Patent Foramen Ovale and Risk of Cryptogenic Stroke – Analysis of Outcomes and Perioperative Implications

Michel, Pablo; Villablanca, Pedro A.; Ranka, Sagar; Lemor, Alejandro; Jain, Tarun; Ramakrishna, Harish

doi:10.1053/j.jvca.2019.04.017

Cited by 6 publications

(3 citation statements)

References 52 publications

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“…All patients reported migraine relief after surgery, and it was found that there was no clear correlation between the degree of migraine relief and the diameter of the foramen ovale. There was also no correlation between the degree of migraine relief and the intensity of preoperative pain, which is similar to the results of other studies ( 22 , 23 ). Therefore, it remains to be studied further whether percutaneous foramen ovale occlusion is the best treatment for patients with migraine with a positive bubble test.…”

Section: Discussionsupporting

confidence: 91%

Transesophageal echocardiography-guided percutaneous closure of the patent foramen ovale only uses the sheath

Yang,

Lei,

Wang

et al. 2023

Cardiovasc Diagn Ther

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Background Percutaneous closure of the patent foramen ovale (PFO) is primarily guided by fluoroscopy in the catheter room, during which procedure both the guidewire and sheath need to pass through the PFO. We performed PFO closure using a transesophageal echocardiography (TEE)-guided approach and only the sheath was passed through the PFO during the procedure. This study aimed to evaluate the feasibility and safety of PFO closure using this technique. Methods A retrospective observational study was performed. A total of 117 consecutive adult patients underwent percutaneous PFO closure without fluoroscopy, under the sole guidance of TEE in our hospital between December 2018 and December 2021. The data of each patient consisted of preoperative, operative, and postoperative variables collected. The primary outcome is that the occluder was successfully released. The secondary outcomes included perioperative and follow-up transthoracic echocardiography (TTE), Headache impact test-6 (HIT-6) score and clinical symptoms. Results Transvenous PFO closure under TEE guidance was successful in all cases. The sample consisted of 93 females and 24 males with an average age of 42.3±7.8 years. There were 28 patients with preoperative cerebral infarction [Risk of Paradoxical Embolism (RoPE) score >6 points] and 89 patients with migraine. All patients underwent a preoperative TEE to confirm the presence of PFO, and contrast-enhanced transcranial Doppler (c-TCD) acoustic contrast suggested grades 3 to 4. The average time of surgery for patients (puncture to removal of the sheath) was 32 minutes. Three cases of vagus nerve reflex manifestations during surgery and two cases of transient ventricular arrhythmia all improved after symptomatic treatment. There were no instances of metal allergy, hemolysis, or other acute vascular procedural complications. For all 89 patients with migraine, significant relief or resolution was achieved during the first six-month follow-up (P<0.001). Conclusions As a monotherapy, percutaneous closure of PFO guided by TEE where only the sheath passes through the PFO during the operation is an effective procedure with a high success rate and a low complication rate.

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Section: Discussionsupporting

confidence: 91%

Transesophageal echocardiography-guided percutaneous closure of the patent foramen ovale only uses the sheath

Yang,

Lei,

Wang

et al. 2023

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

show abstract

“…Patients with PFO or ASD are exposed to various threats that increase the vulnerability to paradoxical embolism. 11,12 These risks include haemodynamic changes that increase right-to-left shunting, hypercoagulability, deep venous thromboembolism, air embolism, cement embolism, and carbon dioxide embolism. 11 An association between PFO and an increased risk of stroke in the perioperative period was reported by some studies.…”

mentioning

confidence: 99%

“…11,12 These risks include haemodynamic changes that increase right-to-left shunting, hypercoagulability, deep venous thromboembolism, air embolism, cement embolism, and carbon dioxide embolism. 11 An association between PFO and an increased risk of stroke in the perioperative period was reported by some studies. 13,14 The aim of the present systematic review and meta-analysis was to determine the degree of association between PFO and perioperative stroke after noncardiac surgery.…”

mentioning

confidence: 99%

Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis

Rais

Vassallo

Schorer

et al. 2022

British Journal of Anaesthesia

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Risk of Perioperative Stroke in Patients With Patent Foramen Ovale: A Systematic Review and Meta-analysis

Hobbes

Akseer

Pikula

et al. 2022

Canadian Journal of Cardiology

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Patent Foramen Ovale and Risk of Cryptogenic Stroke – Analysis of Outcomes and Perioperative Implications

Cited by 6 publications

References 52 publications

Transesophageal echocardiography-guided percutaneous closure of the patent foramen ovale only uses the sheath

Transesophageal echocardiography-guided percutaneous closure of the patent foramen ovale only uses the sheath

Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis

Risk of Perioperative Stroke in Patients With Patent Foramen Ovale: A Systematic Review and Meta-analysis

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