Prevalence of Potential Risk Factors for Stroke Assessed by Transesophageal Echocardiography and Carotid Ultrasonography: The SPARC Study

Meissner, Irene; Whisnant, Jack P.; Khandheria, Bijoy K.; Spittell, Peter C.; O’Fallon, W. Michael; Pascoe, R.; Enríquez-Sarano, Maurice; Seward, James B.; Covalt, Jody L.; Sicks, JoRean D.; Wiebers, David O.

doi:10.4065/74.9.862

Cited by 368 publications

(245 citation statements)

References 38 publications

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“…The prevalence of PFO is estimated to be between 25-30% of the population based on an autopsy study and transesophageal echocardiogram (TEE) study (1,2). In patients with cryptogenic stroke, the prevalence of PFO is even higher at almost 40% as determined in the Patent Foramen Ovale with Cryptogenic Stroke Study (3).…”

Section: Introductionmentioning

confidence: 99%

Paradoxical emboli following a pulmonary embolus in the presence of a patent foramen ovale

et al. 2018

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A paradoxical embolism is defined as a systemic arterial embolus due to passage of a venous thrombus through a right to left shunt. We describe a case of acute cerebral vascular accident (CVA), right subclavian arterial embolus, and pulmonary emboli in the setting of a large patent foramen ovale (PFO). A 74-year-old woman with multiple comorbidities presented to the emergency department with acute onset of shortness of breath, weakness, and right arm pain. She was found to have bilateral pulmonary emboli, left CVA, and a right subclavian arterial embolus on computed tomography (CT). She emergently underwent embolectomy of her right upper extremity along with a fasciotomy. On chest CT, a PFO was visualized.Transesophageal echocardiogram (TEE) revealed a large PFO with at least a 3-mm primum/secundum separation and evidence of right to left shunting. Multidisciplinary consensus was that she would benefit from closure of her PFO in order to reduce her risk of further emboli. The patient was agreeable and taken to the catheterization lab where a sizing balloon over a stiff wire was advanced to measure the size of the defect. A 25-mm Cardioform device was successfully delivered across the defect. The patient was started on oral anticoagulation and antiplatelets. In summary, increase in right-sided pressures from pulmonary emboli can cause right to left shunting and lead to a paradoxical embolus. Assessment of patients who present with acute CVA or arterial embolus in the setting of pulmonary emboli with elevated right atrial pressures should include an evaluation for a PFO. Closure of PFO in these patients is of potential additive benefit.

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Section: Introductionmentioning

confidence: 99%

Paradoxical emboli following a pulmonary embolus in the presence of a patent foramen ovale

et al. 2018

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“…Our patient had both the anatomical and functional components of this syndrome, that is, the interatrial shunt and the fact that reversal of flow in the shunt was triggered by change to upright This increases to~57% with agitated saline contrast imaging, and to 92% with transesophageal echocardiography with Valsalva maneuver. 5 Positional right-to-left inter-atrial shunting through a PFO causing orthodeoxia has previously been described in ablebodied patients with normal pulmonary artery pressure and normal heart function. 6 We do not know whether this patient had orthodeoxia before her SCI, as she was asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury

Magimairaj

Hariharan

Thumbikat

2015

Spinal Cord Ser Cases

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STUDY DESIGN: This is a single-subject case report. OBJECTIVES: The objective is to describe and discuss a rare presentation of orthodeoxia after spinal cord injury in a previously healthy adult with an asymptomatic and undiagnosed atrial septal defect. SETTING: This study was conducted at the Tertiary Care Spinal Injuries Center in Sheffield, UK. METHODS: An 81-year-old woman who was otherwise healthy and active sustained a polytrauma following a road traffic collision. Her injuries were managed conservatively. As a complication of epidural analgesia, she developed a complete thoracic paraplegia secondary to an epidural hematoma. She was found to have repeated episodes of severe deoxemia, without any significant postural hypotension when attempts were made to sit her up in bed. Detailed investigations were done to ascertain the cause for this deoxemia. RESULTS: Echocardiography revealed an atrial septal defect; agitated saline contrast transesophageal ultrasound done in various positions revealed interatrial defect with reversal of shunting when the patient was made to sit up in bed. CONCLUSION: Orthodeoxia is an uncommon finding in spinal injury patients. Detailed investigations at an early stage of rehabilitation need to be done to rule out cardiac causes after ruling out the common medical complications seen in the acute and subacute phases following spinal cord injury.Spinal Cord Series and Cases (2015) , 15005; doi:10.1038/scsandc.2015.5; published online 9 July 2015An 81-year-old woman with controlled hypertension presented to the emergency department following a road traffic collision. She sustained a stable C2 and multiple rib fractures. On examination, she had no neurological deficits. As she was immobilized, she was placed on prophylactic anticoagulation with low-molecular-weight heparin. The pain was managed by epidural patient-controlled analgesia for 4 days. On the seventh day following injury, she developed complete flaccid paralysis of both lower limbs with bilateral sensory loss below T8 (ASIA Impairment Scale-A). An MRI confirmed an intradural extramedullary hematoma compressing the spinal cord between T6 and the conus with signs indicating a venous infarct. This was managed conservatively.After 6 weeks of immobilization, reimaging confirmed satisfactory union of her C2 fracture. She was mobilized and racked up in bed to 30 degrees, during which the oxygen saturation (SpO2) dropped to 76%.This was not associated with dyspnea, chest pain or dizziness. There were no changes to her blood pressure and heart rate to suggest postural hypotension. Oxygen saturation returned to normal with supine position. CBC, serum chemistry and chest X-ray were normal. D-dimer was within normal range. CT pulmonary angiogram ruled out pulmonary embolism. ECG ruled out ST-elevation myocardial infarction. The echocardiogram done in supine position showed an atrial septal defect (ASD) measuring 12 mm (Figure 1). Estimated pulmonary artery pressures were within normal limits. Pulmonary function tests were not done.Saline...

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“…In the general population aged 45 years or older, 25.6% of the subjects had atherosclerosis in the aortic arch. 6 It has been reported that factors associated with ACL include age, 1,7 cigarette smoking, 1,8,9 hypertension, 10 diabetes mellitus 11 and coronary artery disease. 12,13 Less invasive methods have recently been developed to examine systemic atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

Predictors of aortic complicated lesions in stroke patients

et al. 2009

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Aortic complicated lesions (ACLs) should be associated with cerebral infarction. Our aim was to develop a simple clinical scale (ACL scale) to predict the presence of ACL. Consecutive stroke patients undergoing transesophageal echocardiogram (TEE) examination were prospectively enrolled. We defined ACL as the presence of 44 mm wall thickness, ulceration or mobile plaque in aortic arch. We also examined carotid intima-media thickness (IMT), ankle-brachial index (ABI) and brachial-ankle pulse-wave velocity (baPWV). We compared the clinical characteristics of patients with ACL (ACL group) and without ACL (non-ACL group), and devised a new ACL scale to predict the presence of ACL. In all, 165 patients (male 108, age 66.9 years) were enrolled and of these, 38% had ACL. The patients of the ACL group were older than those of the non-ACL group (73.0±10.2 vs. 63.1±13.6 years, P¼0.001). Peripheral artery disease (PAD) was more frequent in the ACL group (18 vs. 4%, P¼0.004). IMT was thicker in ACL group than in the non-ACL group (1.29 ± 0.74 vs. 1.11 ± 0.79 mm, P¼0.002), and baPWV was higher in the ACL group (2164.2 ± 643.2 vs. 1833.7 ± 492.9 cm s À1 , P¼0.001). We used three variables for determining the ACL scale score; (1) age 470, (2) presence of PAD and (3) smoking. The frequencies of ACL associated with ACL scale scores were as follows: 6% of patients with ACL scale score 0, 40% with score 1, 58% with score 2 and 100% with score 3. The ACL scale can predict the presence of aortic complicated lesions.

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Prevalence of Potential Risk Factors for Stroke Assessed by Transesophageal Echocardiography and Carotid Ultrasonography: The SPARC Study

Cited by 368 publications

References 38 publications

Paradoxical emboli following a pulmonary embolus in the presence of a patent foramen ovale

Paradoxical emboli following a pulmonary embolus in the presence of a patent foramen ovale

Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury

Predictors of aortic complicated lesions in stroke patients

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