Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle

Aggeli, Constantina; Verveniotis, Aleksis; Andrikopoulou, Efstathia; Vavuranakis, Emmanouil; Toutouzas, K.; Tousoulis, Dimitrios

doi:10.1007/s10554-018-1406-1

Cited by 23 publications

(45 citation statements)

References 37 publications

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“…The DEFENCE trial not only breaks the spear in favor of PFO device closure over medical therapy in reducing the risk of recurrent cryptogenic stroke but also suggests greater effectiveness of device closure in patients with high-risk anatomic PFO features. Albeit this trial reported a PFO size cutoff value of 2 mm, the presence of a large PFO (3 mm) has been previously related to increased recurrence of ischemic stroke (Lee et al 2010), and a distinction between small (1.9 mm), medium (2À3.9 mm) and large (4 mm) PFOs has been proposed (Aggeli et al 2018).…”

Section: Indications For Transcatheter Closurementioning

confidence: 91%

Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up

Vitarelli

2019

Ultrasound in Medicine & Biology

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Patent foramen ovale (PFO) is present in 15%À30% of the general population and has been associated with various pathologic states, including cryptogenic stroke, platypneaÀorthodeoxia syndrome, decompression sickness and migraine with auras. Transesophageal echocardiography (TEE) has a major role in the diagnostic evaluation of PFO, as well as in the post-procedural assessment after transcatheter closure. The goals of this article were to synthesize the echocardiographic transesophageal techniques required for accurate PFO diagnosis and careful anatomic assessment of its anatomic variants, to focus TEE indications for device closure as complementary to clinical indications and to assess the role of TEE in the post-procedure follow-up.

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Section: Indications For Transcatheter Closurementioning

confidence: 91%

Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up

Vitarelli

2019

Ultrasound in Medicine & Biology

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“…Several studies support that one of the most powerful markers of a non-incidental PFO in stroke patients is young age, usually defined as age ≤ 55 years (1,16,35,36). The incidence of PFO in the stroke population tends to decrease with increasing age (0-30 years: 34.3%, 30-80 years: 25.4%, 90-100 years: 20.2%),while other more traditional stroke risk factors, such as hypertension, dyslipidemia, smoking, and arrhythmias increase (2,5,22).…”

Section: Agementioning

confidence: 99%

“…In most studies, size is an independent risk factor for stroke occurrence and recurrence (1,5,39,40), with OR of 2.54 when the size is ≥2 mm (41). Moreover, CS patients tend to have larger PFOs, when compared to stroke patients of other known causes (13,36).…”

Section: High-risk Anatomical Features Of Pfomentioning

confidence: 99%

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Ioannidis

Mitsias

2020

Front. Neurol.

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Patent foramen ovale (PFO) has been associated with cryptogenic stroke. There is conflicting data and it remains uncertain whether PFO is the direct cause, a risk factor or an incidental finding. 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 signaling disruption. Main risk factors linked with PFO-attributable strokes are young age, PFO size, right-to-left shunt degree, PFO morphology, presence of atrial septal aneurysm, intrinsic coagulation-anticoagulation systems imbalance, and coexistence of other atrial abnormalities, such as right atrial septal pouch, Eustachian valve and Chiari's network. These may act independently or synergistically, multiplying the risk of embolic events. The RoPE score, a scale that includes factors such as young age, cortical infarct location and absence of traditional stroke risk factors, is associated with the probability of a PFO being pathogenic and stroke recurrence risk after the index stroke. Multiple investigators have attempted to correlate other PFO features with the risk of PFO-related stroke, but further investigation is needed before any robust conclusions are reached. PFO presence in young patients with cryptogenic stroke should be considered as etiologically suspect. Caution should be exercised in interpreting the relevance of other PFO features.

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“…On the contrary, in endocardiac shunts, the shunt is dependent on pressure difference between right and left atrium and it is affected by breathing pattern and Valsalva maneuver. Microbubbles are typically seen within the first 3 cardiac cycles [93,94]. Because in HPS shunt worsens in the upright position, this body position may facilitate microbubbles passage in the left cardiac chambers [92].…”

Section: Hepatopulmonary Syndrome and Portopulmonary Hypertension: Cumentioning

confidence: 99%

Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives

Dimitroglou

Aggeli

Alexopoulou

et al. 2019

JCM

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Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications.

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Echocardiographic features of PFOs and paradoxical embolism: a complicated puzzle

Cited by 23 publications

References 37 publications

Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up

Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up

Patent Foramen Ovale in Cryptogenic Ischemic Stroke: Direct Cause, Risk Factor, or Incidental Finding?

Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives

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