Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials

Vidale, Simone; Russo, Filippo; Campana, Carlo; Agostoni, Elio

doi:10.1177/0003319718802635

Cited by 12 publications

(12 citation statements)

References 33 publications

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“…The foramen ovale normally closes completely at birth as left atrial pressures rise relative to right atrial pressure, but the condition patent foramen ovale (PFO) results from failure of the foramen ovale to close. The result is a L-R shunt of variable magnitude that, in humans, causes various symptoms including migraine headaches along with increased risk of stroke, transient ischemic attack or myocardial infarction (Kumar et al, 2019;Vidale et al, 2019). It is estimated that as many as 25% of human adults may have a patent foramen ovale because of failure of anatomical closure at birth (Fisher et al, 1995).…”

Section: (A) Intracardiac Shuntsmentioning

confidence: 99%

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

2019

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This review explores the long‐standing question: ‘Why do cardiovascular shunts occur?’ An historical perspective is provided on previous research into cardiac shunts in vertebrates that continues to shape current views. Cardiac shunts and when they occur is then described for vertebrates. Nearly 20 different functional reasons have been proposed as specific causes of shunts, ranging from energy conservation to improved gas exchange, and including a plethora of functions related to thermoregulation, digestion and haemodynamics. It has even been suggested that shunts are merely an evolutionary or developmental relic. Having considered the various hypotheses involving cardiovascular shunting in vertebrates, this review then takes a non‐traditional approach. Rather than attempting to identify the single ‘correct’ reason for the occurrence of shunts, we advance a more holistic, integrative approach that embraces multiple, non‐exclusive suites of proposed causes for shunts, and indicates how these varied functions might at least co‐exist, if not actually support each other as shunts serve multiple, concurrent physiological functions. It is argued that deposing the ‘monolithic’ view of shunting leads to a more nuanced view of vertebrate cardiovascular systems. This review concludes by suggesting new paradigms for testing the function(s) of shunts, including experimentally placing organ systems into conflict in terms of their perfusion needs, reducing sources of variation in physiological experiments, measuring possible compensatory responses to shunt ablation, moving experiments from the laboratory to the field, and using cladistics‐related approaches in the choice of experimental animals.

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Section: (A) Intracardiac Shuntsmentioning

confidence: 99%

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

2019

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“…Recent studies have identified RLS as a common risk factor for stroke, transient ischemic attack, and migraine. [1][2][3] Majority of these patients were first diagnosed in the department of neurology, and c-TCD was often used to detect RLS. As RLS was mostly caused by patent foramen ovale (PFO) of heart, VM could increase the PFO or open the PFO that was closed at resting state to increase the extent of RLS and the detection or the grading of RLS.…”

Section: Discussionmentioning

confidence: 99%

“…Right to left shunt (RLS) is a potential risk factor for ischemic stroke, transient ischemic attack and migraine, thus its detection rate should be paid attention specifically. Contrast‐enhanced transcranial doppler (c‐TCD), which is usually conducted at resting state and after valsalva maneuver (VM), is a common method for detecting RLS.…”

Section: Introductionmentioning

confidence: 99%

Is inferior vena cava compression an alternative for valsalva maneuver in contrast‐enhanced transcranial doppler？

Deng

et al. 2019

Echocardiography

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Objectives To evaluate whether inferior vena cava compression (IVCC) can be an alternative for valsalva maneuver (VM) in contrast‐enhanced transcranial doppler (c‐TCD). Methods Patients diagnosed with ischemic stroke, transient ischemic attack, and migraine were enrolled in this study. C‐TCD was conducted at resting state, after VM and IVCC to detect right to left shunt (RLS). Then, the RLS was compared to examine whether IVCC could be an alternative for VM in c‐TCD. Results A total of 246 patients were enrolled in this study. Via Wilcoxon signed‐rank test of paired data, the detection for RLS of c‐TCD conducted after IVCC was superior to at resting state, but inferior to after VM (P ＜ .001, P = .01, respectively); the detection for RLS of c‐TCD conducted after IVCC was inferior to after VM for patients with good cooperation of VM, but was superior for patients with poor cooperation of VM (P ＜ .001, P ＜ .001, respectively); the detection for RLS of c‐TCD conducted after IVCC and after VM showed no significant difference for patients with good cooperation of VM and without abdominal obesity, or with poor cooperation of VM and with abdominal obesity (P = .201, P = .157, respectively); the detection for RLS of c‐TCD conducted after IVCC was superior to at resting state for patients with abdominal obesity (P ＜ .001). Conclusions For patients with poor cooperation of VM, IVCC could be used as an effective supplement to increase the detection of RLS in c‐TCD.

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“…According to echocardiography studies and post-mortem epidemiological studies, the prevalence of ASA of the general population is about 1-2.5% ( 9 , 50 ). PFO complicated with atrial septal tumor have been shown to be a risk factor for both cryptogenic ( 51 , 52 ) and recurrent cryptogenic strokes, suggesting that medical treatment could be refined ( 53 – 55 ). Recent studies also showed that migraine has a high correlation with PFO and ASA ( 44 , 56 ).…”

Section: The Relationship Between Patent Foramen Ovale and Migrainementioning

confidence: 99%

The Correlation Between Migraine and Patent Foramen Ovale

Liu

Wang

et al. 2020

Front. Neurol.

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Background: Migraine is a widespread neurological disorder. The patent foramen ovale (PFO) is a remnant of the fetal circulation. Multiple studies suggest that migraine is more prevalent in subjects with PFO and vice versa. It is unclear if there is a causal relationship or simply a co-existence of these two conditions. Furthermore, the treatment of migraine with percutaneous closure PFO remains controversial.Methods: We reviewed studies pertaining to the relationship between PFO and migraine as well as the effects of treatments on migraine attacks.Results: We briefly summarized potential pathophysiological mechanisms of migraine, and elaborated on migraine type, frequency, and clinical symptoms of migraine with PFO and the clinical features of PFO with migraine. We also addressed the effects of PFO closure on migraine attacks.Conclusion: The evidence supports a “dose-response” relationship between migraine and PFO although more work needs to be done in terms of patient selection as well as the inclusion of an antiplatelet control group for PFO closure interventions to uncover possible beneficial results in clinical trials.

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Patent Foramen Ovale Closure Versus Medical Therapy in Cryptogenic Strokes and Transient Ischemic Attacks: A Meta-Analysis of Randomized Trials

Cited by 12 publications

References 33 publications

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

Is inferior vena cava compression an alternative for valsalva maneuver in contrast‐enhanced transcranial doppler？

The Correlation Between Migraine and Patent Foramen Ovale

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