Patent Foramen Ovale Closure in 2019

Giblett, Joel P.; Abdul-Samad, Omar; Shapiro, Leonard M.; Rana, Bushra S.; Calvert, Patrick A.

doi:10.15420/icr.2018.33.2

Cited by 49 publications

(67 citation statements)

References 48 publications

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“…The need for short-term dual antiplatelet therapy (DAPT), followed by longer term and potentially indefinite use of a single antiplatelet after device implantation is broadly supported. 8,18 The decision regarding discontinuation of antithrombotic therapy should be informed by imaging (preferably TTE or TEE) or by cTCD to assess residual shunt and thrombus. However, no clinical data are available to determine which level of residual shunting justifies discontinuation of antithrombotic therapy.…”

Section: Which Patients Can Benefit From Pfo Closure?mentioning

confidence: 99%

Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Diener

Akagi

Durongpisitkul

et al. 2020

International Journal of Stroke

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Recently published long-term data from randomized controlled trials have provided evidence for the prevention of recurrent embolic stroke of undetermined source by percutaneous closure of the patent foramen ovale. However, most data were obtained from Caucasian populations and evidence on patent foramen ovale closure in Asian-Pacific patients is limited. The relative paucity in clinical data from this population, as well as the fact that Asian-Pacific patients may have higher bleeding risks than Caucasians, complicates clinical decision-making. This document, resulting from a consensus meeting of Asian-Pacific clinical experts, states the consensus among these experts about how to treat Asian-Pacific patients who had an embolic stroke of undetermined source and have a patent foramen ovale, based on currently available evidence and expert opinions. In addition, uncertainties and the need for clinical data regarding patent foramen ovale closure for prevention of recurrent embolic stroke of undetermined source in general, and specifically for Asian-Pacific patients, are identified.

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Section: Which Patients Can Benefit From Pfo Closure?mentioning

confidence: 99%

Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Diener

Akagi

Durongpisitkul

et al. 2020

International Journal of Stroke

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“…The most common atrial left-to-right shunts include the following defects: ostium secundum atrial septal defect (ASD II), sinus venosus defect (SVD), ostium primum atrial septal defect (ASD I), coronary sinus defect and anomalous pulmonary venous connection [4]. Atrial shunt lesions can occur in combination with a patent foramen ovale (PFO) [5].…”

Section: Introductionmentioning

confidence: 99%

Detection of atrial shunt lesions with a single echocardiographic parameter

Goliasch

Hengstenberg

Binder

et al. 2020

Wien Klin Wochenschr

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Background Unrepaired left to right atrial shunt lesions can cause significant right ventricular (RV) volume overload. The parameter pulmonary to systemic shunt volume ratio (Qp:Qs) has been shown to detect even small differences between left and right ventricular stroke volume; however, four parameters are needed for its calculation. This study was carried out to evaluate the accuracy of the single parameter right ventricular outflow tract (RVOT) velocity time integral (VTI) to identify atrial shunt lesions. Methods All patients who underwent transesophageal echocardiography (TEE) examination at this institution between 1 January 2013 and 1 January 2018 were retrospectively analyzed. The RVOT-VTI was measured in the transthoracic echocardiography performed immediately before each TEE. The diagnostic accuracy for detection of atrial shunt lesions was tested. Results A total of 2797 patients with a median age of 67 years (interquartile range, IQR 54-77 years) were included in the final analysis. A total of 113 (4%) patients had a relevant atrial shunt lesion. The mean RVOT-VTI of the shunt group was 25 cm (SD ± 8.1 cm) and was significantly higher than that of the non-shunt group with 17 cm (SD ± 4.8 cm) (p < 0.001). The area under the curve (AUC) was 0.81. A total of 106 pa-Electronic supplementary material The online version of this article (

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“…In about 75% of infants, the septae fuse shortly after birth. However, in about 20-34% of the population, there is failure of fusion resulting in a patent foramen ovale (PFO) that persists beyond birth [1,2]. For most individuals, this anatomical variation goes undetected throughout their lives or is only incidentally discovered on cardiac investigations.…”

Section: Introductionmentioning

confidence: 99%

Large Left Atrial Thrombus on Amplatzer Septal Occluder Secondary to Medication Nonadherence

Hossain¹,

Kariyanna²,

Hossain³

et al. 2020

AJMCR

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Patent foramen ovale (PFO) is a common clinical entity that is encountered in 20-34% of the general population. In most individuals, this anatomical variation is asymptomatic and goes undetected throughout their lives or is only incidentally discovered on cardiac investigations. In situations when the conduit is large enough and when the right atrial pressure exceeds the left atrial pressure, right to left interatrial flow may occur in these individuals. This creates a channel for translocation of air or thrombi from the venous to the arterial circulation, a phenomenon known as paradoxical embolism. Approximately 25-40% of strokes and transient ischemic attacks in patients less than 60 years of age are classified as cryptogenic and studies have identified a higher prevalence (60%) of PFO in young adults with strokes of unidentifiable etiology. Recent trials have demonstrated utility of PFO closure with mechanical devices for secondary prevention of recurrent strokes in patients aged <60 years of age. The general consensus of post-operative management of PFO closure has been largely drawn from randomized controlled trials and comprises use of aspirin and clopidogrel for 6 months followed by use of aspirin alone for at least 5 years. We present a case of an incidentally discovered left intra-atrial thrombus attached to a PFO closure device in a 36-yearold female with a history of cryptogenic stroke three months after implantation.

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Patent Foramen Ovale Closure in 2019

Cited by 49 publications

References 48 publications

Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Closure of the patent foramen ovale in patients with embolic stroke of undetermined source: A clinical expert opinion and consensus statement for the Asian-Pacific region

Detection of atrial shunt lesions with a single echocardiographic parameter

Large Left Atrial Thrombus on Amplatzer Septal Occluder Secondary to Medication Nonadherence

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