First direct evidence of a Patent Foramen Ovale (PFO): a large thrombus straddling the foramen ovale

Shang, Xiaoke; Li, Dingyang; Qiu, Qiu; Xiao, Shiyi; Wang, Lijun; Zhang, Changdong; Lü, Rong; Yu, Jie; Xia, Cheng; Zhou, Hongmei; Zhang, Gangcheng

doi:10.1093/eurheartj/ehv380

Cited by 5 publications

(3 citation statements)

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“…Some strokes of unknown origin may be caused by paradoxical embolism due to PFO (1). Although observing a thrombus straddling the PFO is difficult, some cases are detected by echocardiography (6)(7)(8)(9)(10)(11). In the present case, we considered there to be a high possibility of tumor embolism rather than thromboembolism, including Trousseau syndrome.…”

Section: Discussionmentioning

confidence: 76%

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

et al. 2021

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An 82-year-old woman with a history of bladder cancer presented with dyspnea and loss of consciousness. Contrast-enhanced computed tomography revealed pulmonary embolism, and emergency thrombus aspiration therapy was performed, but the thrombus was not aspirated. Echocardiography showed mobile masses in the heart and a right-to-left shunt due to a patent foramen ovale (PFO). Magnetic resonance imaging showed multiple cerebral infarctions. Surgical thrombectomy and PFO closure were performed, and the patient was diagnosed with intracardiac metastasis of bladder cancer based on intraoperative histopathology. This is a rare case of concomitant pulmonary and cerebral tumor embolism and intracardiac metastasis from bladder cancer.

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Section: Discussionmentioning

confidence: 76%

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

et al. 2021

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“…The occasional opening of the PFO results in an abnormal right-to-left shunt (RLS). A thrombus and tumor straddling the PFO provide direct evidence that the RLS-related paradoxical embolism is correlated with cryptogenic stroke, migraine, and some of other symptoms ( 2 , 3 ). Given the increasingly understanding of PFO closure for stroke prevention, current guidelines recommend PFO screenings for stroke patients as necessary ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 98%

Agitated saline with 10% blood increases number and stability of microbubbles in detection right-to-left shunt by contrast-enhanced transcranial Doppler: an in vitro and in vivo observational study

Li¹,

Shen²,

Deng³

et al. 2023

J Thorac Dis

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Background Agitated saline (AS) with blood has been shown to have good tolerance and increased efficacy when used in contrast-enhanced transcranial Doppler (c-TCD) to detect right-to-left shunt (RLS). However, little is known about the effects of blood volume on c-TCD results. Our study investigated the characterization of AS with different blood volumes in vitro and compared the c-TCD results in vivo . Methods In vitro , AS without blood, AS with 5% blood (5% BAS), and AS with 10% blood (10% BAS) were prepared based on previous studies and observed under microscopy. The numbers and sizes of the microbubbles from different contrast agents were compared immediately, 5 min, and 10 min post-agitation. In vivo , 74 patients were recruited. c-TCD was repeated 3 times using AS with different blood volumes in each patient. Signal detection times, positive rates, and classifications of RLS were compared among the 3 groups. Results In vitro , the AS without blood produced 5.4±2.4/field microbubbles after agitation, the 5% BAS produced 30.4±4.2/field, and the 10% BAS produced 43.9±12.7/field. More microbubbles remained in the 10% BAS than the 5% BAS within 10 min (18.5±6.1 vs. 7.1±2.0/field, P<0.001). The size of the microbubbles from the 5% BAS increased from 9.2±8.2 to 22.1±10.6 µm within 10 min post-agitation (P=0.014), while the 10% BAS changed insignificantly. In vivo , the signal detection times of the 5% BAS (1.1±0.7 s) and 10% BAS (1.0±0.8 s) were significantly shorter than the AS without blood (4.0±1.5 s, P<0.0001). The RLS positive rates were 63.5%, 67.6% and 71.6% in AS without blood, 5% BAS and 10% BAS respectively; however, the differences were not statistically significant. The AS without blood reached 12.2% level III RLS, while the 5% BAS reached 25.7%, and the 10% BAS reached 35.1% (P=0.005). Conclusions The 10% BAS would be suggested in c-TCD as it addressed larger RLS by increasing the number and stability of microbubbles, and it improves the diagnosis of patent foramen ovale (PFO).

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“…The higher prevalence of PFO in CS of all ages (3, 4) suggests a pathogenic role for PFO, at least in a substantial portion of these patients. Assuming that paradoxical embolism is the predominant pathogenic mechanism for recurrent strokes (5), PFO closure is a logical treatment option. However, recent RCTs comparing percutaneous closure with antithrombotic treatment revealed inconsistent results-some of them in favor of closure (6)(7)(8)(9), whereas others without a significant advantage of closure (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors

Kahles

Michel

Hapfelmeier³

et al. 2020

Front. Neurol.

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Background and Purpose: To identify factors associated with prior stroke at presentation in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO). Methods: We studied cross-sectional data from the International PFO Consortium Study (NCT00859885). Patients with first-ever stroke and those with prior stroke at baseline were analyzed for an association with PFO-related (right-to-left shunt at rest, atrial septal aneurysm, deep venous thrombosis, pulmonary embolism, and Valsalva maneuver) and PFO-unrelated factors (age, gender, BMI, hypertension, diabetes mellitus, hypercholesterolemia, smoking, migraine, coronary artery disease, aortic plaque). A multivariable analysis was used to adjust effect estimation for confounding, e.g., owing to the age-dependent definition of study groups in this cross-sectional study design. Results: We identified 635 patients with first-ever and 53 patients with prior stroke. Age, BMI, hypertension, diabetes mellitus, hypercholesterolemia, coronary artery disease, and right-to-left shunt (RLS) at rest were significantly associated with prior stroke. Using a pre-specified multivariable logistic regression model, age (Odds Ratio 1.06), BMI (OR 1.06), hypercholesterolemia (OR 1.90) and RLS at rest (OR 1.88) were strongly associated with prior stroke.Based on these factors, we developed a nomogram to illustrate the strength of the relation of individual factors to prior stroke. Kahles et al.

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First direct evidence of a Patent Foramen Ovale (PFO): a large thrombus straddling the foramen ovale

Cited by 5 publications

References 0 publications

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer

Agitated saline with 10% blood increases number and stability of microbubbles in detection right-to-left shunt by contrast-enhanced transcranial Doppler: an in vitro and in vivo observational study

Prior Stroke in PFO Patients Is Associated With Both PFO-Related and -Unrelated Factors

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