Epidemiology of Myocardial Infarction Caused by Presumed Paradoxical Embolism via a Patent Foramen Ovale

Abstract

paradoxical embolism as the reason for acute myocardial infarction (AMI) in patients with PFO and normal coronary arteries. 26,28-47 Even fatal outcomes have been convincingly published. 48,49 However, to date there has not been a large scale evaluation of this phenomenon. MethodsOur approach to describing the epidemiology of AMI included a retrospective and a prospective study. We retrospectively analyzed the incidence over 10 years of paradoxical coronary embolism in a tertiary care center and then prospectively undertook an effort to prove this using the same criteria over 39 months in another tertiary care center. Retrospective and Prospective StudiesFor the retrospective study, we searched the database of the hospital's information system over a period of 10 years for cases of MI according to the International Classification of Diseases, searching for AMI, recurrent MI, and acute as well as silent ischemia. Subsequently all angiogram A patent foramen ovale (PFO) is caused by defective fusion of the septum primum coverage of the fossa ovalis area after birth. A PFO is present in approximately 25% of the general population. 1 In most cases it never leads to any health issues, but PFO has been recognized as a possible source of paradoxical (venoarterial) embolism since the late 18 th century, 2 especially in patients with additional risk factors such as large right-to-left shunt, 3 atrial septal aneurysm, 4-7 thrombophilia 8-11 or prominent Eustachian valve. 12 A possible mechanism for PFO-related systemic embolic events is paradoxical embolism from the peripheral venous system 13-17 through the interatrial communication to the systemic circulation. The embolisms have a preference to be transmitted to vascular areas in accordance with the anatomy and the centrifugal force (i.e., primarily into the cerebral arteries and there to the posterior vessels). 18 There are a few small studies and case reports that have reported paradoxical embolism to the non-cerebral circulation causing limb ischemia, splanchnic ischemia, and splenic or renal infarction. 19-28Almost exclusively the case reports suggest suspected Background: Despite several negative prospective randomized trials on the efficacy of patent foramen ovale (PFO) occlusion, the discussion on indications is ongoing. Because the incidence of paradoxical coronary embolism through a PFO is unknown, we investigated the risk of paradoxical embolic myocardial infarction over a period of 13 years.

Acute Myocardial Infarction in Young Individuals

“…46 Paradoxical embolism as the cause should be considered in young adults in the presence of additional hypercoagulable risk factors (pregnancy, ischemic stroke, factor V Leiden). [47][48][49] MI Due to Atheromatous CAD Without Critical Coronary Stenosis Antemortem characterization of unruptured plaque is now feasible with optical coherence tomography (OCT) and intravascular ultrasound (IVUS). [50][51][52][53][54] The classic demographic profile of such patients includes younger women who are smokers but do not have other cardiovascular risk factors such as diabetes mellitus or hyperlipidemia commonly seen in patients with plaque rupture.…”

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

“…The presence of a severely hypokinetic left ventricular myocardium segment also increases the risk of thrombus formation (14,15) which may embolize simultaneously to both coronary and cerebral arteries. Embolization to the coronary and cerebral arteries have also been reported in patients with atrial fibrillation (16), and likewise is the possibility of a paradoxical embolus of a right ventricular thrombus or a deep vein thrombosis through a patent foramen ovale (17,18).…”

Cardiac arrest in a healthy child due to paradoxical embolus across a previously unrecognised sinus venosus defect

“…It is a relatively rare, but well-known complication of atrial septal defect (atrial shunt)/patent foramen ovale (PFO) 5. Paradoxical embolus has been associated with transient ischaemic attack, stroke and cryptogenic abscess and for peripheral emboli 6. Typically, the patient has some predisposition to thrombosis—like hypercoagulable state, obesity, sedentary lifestyle, lower body operation (ie, knee or hip replacement operation) or atrial arrhythmia (with thrombi in the appendage).…”