Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Hanna, Joseph P.; Sun, Jing Ping; Furlan, Anthony J.; Stewart, William J.; Sila, Cathy A.; Tan, Ming

doi:10.1161/01.str.25.4.782

Cited by 124 publications

(62 citation statements)

References 17 publications

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“…Four studies have reported retrospectively on 86 patients treated nonrandomly with aspirin (a small number were also treated with warfarin). The weighted average recurrence rate is 6%/year [57][58][59][60]. In a different group of 86 patients treated nonrandomly with warfarin (a small undefined number were in reality treated only with aspirin), the recurrent stroke rate was slightly lower at 4.7%/year [57][58][59][60] (Fig.…”

Section: Patent Foramen Ovale (Pfo)mentioning

confidence: 99%

Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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Objective. To determine the value of routine transthoracic echocardiography in patients with cerebral ischemia without known cardiac disease. Design. The literature from 1990 to 1995 was searched and relevant bibliographies from these papers reviewed. Articles reporting the prevalence and/or risk of stroke for myxoma, vegetation, mitral stenosis, left atrial thrombus, left ventricular thrombus or cardiomyopathy, patent foramen ovale, and atrial septal aneurysm were used. Prevalences and recurrent stroke risk were examined for adult patients less than and greater than 45 years.Results. Both the prevalence of transthoracic echocardiographic findings and recurrent risk of stroke differ by age. The finding of a patent foramen ovale can be expected in nearly half of younger patients with stroke, whilst transthoracic echo can be expected to yield no relevant lesion in three quarters of patients > 45 years. Warfarin anticoagulation appears beneficial in patients with mitral stenosis, left atrial thrombus, left ventricular thrombus, and left ventricular dysfunction, but is of unproven benefit for patent foramen ovale, atrial septal aneurysm, or in the absence of a risk-associated abnormality. Conclusion. For most transthoracic echo findings in stroke, optimal management strategies have not been well defined. Future research is needed to evaluate the appropriate therapeutic approaches.

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Section: Patent Foramen Ovale (Pfo)mentioning

confidence: 99%

Role of routine transthoracic echocardiography in evaluation and management of stroke

Beattie

Cohen

Manning³

et al. 1998

Journal of Internal Medicine

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“…Patients with documented PFO and previous embolic events are at increased risk for recurrent stroke of up to 4.2% per year, even in the context of therapeutic anticoagulation. [1][2][3][4] Percutaneous transcatheter closure is a potential option for patients with PFO and thromboembolic phenomena that avoids the morbidity associated with surgical closure or lifelong anticoagulation. 1 However, long-term data on the effectiveness of transcatheter PFO closure in stroke prevention are limited.…”

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confidence: 99%

Five-Year Experience With Percutaneous Closure of Patent Foramen Ovale

Slavin

Tobis

Rangarajan

et al. 2007

The American Journal of Cardiology

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Patent foramen ovale (PFO) has been implicated in the pathogenesis of cryptogenic stroke, arterial desaturation, decompression illness, and migraine headache (MH). This study evaluated the safety of percutaneous transcatheter PFO closure in patients with cryptogenic stroke, transient ischemic attack, or arterial desaturation. Additionally, symptomatic reduction in MH was determined after interatrial shunt closure. Of the 252 patients referred to the University of California, Los Angeles, with PFO, 131 underwent closure of the interatrial communication with a CardioSEAL (n ‫؍‬ 30) or Amplatzer (n ‫؍‬ 101) device. PFO morphology was evaluated with transesophageal echocardiography. Follow-up was conducted at 1 to 2 months with echocardiography, with clinical assessment annually thereafter. At an average follow-up of 30 months, there was no recurrence of any thromboembolic event (transient ischemic attack, stroke, or peripheral). There was a reduction in MH, defined as the complete resolution of headache or a >50% reduction in the number of headache days, in 85% of patients after PFO closure. Temporary problems after device implantation, including chest discomfort and palpitations, were reported in 23% of patients and occurred more frequently in patients with nickel hypersensitivity (p <0.05). In conclusion, transcatheter PFO closure is an effective and safe therapeutic modality in the prevention of thromboembolic events and MH associated with interatrial shunting in patients who present with cryptogenic stroke. Pending randomized, controlled trials are necessary to determine if this invasive approach is preferable to medical therapy for the prevention of recurrent stroke or as primary treatment for patients with MH.

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“…9,10 Patients with PFO and paradoxical embolism are at increased risk of recurrent systemic thromboembolic events, ranging from 3.2% to 3.8% per year. [11][12][13][14] The optimal management of these patients remains controversial. Longterm anticoagulation, 11,12,15 surgical PFO closure, 16 -18 and percutaneous transcatheter closure of the PFO 19 -21 have been proposed as therapeutic options.…”

mentioning

confidence: 99%

“…[11][12][13][14] The optimal management of these patients remains controversial. Longterm anticoagulation, 11,12,15 surgical PFO closure, 16 -18 and percutaneous transcatheter closure of the PFO 19 -21 have been proposed as therapeutic options. Oral anticoagulation and surgical closure are associated with a significant morbidity and mixed results regarding stroke prevention.…”

mentioning

confidence: 99%

“…Oral anticoagulation and surgical closure are associated with a significant morbidity and mixed results regarding stroke prevention. 11,12,[15][16][17][18] Transcatheter techniques to close PFO have been used with increasing frequency during the last few years. The present study prospectively assessed the immediate and long-term clinical and echocardiographic follow-up of 110 consecutive patients with paradoxical embolism who underwent percutaneous PFO closure at Massachusetts General Hospital.…”

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confidence: 99%

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Percutaneous Transcatheter Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism

et al. 2002

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Background-Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO. Methods and Results-We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47Ϯ14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. Conclusions-Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.

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Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Cited by 124 publications

References 17 publications

Role of routine transthoracic echocardiography in evaluation and management of stroke

Role of routine transthoracic echocardiography in evaluation and management of stroke

Five-Year Experience With Percutaneous Closure of Patent Foramen Ovale

Percutaneous Transcatheter Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism

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