Assessing patent foramen ovale on coronary computed tomographic angiography: a comparison with transesophageal echocardiography

Xiong, Li; Zeng, Yingting; Gan, Tian; Yan, F.; Bai, Jiao; Shi, Yanling; Zhou, Xiaoyue; Wu, Yu; Zhang, Xiaochun

doi:10.1007/s11604-021-01244-z

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Compared with TEE, the sensitivity of CCT for PFO diagnosis in a single-center study was 85.3% and the specificity 33.3%, with a negative predictive value of 33%. 28 Notably, 1 out of 7 patients with PFO diagnosed on TEE were missed by cardiac computed tomography (CT). Single-phase CCT is performed during a fraction of the cardiac cycle, usually the end-systole or mid-diastole.…”

Section: Cardiac Computed Tomographymentioning

confidence: 99%

Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence

Sposato,

Albin,

Elkind

et al. 2024

Stroke

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Patent foramen ovale (PFO) is frequently identified in young patients with ischemic stroke. Randomized controlled trials provide robust evidence supporting PFO closure in selected patients with cryptogenic ischemic stroke; however, several questions remain unanswered. This report summarizes current knowledge on the epidemiology of PFO-associated stroke, the role of PFO as a cause of stroke, and anatomic high-risk features. We also comment on breakthrough developments in patient selection algorithms for PFO closure in relation to the PFO-associated stroke causal likelihood risk stratification system. We further highlight areas for future research in PFO-associated stroke including the efficacy and safety of PFO closure in the elderly population, incidence, and long-term consequences of atrial fibrillation post-PFO closure, generalizability of the results of clinical trials in the real world, and the need for assessing the effect of neurocardiology teams on adherence to international recommendations. Other important knowledge gaps such as sex, race/ethnicity, and regional disparities in access to diagnostic technologies, PFO closure devices, and clinical outcomes in the real world are also discussed as priority research topics.

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Section: Cardiac Computed Tomographymentioning

confidence: 99%

Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence

Sposato,

Albin,

Elkind

et al. 2024

Stroke

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“…Of note, in some cases, the presence of PFO can facilitate the LA access. Ziong et al considers CT to be a practical and efficient alternative to transesophageal echocardiography for PFO diagnosis [50]. Indeed, pre-procedural CT scan allows to accurately plan this element of the procedure and to decide whether to apply intracardiac echocardiography (ICE) or TEE in cases of anticipated difficulties.…”

Section: Interatrial Septummentioning

confidence: 99%

Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging

Stachyra

Główniak

Czekajska-Chehab

2022

Current Issues in Pharmacy and Medical Sciences

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Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Despite significant advances in its treatment, it still remains one of the leading causes of cardiovascular morbidity and mortality. In the last two decades, pulmonary vein isolation (PVI) was developed as the most effective treatment option. The reported effectiveness of a single ablation procedure ranges from 40% to 69% with single, and up to 88% with repeated procedures, with acceptable safety profile. The PubMed database was searched, using terms including ‘atrial fibrillation ablation’, ‘pulmonary vein isolation’, ‘computed tomography’, ‘pulmonary vein anatomy’ and ‘ovality index’. Papers were reviewed for relevance and scientific merit. Different imaging techniques are used for pre-procedural assessment of left atrial (LA) anatomy, of which computed tomography (CT) is the most common. It allows assessing pulmonary vein (PV) anatomy, the LA wall thickness in different regions and the left atrial appendage (LAA) anatomy, together with excluding the presence of intracardiac thrombi. Pre-procedural PVs imaging is important regardless of the selected ablation technique, however, cryoballoon (CB) ablation seems to be particularly anatomy-dependent. Additionally, CT also permits assessment of several PVs characteristics (geometry, dimensions, angulations, the ostium area, orientation and ovality index (OI), which are essential for the patients’ qualification and designing the strategy of AF ablation. In this paper, we have reviewed the role of CT imaging in patients undergoing ablation procedure due to recurrent/symptomatic atrial fibrillation. Moreover, we discussed the relevant literature.

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European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke

Caso,

Turc,

Abdul-Rahim

et al. 2024

European Stroke Journal

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Patent foramen ovale (PFO) is frequently identified in young patients with cryptogenic ischaemic stroke. Potential stroke mechanisms include paradoxical embolism from a venous clot which traverses the PFO, in situ clot formation within the PFO, and atrial arrhythmias due to electrical signalling disruption. The purpose of this guideline is to provide recommendations for diagnosing, treating, and long-term managing patients with ischaemic stroke and PFO. Conversely, Transient Ischaemic Attack (TIA) was not considered an index event in this context because only one RCT involved TIA patients. However, this subgroup analysis showed no significant differences between TIA and stroke outcomes. The working group identified questions and outcomes, graded evidence, and developed recommendations following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the European Stroke Organisation (ESO) standard operating procedure for guideline development. This document underwent peer-review by independent experts and members of the ESO Guideline Board and Executive Committee. The working group acknowledges the current evidentiary gap in delineating an unequivocal diagnostic algorithm for the detection of PFO. Although transoesophageal echocardiography is conventionally held as the most accurate diagnostic tool for PFO identification, its status as the ‘gold standard’ remains unsubstantiated by rigorously validated evidence. We found high-quality evidence to recommend PFO closure plus antiplatelet therapy in selected patients aged 18–60 years in whom no other evident cause of stroke is found but a PFO (i.e. PFO-associated stroke). The PASCAL classification system can be used to select such candidates for PFO closure. Patients with both a large right-to-left shunt and an atrial septal aneurysm benefit most from PFO closure. There is insufficient evidence to make an evidence-based recommendation on PFO closure in patients older than 60 and younger than 18 years. We found low quality evidence to suggest against PFO closure in patients with unlikely PFO-related stroke according to the PASCAL classification, except in specific scenarios (Expert Consensus). We suggest against long-term anticoagulation in patients with PFO-associated stroke unless anticoagulation is indicated for other medical reasons. Regarding the long-term AF monitoring after PFO closure, the working group concluded that there remains significant uncertainty regarding the risks and benefits associated with the use of long-term cardiac monitoring, such as implantable loop recorders. This document provides additional guidance, in the form of evidence-based recommendations or expert consensus statements, on diagnostic methods for PFO detection, and medical management after PFO closure.

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Assessing patent foramen ovale on coronary computed tomographic angiography: a comparison with transesophageal echocardiography

Cited by 3 publications

References 18 publications

Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence

Patent Foramen Ovale Management for Secondary Stroke Prevention: State-of-the-Art Appraisal of Current Evidence

Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging

European Stroke Organisation (ESO) Guidelines on the diagnosis and management of patent foramen ovale (PFO) after stroke

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