Central Retinal Artery Occlusion Secondary to Patent Foramen Ovale: The Unexpected Journey of a Paradoxical Embolus

Sabanis, Nikolaos; Zagkotsis, Georgios; Krikos, Vasileios D; Paschou, Eleni; Tapanlis, Angelos

doi:10.7759/cureus.9496

Cited by 4 publications

(7 citation statements)

References 18 publications

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“…16,17 There have been multiple reports of PFO as a source of emboli in patients with RAO. 14,[17][18][19][20][21][22][23] Here, we describe a young woman who developed multiple RAO in the right eye after HA injection into the nasal root. She had a concurrent PFO and experienced vision loss in two stages, leading to a gradual decline in visual acuity.…”

Section: Introductionmentioning

confidence: 99%

Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

Si,

Wang

2023

J Int Med Res

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We describe a young woman with patent foramen ovale who developed multiple retinal artery occlusion in the right eye after injection of hyaluronic acid into the nasal root. She reported a gradual decline in visual acuity, with visual field defects that had developed in two stages. Multiple retinal artery occlusion was confirmed by slit-lamp examination, dilated fundus examination, optical coherence tomography, visual field examination, and fundus fluorescein angiography. A patent foramen ovale was detected by electrocardiography, transesophageal echocardiography, and transthoracic sonography. The patient was treated with intravenous dexamethasone and cobamamide, as well as extracorporeal counterpulsation therapy; this approach has not been described in previous literature regarding retinal artery occlusion. The patient’s visual acuity improved from counting fingers at 30 cm to 20/133 within 3 days. Our report emphasizes the need for better understanding of vascular anatomy to minimize the risk of complications. Moreover, patients undergoing hyaluronic acid injection should receive information regarding the potential for mild and severe complications; relevant tests should be performed before surgery to exclude vulnerable patients. Finally, a nursing system is needed to facilitate the emergency recognition, triage, and management of retinal artery occlusion.

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Section: Introductionmentioning

confidence: 99%

Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

Si,

Wang

2023

J Int Med Res

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“…Epidemiological studies have documented that PFO contributes to the majority of paradoxical emboli leading to cryptogenic ischemic strokes [ 1 , 3 , 4 ]. This is largely seen among young patients (<60 years) with unexplained etiology for a cryogenic stroke [ 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…While most patients with PFO are asymptomatic, the most common presentation is paradoxical emboli affecting the larger arterial vessels [ 1 , 4 ]. The central retinal artery is considered an unusual site for systemic paradoxical embolism from a PFO, which warrants a thorough investigation into the source of the initial thrombus [ 4 ]. The incidence of a smaller arterial occlusion due to paradoxical emboli, as in the case of central retinal artery occlusion (CRAO), is quite uncommon [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of a smaller arterial occlusion due to paradoxical emboli, as in the case of central retinal artery occlusion (CRAO), is quite uncommon [ 1 ]. CRAO usually results from an embolus that either originated from the heart or dislodged from an unstable atherosclerotic plaque in the carotid bifurcation [ 4 ]. With this in mind, the most common risk factors for a CRAO are carotid atherosclerosis, cardiac valvular conditions, cardiac arrhythmias, and atrial fibrillation [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…CRAO usually results from an embolus that either originated from the heart or dislodged from an unstable atherosclerotic plaque in the carotid bifurcation [ 4 ]. With this in mind, the most common risk factors for a CRAO are carotid atherosclerosis, cardiac valvular conditions, cardiac arrhythmias, and atrial fibrillation [ 4 ]. This case represents one of the rare occurrences of CRAO secondary to a PFO in a middle-aged man.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Central Retinal Artery Occlusion in the Setting of Patent Foramen Ovale

Kaliounji¹,

Alkoutami²,

Kaliounji³

et al. 2023

Cureus

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Patent foramen ovale (PFO) is a congenital heart anomaly with persistent non-closure of the atrial septum that generally closes six to 12 months after birth in the majority of adults. While remaining asymptomatic in the majority of cases, PFO could lead to paradoxical embolism and cryptogenic strokes in most symptomatic cases. The incidence of small arterial occlusion due to paradoxical emboli is quite uncommon. In this report, we present a case of a 51-year-old man who presented with acute left-sided painless visual loss due to central retinal artery occlusion (CRAO). Stroke work-up and hypercoagulability evaluations were negative. The patient was found to have PFO with the initial presentation as CRAO, a rather rare presentation in the setting of PFO. In this report also, we discuss the clinical presentation, pathogenesis, and the current evidence-based therapeutic options in the management of PFO in adults, highlighting the importance of considering this diagnostic entity in the setting of acute visual loss, as with our case presentation.

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Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

Meng,

Song,

Zhang

et al. 2024

MedComm

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Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long‐term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.

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Central Retinal Artery Occlusion Secondary to Patent Foramen Ovale: The Unexpected Journey of a Paradoxical Embolus

Cited by 4 publications

References 18 publications

Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

Retinal artery occlusion after facial filler injection in a patient with patent foramen ovale: a case report and literature review

A Rare Case of Central Retinal Artery Occlusion in the Setting of Patent Foramen Ovale

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

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