


Assuntos
Anticoagulantes/uso terapêutico , Cardiopatias/tratamento farmacológico , Embolia Pulmonar/tratamento farmacológico , Trombose/tratamento farmacológico , Angiografia por Tomografia Computadorizada , Quimioterapia Combinada , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/tratamento farmacológico , Feminino , Átrios do Coração , Cardiopatias/diagnóstico por imagem , Heparina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Infarto Pulmonar/diagnóstico por imagem , Infarto Pulmonar/tratamento farmacológico , Trombose/diagnóstico por imagem , Resultado do Tratamento , Varfarina/uso terapêutico
14.
Asian Cardiovasc Thorac Ann ; 26(5): 413-415, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29734837

RESUMO

Paradoxical embolism through a patent foramen ovale is a very unusual event considering that this cardiac anomaly may be present in as much as 26% of the general population. We describe the case of a 68-year-old man with a pulmonary and paradoxical coronary embolism in the presence of a patent foramen ovale. The finding of a worm-shaped thrombus though the atrial septum together with the risk of further embolization through the atrial septum prompted surgical treatment.


Assuntos
Oclusão Coronária/etiologia , Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Embolia Pulmonar/etiologia , Trombose/complicações , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Ecocardiografia , Embolectomia , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/cirurgia , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/cirurgia , Humanos , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/cirurgia , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
15.
J Stroke Cerebrovasc Dis ; 27(7): e125-e127, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29628339

RESUMO

Paradoxical embolism due to isolated pulmonary arteriovenous malformation (AVM) is an uncommon cause of ischemic stroke, with the majority occurring in patients who have not yet been diagnosed with their malformation. We report a 32-year-old man who presented with an abrupt onset of right facial weakness and expressive aphasia. Brain magnetic resonance imaging revealed an acute infarct in the left middle cerebral artery territory and chronic infarcts in the bilateral cerebellar hemispheres. A cardioembolic mechanism was initially considered in the setting of perimyocarditis diagnosed a few months earlier. Transthoracic and transesophageal echocardiograms revealed high volume right to left shunting, but no septal defects. A pulmonary AVM was confirmed with computed tomography angiography and fistualization was successfully treated with embolization. This report highlights a case of undiagnosed pulmonary AVM leading to recurrent paradoxical emboli to the brain. We review the epidemiology, pathophysiology, and management of pulmonary AVMs in relation to stroke risk.


Assuntos
Malformações Arteriovenosas/complicações , Isquemia Encefálica/etiologia , Embolia Paradoxal/complicações , Embolia Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/epidemiologia , Malformações Arteriovenosas/terapia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/terapia , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/epidemiologia , Embolia Paradoxal/terapia , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/terapia , Masculino , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
17.
J Stroke Cerebrovasc Dis ; 27(7): e117-e118, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29501267

RESUMO

Development of paradoxical cerebral embolism requires both unstable venous thrombosis and right-to-left shunt (RLS). Gastrointestinal endoscopy (GE) has the potential to affect intrathoracic and abdominal venous thrombi and to enhance RLS because the procedure alters intrathoracic and abdominal pressure. We describe a patient with Crohn's disease who developed paradoxical cerebral embolism after GE. Both an unstable venous thrombus in the superior vena cava and RLS through patent foramen ovale were thought to be responsible for the stroke. Considering that patients with digestive system diseases undergo GE as a routine examination or therapy, screenings for hypercoagulable state and intrathoracic and abdominal thrombi are important to prevent thromboembolism related to GE.


Assuntos
Doença de Crohn/diagnóstico por imagem , Embolia Paradoxal/etiologia , Endoscopia Gastrointestinal , Embolia Intracraniana/etiologia , Complicações Pós-Operatórias , Idoso , Encéfalo/diagnóstico por imagem , Doença de Crohn/complicações , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/tratamento farmacológico , Humanos , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/tratamento farmacológico , Masculino
18.
J Stroke Cerebrovasc Dis ; 27(7): 1987-1991, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29571765

RESUMO

BACKGROUND: Atrial septal defects have a low prevalence in the general population, and are recognized as a rare cause of paradoxical brain embolism. METHODS: We extensively examined stroke causes in patients with acute stroke admitted to a single stroke center within 1 year. RESULTS: Among 186 consecutive patients, transesophageal or transthoracic echocardiography revealed 5 cases of paradoxical brain embolism: 3 (1.6%) were related to atrial septal defects, whereas 2 were patent foramen ovale patients. Although right-to-left shunt may have occurred after the development of acute pulmonary embolism in atrial septal defects case #1, the Valsalva maneuver elicited right-to-left shunt in atrial septal defects cases #2 and #3. The 3 cases were elderly (>60 years old), harbored small defects with normal systemic hemodynamics, and had not experienced any clinical symptoms related to atrial septal defects. CONCLUSIONS: Small atrial septal defect may cause paradoxical embolism as its initial related event, particularly in elderly subjects.


