Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Collado, F.; Poulin, Marie-France; Murphy, James W.; Jneid, Hani; Kavinsky, Clifford J.

doi:10.1161/jaha.117.007146

Cited by 90 publications

(105 citation statements)

References 88 publications

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“…The described case, stresses the need for an individualized assessment of each patient and potentially favors the direct surgical closure in those who present with recurrent embolization and ASDs. This entails the identi cation of shunts with high-risk morphological features and the utilization of the RoPE score to determine the probability of the shunt being responsible for causing the stroke (5). Surgical closure may offer an extra advantage over device closure by allowing the direct inspection and extraction of a possible embolization source within the left heart not picked-up on preoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

Atrial septal defect closure in a young patient presenting with recurrent cryptogenic stroke: A case report

Nazer¹

2020

Preprint

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Background: Having an inter-atrial shunt in the form of a patent foramen ovale or atrial septal defect increases the risk of developing cryptogenic stroke. Prompt action is required in order to prevent stroke recurrence. The source of embolization may not be clear on stroke workup.Case presentation: A young female acutely presented with recurrent embolizations to the eye and brain. She was found to have an atrial septal defect. No clear intra-cardiac source of embolization was detected on workup including trans-esophageal echocardiography. Given the options between surgical versus device closure, the attending team opted for the surgical closure which yielded on direct left heart inspection small organized clots adherent to the tips of the mitral valve leaflets. Conclusions: The case report illustrates the potential advantages of the direct surgical closure in detecting and extracting the embolization source in patients who present with recurrent cryptogenic stroke.

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Section: Discussionmentioning

confidence: 99%

Atrial septal defect closure in a young patient presenting with recurrent cryptogenic stroke: A case report

Nazer¹

2020

Preprint

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“…In patients with cryptogenic stroke or transient ischemic attack and PFO diagnosis (Table 1), the ideal secondary prevention has been controversial and extensively debated (Baumgartner et al 2010;Collado et al 2018;Kent et al 2011;Kernan et al 2014;Van Dijk et al 2017;Wein et al 2018). Cryptogenic stroke is defined as a stroke of unknown cause, despite extensive investigations to exclude other etiologies, such as large-vessel atherosclerosis, small-artery disease, carotid dissection, space-occupying lesions, intracerebral hemorrhage and atrial fibrillation.…”

Section: Indications For Transcatheter Closurementioning

confidence: 99%

“…The early randomized trials failed to determine the superiority of percutaneous PFO closure over pharmacotherapy for the secondary prevention of cryptogenic stroke (Collado et al 2018). Various recommendations for percutaneous closure have been reported.…”

Section: Indications For Transcatheter Closurementioning

confidence: 99%

“…There are many commercially available PFO and ASD closure devices on the world market. Based on extended follow-up results of the RESPECT and REDUCE trials, the U.S. Food and Drug Administration approved the Amplatzer PFO Occluder on October 28, 2016, and the Gore Cardioform Septal Occluder on March 30, 2018, for PFO closure in the United States (Collado et al 2018).…”

Section: Indications For Transcatheter Closurementioning

confidence: 99%

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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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“…22 The REDUCE and RESPECT trials resulted in FDA approval of two PFO occluder devices-the GORE and the Amplatzer, respectively. 22 Transcatheter PFO closure is hailed as a safe procedure with a very low risk of complications. In the RESPECT trial, the risk of serious complications such as tamponade, vascular complications, or thrombus were <1%.…”

Section: Introductionmentioning

confidence: 99%

Provocative maneuvers to improve patent foramen ovale detection: A brief review of the literature

2019

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Patent foramen ovale (PFO) is the most common type of inter‐atrial shunt, with prevalence as high as 30%. Detection of PFO has implications in patients with stroke, peripheral embolism, decompression illness, and other conditions. Transesophageal echo (TEE) with saline contrast injection is the current standard for PFO detection, but even with TEE, PFOs are sometimes missed. With advances in percutaneous PFO closure therapies and proven long‐term benefit of closure, accurate PFO detection takes on cardinal importance. Various provocative maneuvers to enhance PFO detection are in clinical use and have been studied. The Valsalva maneuver has long‐held position as the ideal provocation to unmask PFO, but other maneuvers such as cough, sniff, Müller's, and more have gained relevance. In this article, we will examine various maneuvers and discuss their utility in PFO detection.

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Patent Foramen Ovale Closure for Stroke Prevention and Other Disorders

Cited by 90 publications

References 88 publications

Atrial septal defect closure in a young patient presenting with recurrent cryptogenic stroke: A case report

Atrial septal defect closure in a young patient presenting with recurrent cryptogenic stroke: A case report

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

Provocative maneuvers to improve patent foramen ovale detection: A brief review of the literature

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