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2.
BMJ Case Rep ; 12(10)2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645396

RESUMO

Platypnoea-orthodeoxia syndrome (POS) is a rare disorder characterised by both dyspnoea (platypnoea) and arterial desaturation (orthodeoxia) in the upright position, with improvement in the supine position. We report an unusual case in which an 82-year-old woman developed severe hypoxaemia with POS after left total knee replacement. A significant difference in alveolar-arterial blood gas oxygen tension was demonstrated, and hypoxaemia failed to respond to 100% oxygen supply. A patent foramen ovale with a right-to-left shunt was evident on transoesophageal echocardiogram employing colour Doppler and agitated normal saline studies. Interestingly, the patient's symptoms resolved within 6 months with ongoing chest physiotherapy, without surgical or medical intervention.


Assuntos
Artroplastia do Joelho/efeitos adversos , Dispneia/diagnóstico , Forame Oval Patente/diagnóstico , Defeitos dos Septos Cardíacos/diagnóstico , Hipóxia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Idoso de 80 Anos ou mais , Dispneia/complicações , Feminino , Forame Oval Patente/complicações , Defeitos dos Septos Cardíacos/complicações , Humanos , Hipóxia/sangue , Hipóxia/complicações , Postura , Síndrome
3.
Arq Bras Cardiol ; 113(5): 915-922, 2019 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31596323

RESUMO

BACKGROUND: Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis. OBJECTIVE: To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS. METHODS: cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student's t-test and the chi-square test (p < 0.05). RESULTS: cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09). CONCLUSION: In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.


Assuntos
Dilatação Patológica/diagnóstico por imagem , Ecocardiografia Transesofagiana/métodos , Ecocardiografia/métodos , Hepatopatias Parasitárias/diagnóstico por imagem , Esquistossomose/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Adulto , Idoso , Meios de Contraste , Feminino , Forame Oval Patente/diagnóstico , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/diagnóstico por imagem , Humanos , Masculino , Microbolhas , Pessoa de Meia-Idade , Sensibilidade e Especificidade
4.
J Invasive Cardiol ; 31(11): 319-324, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522140

RESUMO

BACKGROUND: The aim of this study was to assess safety, efficacy, and clinical outcome of the IrisFIT PFO Closure System (Lifetech Scientific) for transcatheter closure of patent foramen ovale (PFO) in patients with a history of cryptogenic stroke, transient ischemic attack (TIA), or peripheral embolization. PATIENTS AND METHODS: We report the results of 60 consecutive patients undergoing PFO closure with the IrisFIT occluder for secondary prevention of paradoxical embolization. All cases were analyzed for periprocedural and device-related adverse events up to 12 months after implantation. In addition, the patients were evaluated for complete defect closure with transesophageal echocardiography (TEE) after 1 month, 6 months, and (if indicated) 12 months. Mean patient age was 53 ± 14 years and 37 patients (62%) were males. All patients had a history of at least 1 cryptogenic stroke, TIA, or peripheral embolization. RESULTS: Technical success was achieved in all 60 procedures. The mean procedure time was 28 ± 11 minutes. There were no periprocedural or device-related complications up to 12 months after the implant. Successful defect closure at 6 months post device implantation was achieved in 56 cases (93.3%). Within 12 months of follow-up, 2 patients had recurrent TIAs, both with complete PFO sealing at the last TEE prior to the event. CONCLUSION: The IrisFIT PFO Closure System can be used safely and with high technical success for secondary prevention of cryptogenic stroke or peripheral embolization.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Embolia/prevenção & controle , Forame Oval Patente/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Transesofagiana , Embolia/etiologia , Feminino , Seguimentos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados/métodos , Desenho de Prótese , Estudos Retrospectivos , Adulto Jovem
6.
J Invasive Cardiol ; 31(8): E242-E248, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31368895

RESUMO

BACKGROUND: Randomized trials for percutaneous closure of patent foramen ovale (PFO) have demonstrated a lower rate of recurrent ischemic events compared with medical therapy. The aim of this long-term follow-up analysis was to validate the impact of PFO closure on recurrent ischemic events. METHODS AND RESULTS: A total of 570 patients were enrolled. Patients were followed for recurrent ischemic events for a median of 7.2 years. Mean age at the time of procedure was 49.3 ± 13.1 years. PFO closure was performed with the Amplatzer occluder in 44.9% of patients and with BioStar, Cardia or Premere occluders in 55.1% of patients. Within 10 years of follow-up, recurrent ischemic stroke occurred in 5.1% of patients in the Amplatzer group vs 7.6% with the other occluders (log rank P=.61). There was no difference in the rate of recurrent transient ischemic attack (1.86% vs 1.51%; log rank P=.52) or all-cause mortality (2.9% vs 3.8%; log rank P=.84) between the two groups, in patients with or without an atrial septal aneurysm or with respect to grade of preprocedural shunt. Recurrent stroke was lower in patients <45 years old at the time of occluder implantation (hazard ratio, 4.14; 95% confidence interval, 0.94-18.8; log rank P=.05). CONCLUSION: In this long-term follow-up after PFO closure, the rate of recurrent stroke was low. There were no significant differences in event rates between different occluder devices, the existence of an atrial septal aneurysm, or grade of preprocedural shunt at baseline. Patients <45 years old had lower rates of recurrent ischemic stroke.


Assuntos
Isquemia Encefálica/prevenção & controle , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Forame Oval Patente/cirurgia , Prevenção Secundária/métodos , Dispositivo para Oclusão Septal , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Ecocardiografia Transesofagiana , Feminino , Seguimentos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
Arch Cardiovasc Dis ; 112(8-9): 532-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31378692

RESUMO

BACKGROUND: Unlike previous randomized clinical trials (RCTs), recent trials and meta-analyses have shown that transcatheter closure of patent foramen ovale (PFO) reduces stroke recurrence risk in young and middle-aged adults with an otherwise unexplained PFO-associated ischaemic stroke. AIM: To produce an expert consensus on the role of transcatheter PFO closure and antithrombotic drugs for secondary stroke prevention in patients with PFO-associated ischaemic stroke. METHODS: Five neurologists and five cardiologists with extensive experience in the relevant field were nominated by the French Neurovascular Society and the French Society of Cardiology to make recommendations based on evidence from RCTs and meta-analyses. RESULTS: The experts recommend that any decision concerning treatment of patients with PFO-associated ischaemic stroke should be taken after neurological and cardiological evaluation, bringing together the necessary neurovascular, echocardiography and interventional cardiology expertise. Transcatheter PFO closure is recommended in patients fulfilling all the following criteria: age 16-60 years; recent (≤6 months) ischaemic stroke; PFO associated with atrial septal aneurysm (>10mm) or with a right-to-left shunt>20 microbubbles or with a diameter≥2mm; PFO felt to be the most likely cause of stroke after thorough aetiological evaluation by a stroke specialist. Long-term oral anticoagulation may be considered in the event of contraindication to or patient refusal of PFO closure, in the absence of a high bleeding risk. After PFO closure, dual anti-platelet therapy with aspirin (75mg/day) and clopidogrel (75mg/day) is recommended for 3 months, followed by monotherapy with aspirin or clopidogrel for≥5 years. CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists.


Assuntos
Isquemia Encefálica/prevenção & controle , Cateterismo Cardíaco/normas , Cardiologia/normas , Forame Oval Patente/terapia , Prevenção Secundária/normas , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Consenso , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Medição de Risco , Fatores de Risco , Dispositivo para Oclusão Septal/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Resultado do Tratamento , Adulto Jovem
8.
J Card Surg ; 34(9): 867-870, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31233236

RESUMO

Thrombus straddling a patent foramen ovale and massive pulmonary embolism is a very rare and life-threatening condition. Optimal management can be controversial because different therapeutic options are available and individual approach based in individual risk is needed. We present a case of a thrombus straddling the patent foramen ovale with massive pulmonary embolism, hemodynamic instability, and upper extremity embolism. We performed surgical pulmonary embolectomy, and venous arterial extracorporeal membrane oxygenation was needed to successfully overcome severe right ventricular impairment and pulmonary injury.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Embolectomia/métodos , Oxigenação por Membrana Extracorpórea/métodos , Forame Oval Patente/complicações , Ventrículos do Coração , Embolia Pulmonar/complicações , Trombose/etiologia , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/cirurgia , Humanos , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Trombose/diagnóstico , Trombose/cirurgia , Tomografia Computadorizada por Raios X
9.
Heart Lung Circ ; 28(10): e134-e136, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31213345

RESUMO

A 73-year-old farmer presented with platypnoea-orthodeoxia syndrome (POS). A transoesophageal echocardiogram (TOE) disclosed a patent foramen ovale (PFO) with significant right-to-left shunt on assuming upright posture. An initial attempt at PFO closure through the femoral vein was abandoned due to a completely occluded inferior vena cava. A second attempt through the internal jugular vein was also unsuccessful due to the steep angulation between superior vena cava and septum primum flap. Because of disabling symptoms, an attempt through a hepatic vein (HV) was scheduled and performed under general anaesthesia with TOE guidance. Ultrasound-guided access through an intercostal window to a peripheral HV was performed and the position confirmed with contrast injections. The PFO was easily crossed with a glide wire which was exchanged to a stiffer guide wire. A 25mm closure device was successfully deployed across the PFO. After retrieval of the delivery system, haemostasis of the HV was attained with a contrast-guided Gelfoam (Pfizer, New York, NY, USA) injection. Unfortunately, the patient had to undergo subsequent emergency coiling to an iatrogenically injured hepatic artery branch leading to full recovery and significant clinical improvement. Subsequent echocardiography demonstrated a well-positioned device with no residual shunt. This case illustrates that percutaneous PFO closure through a HV is a feasible procedure and should be considered in anatomy that is otherwise prohibitive for conventional approach. Extra care should be taken with initial vascular access into the HV and final haemostasis of the access site.


Assuntos
Cateterismo Cardíaco/métodos , Forame Oval Patente/cirurgia , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador/métodos , Idoso , Ecocardiografia Transesofagiana/métodos , Fluoroscopia , Forame Oval Patente/diagnóstico , Veias Hepáticas , Humanos , Masculino , Tomografia Computadorizada por Raios X
10.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
11.
Undersea Hyperb Med ; 46(1): 87-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154690

RESUMO

Middle ear barotrauma is common in diving. However, facial nerve baroparesis is a relatively rare complication. A dehiscent facial nerve canal may be a predisposing factor to developing this complication. Although there is an increasing number of facial baroparesis cases in the literature, they are likely still under-reported. In order to avoid unnecessary recompression treatments or detrimental effects to a professional diver's career, it is important to consider this in the differential diagnosis while evaluating dive injuries. This case report describes recurrent facial baroparesis in a military diver, which manifested on contralateral sides of his face. His initial presentation was misdiagnosed as an arterial gas embolism, which led to recompression treatment and a cardiac procedure. Upon recurrence about one year later, a complete work-up was done, which included an ENT evaluation and a CT scan. Imaging demonstrated a predisposing anatomic variant bilaterally. His symptoms resolved quickly and spontaneously both times, and he has been able to return to diving.


Assuntos
Barotrauma/complicações , Mergulho/efeitos adversos , Paralisia Facial/etiologia , Adulto , Barotrauma/diagnóstico , Doença da Descompressão/diagnóstico , Erros de Diagnóstico , Embolia Aérea/diagnóstico , Nervo Facial/diagnóstico por imagem , Forame Oval Patente/diagnóstico , Humanos , Masculino , Militares , Recidiva , Retorno ao Trabalho , Água do Mar , Osso Temporal/diagnóstico por imagem
12.
Rev. bras. ter. intensiva ; 31(2): 262-265, abr.-jun. 2019. graf
Artigo em Português | LILACS | ID: biblio-1013780

RESUMO

RESUMO O traumatismo cardíaco é comum em acidentes com veículos automotores. Uma mulher com 50 anos de idade foi transportada para nosso hospital após sofrer múltiplos traumatismos em um acidente de automóvel quando dirigia em alta velocidade. Após admissão à unidade de terapia intensiva, uma ultrassonografia cardíaca revelou ruptura traumática de músculo papilar da valva tricúspide e forame oval patente, enquanto se observou, no exame físico, o sinal de Lancisi. Foi realizado tratamento cirúrgico com anuloplastia da valva e fechamento do forame oval patente; durante o ato cirúrgico, diagnosticou-se ruptura oculta do átrio direito.


ABSTRACT Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Humanos , Feminino , Músculos Papilares/lesões , Valva Tricúspide/lesões , Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia , Acidentes de Trânsito , Forame Oval Patente/cirurgia , Forame Oval Patente/diagnóstico , Anuloplastia da Valva Cardíaca/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/cirurgia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Pessoa de Meia-Idade
13.
Brain Behav ; 9(5): e01283, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30941931

RESUMO

OBJECTIVE: In recent years, increasing attention has been paid to cryptogenic stroke (CS) caused by the patent foramen ovale (PFO). This study aims to compare contrast transthoracic echocardiography (cTTE) and contrast transcranial Doppler (cTCD) to determine whether cTTE is more suitable and reliable than cTCD for clinical use. METHODS: From March 2017 to May 2018, patients who suffered from migraines, stroke, hypomnesis, or asymptomatic stroke found casually were included in our study. Patients with CS were semirandomly divided into two groups (cTTE and cTCD) according to the date of the outpatient visit. Patients with either of the examination above found positive were selected to finish transesophageal echocardiography (TEE). RESULTS: In our study, the sensitivities of group cTTE positive (group cTTE+) and group cTCD positive (group cTCD+) did not have any statistical difference (89% vs. 80%, p = 0.236). Focusing on group cTCD+, we discovered that the semiquantitative shunt grading was not correlated with whether a PFO was present or not (p = 0.194). However, once the PFO has been diagnosed, the shunt grading was shown to be related to the width of the gaps (p = 0.032, pdeviation  = 0.03). CONCLUSION: Both cTTE and the cTCD can be used for preliminary PFO findings. The semiquantitative shunt grading of cTCD and cTTE can suggest the size of the PFO and the next course of treatment. The cTTE may be more significant to a safe PFO (a PFO does not have right-to-left shunts, RLSs). Combining cTTE and TEE could help diagnose PFO and assess CS risk.


Assuntos
Ecocardiografia/métodos , Forame Oval Patente , Acidente Vascular Cerebral , Ultrassonografia Doppler Transcraniana/métodos , Adulto , Doenças Assintomáticas , Meios de Contraste/farmacologia , Correlação de Dados , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Seleção de Pacientes , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
15.
Am J Cardiol ; 123(12): 2022-2025, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-30979412

RESUMO

Over 50% of patients who rapidly ascend to extreme altitudes develop various symptoms known as acute mountain sickness (AMS), which rarely can be life threatening. It is unclear why some patients are more susceptible to AMS than others. Our objective was to determine whether patent foramen ovale (PFO) is a risk factor for AMS. Subjects who had hiked to altitudes above 10,000' (∼3,000 meters) on the John Muir Trail in California were recruited. Participants completed a questionnaire and 2-physician adjudication was performed in regard to AMS status. A transcranial Doppler with agitated saline contrast injection was performed to evaluate the presence or absence of PFO. The primary outcome was the development of AMS. From 2016 to 2018, 137 hikers were recruited into the study. There was a higher prevalence of PFO in hikers with AMS 15 of 24 (63%) compared with hikers without AMS 44 of 113 (39%); p = 0.034. In the multivariate model, the presence of a PFO significantly increased the risk for developing AMS: odds ratio 4.15, 95% confidence intervals 1.14 to 15.05; p = 0.030. In conclusion, hikers with a PFO had significantly higher risk of developing AMS relative to hikers without a PFO. Clinicians should consider PFO a risk factor in patients who plan to hike to high altitudes.


Assuntos
Doença da Altitude/etiologia , Forame Oval Patente/diagnóstico , Forame Oval Patente/epidemiologia , Doença Aguda , Adulto , Doença da Altitude/diagnóstico , California , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Ultrassonografia Doppler Transcraniana
17.
G Ital Cardiol (Rome) ; 20(3 Suppl 1): 4S-8S, 2019 03.
Artigo em Italiano | MEDLINE | ID: mdl-30855026

RESUMO

Patent foramen ovale (PFO) is associated with a number of clinical syndromes in which it plays variable roles that, often, cannot be accurately determined. This situation creates conflicting data and controversial studies. However, in 2017 and 2018, four randomized clinical trials have been published, allowing for the clarification of certain issues pertaining to cryptogenic stroke. Shortly after this, 8 European scientific societies collaborated to publish the first official international position paper on PFO and cryptogenic stroke, based upon best-available evidence. In the current report, the main positions are presented, relating to PFO diagnosis, general management, and therapeutic choices. Generally speaking, given the complexity of PFO roles, an interdisciplinary and personalized approach was chosen, especially taking into consideration patient involvement at all stages of management. This approach is not suitably addressed by standard guidelines, but can be accommodated in a position statement like this. For this reason, it was possible to offer an approach capable of aiding clinicians to make rational, patient-shared decisions, even when the available evidence is either weak or scarce.


Assuntos
Forame Oval Patente/terapia , Acidente Vascular Cerebral/prevenção & controle , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Humanos , Participação do Paciente , Medicina de Precisão/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/etiologia
18.
J Stroke Cerebrovasc Dis ; 28(6): 1636-1639, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30890394

RESUMO

BACKGROUND AND PURPOSE: The routine use of percutaneous transcatheter patent foramen ovale closure (PPFOC) to prevent recurrent stroke in patients with cryptogenic stroke is still a matter of debate after completion major randomized controlled trials (RCTs). METHODS: The fragility index of RCTs evaluating effect of PPFOC against medial therapy alone in stroke prevention was calculated to assess the robustness of statistically significant findings. RESULTS: Literature search with PubMed identifies 6 RCTs on PPFOC. Median number of patients who underwent PPFOC and medical treatment were 340 and 229, respectively. Median number of the patients lost to follow-up was 20 in PPFOC and 18 in medical group. Fragility index was 0 for 4 studies. Median fragility index was also 0 for both "stroke" (interquartile range: 0-5.3) and "combined stroke and TIA" (interquartile range: 0-2) endpoints. In all studies except CLOSE, fragility index was smaller than or equal to the number of the subjects lost to follow-up. CONCLUSIONS: Recent positive results of PFO closure studies should be interpreted cautiously because of their fragile characteristics. Routine PFO closure should be reserved for prevention of recurrence when suspicion for paradoxical embolism is high. Detailed individualized decision-making is crucial before ordering PPFOC for stroke prevention in patients with cryptogenic embolism.


Assuntos
Embolia Paradoxal/prevenção & controle , Forame Oval Patente/terapia , Fragilidade/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Projetos de Pesquisa , Acidente Vascular Cerebral/prevenção & controle , Tomada de Decisão Clínica , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico , Fragilidade/complicações , Nível de Saúde , Humanos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
20.
Ann Thorac Surg ; 108(2): e73-e75, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30763556

RESUMO

Impending paradoxical embolism (IPDE) is the presence of a thrombus in the patent foramen ovale. Usually, IPDE is diagnosed by echocardiography or a multislice computed tomography scan and is performed during the evaluation of a patient presenting with suspected pulmonary embolism. We report 2 patients who presented with IPDE and were successfully treated with cardiac surgery and thrombolytic therapy. Thus, we focus our discussion on the diagnosis and treatment modalities of this rare entity.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Embolia Paradoxal/cirurgia , Forame Oval Patente/complicações , Embolia Pulmonar/cirurgia , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/etiologia , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia
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