Assuntos
Isquemia Encefálica/etiologia , Embolia Paradoxal/etiologia , Comunicação Interatrial/complicações , Embolia Intracraniana/etiologia , Acidente Vascular Cerebral/etiologia , Idoso , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Diagnóstico Diferencial , Embolia Paradoxal/diagnóstico por imagem , Feminino , Coração/diagnóstico por imagem , Comunicação Interatrial/diagnóstico por imagem , Humanos , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem
19.
J Stroke Cerebrovasc Dis ; 27(6): e92-e94, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29373226

RESUMO

A 51-year-old man was diagnosed with eosinophilic granulomatosis with polyangiitis 6 years ago due to asthma, sinusitis, hypereosinophilia, and peripheral neuropathy based on the diagnostic criteria of American College of Rheumatology, and corticosteroid therapy achieved a remission. One year ago, he was hospitalized due to deep venous thrombosis (DVT) and pulmonary embolism, and rivaroxaban was administrated. He was admitted to our hospital for acute onset of diplopia and right hemiparesis. Peripheral blood examinations disclosed leukocytosis with hypereosinophilia. Perinuclear anti-neutrophil cytoplasmic antibodies were positive. Diffusion-weighted imaging showed multiple fresh ischemic lesions. Chronic ischemic lesions were seen in subcortical cerebral region. No stenosis or occlusion was shown in extracranial and intracranial arteries on magnetic resonance angiography. Ultrasonography of leg vein showed DVT. Right-to-left shunt through patent foramen ovale after Valsalva maneuver was seen on transesophageal echocardiography. Treatment with corticosteroid and cyclophosphamide alleviated clinical deterioration. Rivaroxaban was changed to warfarin. Diplopia and muscle strength of right limbs were improved. This is a first case of multiple cerebral infarction caused by paradoxical embolism due to patent foramen ovale with DVT based on hypercoagulable state of hypereosinophilia. Overall this case illustrates that eosinophilic granulomatosis with polyangiitis can be a risk factor for multiple cerebral infarction in the systemic phase and that transesophageal echocardiography and ultrasonography of leg vein should be conducted in stroke patient with eosinophilic granulomatosis with polyangiitis.


Assuntos
Infarto Cerebral/etiologia , Embolia Paradoxal/complicações , Forame Oval Patente/complicações , Granulomatose com Poliangiite/complicações , Encéfalo/diagnóstico por imagem , Infarto Cerebral/sangue , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/tratamento farmacológico , Embolia Paradoxal/sangue , Embolia Paradoxal/diagnóstico por imagem , Embolia Paradoxal/tratamento farmacológico , Forame Oval Patente/sangue , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/tratamento farmacológico , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
20.
J Stroke Cerebrovasc Dis ; 27(2): 357-364, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29031497

RESUMO

BACKGROUND: Pulmonary embolism (PE) is associated with a risk of consecutive paradoxical embolism with brain infarction through a patent foramen ovale (PFO). The aims of this study were to assess the rate of new ischemic brain lesions (IBLs) using magnetic resonance imaging (MRI) during a 12-month follow-up period with anticoagulation and to evaluate the potential relationship with the presence of PFO on transesophageal echocardiography (TEE). SUBJECTS AND METHODS: Seventy-eight patients with acute PE underwent baseline contrast TEE with brain MRI. After the 12-month follow-up, 58 underwent brain MRI. The rates of MRI documenting new IBLs were measured based on the presence of PFO. RESULTS: PFO was detected in 31 patients (39.7%). At baseline MRI, IBL was present in 39 of 78 patients (50%). The presence of IBL was not significantly higher in patients with PFO than in patients without PFO (20 [64.5% patients with PFO] versus 19 [40.4% without PFO] of 39 patients with baseline IBL, P = .063). At the follow-up MRI, in the group with new IBL (9 of 58 patients, 15.5%), the number of patients with PFO was significantly higher than that without PFO (7 [33.3%] versus 2 [5.4%], P = .008). PFO was identified as an independent predictor of new IBL (odds ratio 4.6 [1.6-47.4], P = .008). CONCLUSIONS: The presence of PFO was associated with new IBL in patients with PE. These patients are at a higher risk of ischemic stroke despite effective anticoagulation therapy.


Assuntos
Infarto Cerebral/etiologia , Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Embolia Pulmonar/complicações , Administração Oral , Anticoagulantes/administração & dosagem , Infarto Cerebral/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Imagem de Difusão por Ressonância Magnética , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Humanos , Modelos Logísticos , Angiografia por Ressonância Magnética , Razão de Chances , Estudos Prospectivos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Fatores de Risco , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA