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1.
Medicine (Baltimore) ; 99(15): e19507, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282700

RESUMO

RATIONALE: Paradoxical embolism (PE) is an important cause of cryptogenic stroke, particularly in young patients, which usually have a relation with an unexpected route in circulation. Here we report a rare case of cryptogenic stroke carried 2 uncommon malformations. PATIENT CONCERNS: A 48-year-old female experienced double neurological events in just 2 months. DIAGNOSIS: Patent foramen ovale was diagnosed with transesophageal echocardiography and successfully occluded in the first admission due to stroke. In the second admission, chest tomographic angiography found a chordae shadow in the right middle lobe, was the first clue for pulmonary arteriovenous fistula (PAVF), thereafter further confirmed by the enhanced pulmonary computed tomographic angiography. INTERVENTIONS: This patient then received intervention occlusion therapy with coils for PAVF under the help of microcatheter. Given the possible native origin of the thrombus in PAVF due to the spiral morphology, dual antiplatelet therapy was prescribed for this patient for the first 3 months to prevent device-related embolism after discharge, and the following single antiplatelet therapy was mandated. OUTCOMES: No recanalization was detected on the follow-up enhanced pulmonary computed tomographic angiography (PCTA), no neurological defect event recurred in the 16 months of follow-up. LESSONS: Computed tomograph (CT) deserved more value in screening and depicting the morphology of the PAVF, particular in young adults with no apparent arteriosclerotic risk factor. Microcatheter would be helpful for intervention treatment. Antiplatelet therapy might be adequate in specific patients, yet definitely need more evidence to verify.


Assuntos
Fístula Arteriovenosa/complicações , Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Acidente Vascular Cerebral/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Feminino , Forame Oval Patente/terapia , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem
4.
Undersea Hyperb Med ; 46(5): 625-632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683360

RESUMO

Objective: To evaluate the efficiency of percutaneous patent foramen ovale (PFO) closure on the recurrence of decompression illness (DCI). Design: Retrospective, observational study with interview and questionnaire. Setting: Tertiary referral center. Population: 59 scuba divers with a history of DCI who received a percutaneous PFO closure. Main outcome measurements: Questionnaire about health status, dive habits and recurrence of DCI after PFO closure. Results: A total of 59 divers with DCI were included. The most common manifestations of DCI were cutaneous or vestibular DCI. Procedural complications occurred in four patients but none with long-term consequences. Four patients had recurrence of DCI after closure during a 10-year follow-up. In three of these cases there was residual shunting, all of which were initially considered closed. The fourth patient had aggravating factors for his recurrent DCI. A quarter of the patients stated to have changed their diving habits. Four patients quit diving. Conclusion: Percutaneous PFO closure for secondary prevention of DCI is associated with few, but not negligible, complications. As a large portion of our cohort changed their diving habit after closure it is difficult to ascertain the efficiency of PFO closure for secondary prevention of DCI. However, the study shows that PFO closure does not fully protect against DCI, emphasizing that the relationship between PFO and DCI is but an association. As such it is imperative that divers be counseled to ensure they understand the risks as well as the benefits of percutaneous PFO closure in their specific case.


Assuntos
Doença da Descompressão/prevenção & controle , Mergulho/efeitos adversos , Forame Oval Patente/terapia , Prevenção Secundária/métodos , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Doença da Descompressão/etiologia , Feminino , Forame Oval Patente/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Recreação , Recidiva , Estudos Retrospectivos , Volta ao Esporte/estatística & dados numéricos , Prevenção Secundária/instrumentação , Dispositivo para Oclusão Septal/efeitos adversos , Inquéritos e Questionários , Falha de Tratamento , Adulto Jovem
5.
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
6.
Cardiology ; 143(1): 62-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31307049

RESUMO

Patent foramen ovale (PFO) is a common benign finding in healthy subjects, but its prevalence is higher in patients with stroke of unclear cause (cryptogenic stroke). PFO is believed to be associated with stroke through paradoxical embolism, and certain clinical and anatomical criteria seem to increase the likelihood of a PFO to be pathological. Recent trials have shown that closure of PFO, especially if associated with an atrial septal aneurysm and/or a large interatrial shunt, may reduce the risk of recurrent stroke as compared to medical treatment. However, it remains challenging to risk stratify patients with suspected PFO-related stroke and to decide if device closure is indicated. We sought to review contemporary evidence and to conclude an evidence-based strategy to prevent recurrence of PFO-related stroke.


Assuntos
Forame Oval Patente/complicações , Forame Oval Patente/terapia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Anticoagulantes/uso terapêutico , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto , Eletrocardiografia , Embolia Paradoxal/complicações , Embolia Paradoxal/etiologia , Humanos , Medição de Risco , Prevenção Secundária , Dispositivo para Oclusão Septal , Telemetria
7.
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
8.
Expert Rev Cardiovasc Ther ; 17(6): 389-394, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184225

RESUMO

Introduction: The treatment options for prevention of recurrent of cryptogenic stroke in patients with patent foramen ovale (PFO) have been intensely debated in the recent decades. The suggested options were percutaneous closure of PFO versus medical therapy. However, up to these date there is a controversy regarding the indication of percutaneous closure. Multiple meta-analysis and recent randomized control trials showed the benefit of PFO closure when compared with medical therapy alone. Areas covered: The article reviews the prevalence, physiology, diagnosis and treatment options of PFO after cryptogenic stroke. Furthermore, it will discuss the results of randomized control trials that compared the PFO closure to medical therapy. Expert opinion: The association between PFO and unexplained cryptogenic stroke has been well established in the multiple studies. The diagnosis and management of PFO might be challenging in some cases. Although multiple studies showed that PFO closure is associated with lower rates of recurrent stroke in patients presenting with cryptogenic stroke, the indication and patient selection for this intervention are not well established yet in the guidelines.


Assuntos
Forame Oval Patente/terapia , Seleção de Pacientes , Acidente Vascular Cerebral/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico
9.
Adv Clin Exp Med ; 28(8): 1079-1085, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237120

RESUMO

BACKGROUND: Atrial septal defect (ASD) and patent foramen ovale (PFO) are specific types of atrial septal communications (ASC). OBJECTIVES: We aimed to assess quality of life (QoL) in patients before and after percutaneous closure of ASC and determine the factors influencing QoL in this group of patients. MATERIAL AND METHODS: We performed a clinical assessment and conducted an SF-36 questionnaire, electrocardiography and echocardiography studies in patients before and 6 months after percutaneous ASC closure. RESULTS: Patients with ASD (n = 56) had a lower SF-36 total score than those with PFO (n = 73), before and after percutaneous ASC occlusion (both p < 0.001). After the procedure, the improvement of SF-36 total score in patients with ASD or atrial fibrillation was greater (p < 0.001 and p = 0.005, respectively). We observed correlations between improvement of QoL and baseline supraventricular extrasystolic beats (rs = 0.28; p = 0.002), but not ventricular extrasystolic beats (rs = 0.03; p = 0.76). Quality of life improvement was predicted in patients with ASD by higher baseline tricuspid annular plane systolic excursion (TAPSE) and right ventricular longitudinal dimension R2 = 0.38; p < 0.001. However, in patients with PFO, this was predicted by TAPSE, lack of arterial hypertension and usage of angiotensin-converting enzyme inhibitors, R2 = 0.30; p < 0.001. CONCLUSIONS: Patients with ASD have lower QoL than those with PFO before and after percutaneous ASC occlusion. Six months after the procedure, the improvement of QoL in patients with ASD was higher than in those with PFO. The change in QoL self-assessed by patients after the procedure was associated with episodes of arrhythmia and was predicted with echocardiographic and clinical parameters.


Assuntos
Cateterismo Cardíaco , Forame Oval Patente , Comunicação Interatrial , Qualidade de Vida , Ecocardiografia , Seguimentos , Forame Oval Patente/terapia , Comunicação Interatrial/terapia , Humanos , Resultado do Tratamento
10.
Dermatitis ; 30(3): 213-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31045931

RESUMO

BACKGROUND: The occlusion devices used for repair of atrial septal defect and patent foramen ovale commonly contain nitinol, an alloy containing nickel. There are reports of nickel allergy in the context of intracardiac device implantation. Type IV delayed-type reactions likely predominate in intracardiac metal hypersensitivity, but there are potentially other mechanisms such as cytotoxic or innate immunity. Based on available literature to date, the significance of nickel allergy in intracardiac occluders remains unclear. OBJECTIVE: The aim of the study was to investigate nickel allergy management strategies in intracardiac occluders. METHODS: The American Contact Dermatitis Society facilitated distribution of a survey via e-mail to the members of its association, which included dermatologists and allergists/immunologists. A total of 70 individuals answered the survey. CONCLUSIONS: There was no consensus regarding the ability of patch testing to accurately determine allergic reactions within cardiac tissue. There was also no agreement on the criteria for patch testing in patients undergoing intracardiac implantation. However, most would inquire about a history of contact sensitivity to previously implanted devices. With a positive patch test, nickel-based intracardiac devices should be avoided, or the decision should be left to the discretion of the cardiologist.


Assuntos
Ligas/efeitos adversos , Dermatite Alérgica de Contato/prevenção & controle , Níquel/efeitos adversos , Dispositivo para Oclusão Septal/efeitos adversos , Estudos Transversais , Dermatite Alérgica de Contato/diagnóstico , Feminino , Forame Oval/cirurgia , Forame Oval Patente/terapia , Humanos , Testes do Emplastro/métodos
12.
Rev Med Liege ; 74(S1): S87-S96, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31070322

RESUMO

Atria septal defect (ASD) is one of the most common congenital heart disease. ASD can be responsible for a volume overload of the right chambers associated with an increased morbi-mortality. In these circumstances, percutaneous closure of ASD secundum-type is recommended as a first line therapy. The persistence of a patent foramen ovale (PFO) is found in approximately 25 % of adults. This anomaly can be responsible for paradoxical embolism, especially cryptogenic stroke. Recent studies have shown a clinical benefit to the percutaneous closure of FOP in cryptogenic stroke, with a modest, but significant, decrease in the risk of recurrence. In this article, we discuss the indications and procedure for percutaneous closure of ASD and PFO.


Assuntos
Cateterismo Cardíaco , Forame Oval Patente , Acidente Vascular Cerebral , Adulto , Forame Oval Patente/terapia , Humanos , Recidiva , Acidente Vascular Cerebral/prevenção & controle , Resultado do Tratamento
13.
Heart Vessels ; 34(10): 1657-1662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30868214

RESUMO

The efficacy of percutaneous transcatheter closure for preventing recurrent cerebrovascular events in elderly patients with high-risk patent foramen ovale (PFO) remains unclear, whereas in young patients, it has been shown to effectively prevent the recurrence of embolic stroke. The aim of this study was to investigate the safety and efficacy of percutaneous PFO closure in elderly patients with high-risk PFO. Between September 2012 and October 2018, 14 patients ≥ 60 years old with high-risk PFO underwent percutaneous closure to prevent recurrence of cerebrovascular events. The primary end point was recurrence of cerebrovascular events after closure in elderly patients with high-risk PFO, and the secondary end points were occurrence of device-related complications, cerebral hemorrhage, and new-onset atrial fibrillation (AF). The mean patient age and number of cerebrovascular events before closure were 75.2 ± 6.5 years and 1.7 ± 0.7, respectively. All procedures were successfully performed under general anesthesia by transesophageal echocardiography and using a 25-mm Amplatzer Cribriform device. No procedure-related complications occurred. Patients were followed up for a mean 2.6 ± 1.8 years. No patients experienced device-related complications or recurrent cerebrovascular events. However, one patient had AF-related device closure complications at 1 month postoperatively. In addition, other patient had a cerebral hemorrhage with unknown relationship to PFO closure 3 years postoperatively. Percutaneous closure of high-risk PFO in elderly patients may be as effective and safe as in younger patients. It is crucial to evaluate PFO morphology regardless of age in cases of paradoxical embolism.


Assuntos
Cateterismo Cardíaco , Embolia Paradoxal/complicações , Forame Oval Patente/complicações , Forame Oval Patente/terapia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Ecocardiografia Transesofagiana , Embolia Paradoxal/terapia , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Dispositivo para Oclusão Septal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
14.
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
15.
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
16.
G Ital Cardiol (Rome) ; 20(3 Suppl 1): 9S-16S, 2019 03.
Artigo em Italiano | MEDLINE | ID: mdl-30855027

RESUMO

Percutaneous patent foramen ovale (PFO) closure is an intervention aimed to prevent cardioembolic stroke. It recently proved to be superior to antiplatelet therapy in preventing recurrent strokes in a well-selected population of patients with a previous cryptogenic cerebral ischemic event. A large part of the clinical advantage of PFO transcatheter therapy derives from the very high efficacy and safety of the maneuver. Various types of devices with different characteristics are currently available for the use of the interventionists. Recently, a direct PFO suture device has been added to the device list, allowing for PFO closure without implanting any prosthesis. This article describes the procedure of PFO closure with a particular focus on the main characteristics of the various devices available. A road-map of choice among the various prostheses is also provided, keeping in mind the patient's clinical features and the various PFO anatomies.


Assuntos
Forame Oval Patente/terapia , Implantação de Prótese/métodos , Acidente Vascular Cerebral/prevenção & controle , Técnicas de Sutura , Cateterismo Cardíaco/métodos , Desenho de Equipamento , Forame Oval Patente/complicações , Humanos , Inibidores da Agregação de Plaquetas/administração & dosagem , Prevenção Secundária/métodos , Acidente Vascular Cerebral/etiologia
17.
J Cardiovasc Med (Hagerstown) ; 20(5): 290-296, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30921267

RESUMO

AIM: An underlying atrial vulnerability or a preexisting misdiagnosed atrial fibrillation in some patients who are candidates for patent foramen ovale (PFO) closure may lead to an unnecessary percutaneous intervention. The aim of this work was to define paroxysmal atrial fibrillation rate, through a 6-month insertable loop-recorder monitoring, in patients over 55 years old with cryptogenic stroke and PFO. METHODS: PFO closure criteria: significant right-to-left shunt and at least one high-risk feature (permanent right-to-left shunt, atrial septal aneurysm, prominent Eustachian valve, recurrent brain ischemia, previous deep vein thrombosis, thrombophilia). Insertable cardiac monitoring criteria: previous cryptogenic stroke, more than 55 years and at least one atrial fibrillation risk factor (heart failure, hypertension, age older than 65 years, diabetes, atrial runs, left atrium dilatation, left ventricle hypertrophy, pulmonary disease, thyroid disease, obesity). Atrial fibrillation detection threshold: arrhythmia duration longer than 5 min. RESULTS: From January 2008 to March 2017, 195 patients underwent to loop-recorder monitoring. A total of 70 (36%) patients were candidates for PFO closure. The 6-month silent atrial fibrillation rate was 11.4%. In the arrhythmia-free cohort, 28 patients (45.2%) underwent percutaneous foramen ovale closure (group A) and 34 (54.8%) were medically treated (group B). Atrial fibrillation detection rate was 14.3% in group A and 0% in group B. The 36-month atrial fibrillation-free survival was 76%. CONCLUSION: An occult preexisting atrial fibrillation may lead to unnecessary percutaneous foramen ovale closure in a significant proportion of patients. A 6-month loop-recorder monitoring may improve the patient oriented decision-making.


Assuntos
Fibrilação Atrial/diagnóstico , Cateterismo Cardíaco , Eletrocardiografia/instrumentação , Forame Oval Patente/terapia , Frequência Cardíaca , Acidente Vascular Cerebral/prevenção & controle , Telemetria/instrumentação , Procedimentos Desnecessários , Idoso , Doenças Assintomáticas , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Tomada de Decisão Clínica , Feminino , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
19.
G Ital Cardiol (Rome) ; 20(2): 73-84, 2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30747923

RESUMO

Treatment of patients with cryptogenic stroke and a patent foramen ovale (PFO) has always been a matter of discussion. A clear pathogenic relationship is difficult to demonstrate in most cases, also because of the high prevalence of a PFO in the general population (25-30%). Early randomized trials failed to demonstrate a superiority of PFO transcatheter closure with respect to medical therapy alone but more recent data, coming from new randomized trials, strongly suggest that PFO closure associated with antiplatelet therapy is more effective than antiplatelet therapy alone in preventing recurrent stroke, with no increased risk of major adverse cardiovascular events in the follow-up; only a higher incidence of atrial fibrillation has been reported after PFO closure. PFO closure seems to be more protective only in patients accurately selected on the basis of anamnestic and clinical data together with neurological and cardiological imaging. Pending issues remain such as duration of antiplatelet therapy after PFO closure, the clinical significance of atrial fibrillation before and after PFO closure, and the potential role of old and new oral anticoagulants.


Assuntos
Forame Oval Patente/terapia , Inibidores da Agregação de Plaquetas/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Anticoagulantes/administração & dosagem , Fibrilação Atrial/epidemiologia , Cateterismo Cardíaco/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/etiologia
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