Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events

Schuchlenz, Herwig; Weihs, Wolfgang; Beitzke, A; Stein, Jörg-Ingolf; Gamillscheg, Andreas; Rehak, Peter

doi:10.1161/hs0102.100883

Cited by 95 publications

(61 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…34 After PFO device closure, the presence of ASA is not associated with an increased incidence of recurrent embolic events. The present finding is in agreement with those of Windecker et al 12 and supports the results of Mas et al (ie, that in the absence of a PFO, the presence of ASA alone is not associated with an increased incidence of recurrent embolic events). 5 Thus, patients with the coexistence of ASA and PFO obtain a special benefit from percutaneous closure of the PFO, which might be explained by stabilization of the aneurysmatic atrial septum between the disks of the device and closure of the larger PFO opening associated with an ASA.…”

Section: Discussionsupporting

confidence: 94%

“…ASA was defined as the presence of a localized protrusion of the fossa ovalis, with a base width ≥15 mm and mobile septum excursion ≥10 mm into the left or right atrium. 11 The PFO size was additionally determined by multiplane 2-D TEE as recently reported by Schuchlenz et al 12 Spontaneous or provoked right-to-left shunt was semi-quantitatively graded according to the number of bubbles detected in the left atrium after crossing the interatrial septum on a still frame: grade 0, none; grade 1, minimal (1-5 bubbles); grade 2, moderate (6-20 bubbles); and grade 3, severe (>20 bubbles).…”

Section: Echocardiography Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter Closure of Patent Foramen Ovale in Chinese Patients With Paradoxical Embolism - Immediate Results and Long-Term Follow-up -

Zhang

Huang

et al. 2011

Circ J

View full text Add to dashboard Cite

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp atent foramen ovale (PFO) is an anatomical variant of the interatrial septum with an overall prevalence of 27% in autopsy studies. 1 PFO has been associated with cryptogenic stroke and migraine headaches, 2-4 and increasingly recognized as a source of paradoxical embolism. A high prevalence of PFO has been reported in approximately 50% of patients with cryptogenic transient ischemic attack (TIA) or ischemic stroke, 2 suggesting an association between the presence of PFO, with or without atrial septal aneurysm (ASA), and thromboembolic events (TE). 5 The optimal management for the prevention of a paradoxical embolic event in these patients remains controversial. Medical therapies with anticoagulants or antiplatelet agents, surgical PFO closure and percutaneous transcatheter closure of the PFO have been proposed as therapeutic options. 6 The results of several randomized clinical trials, randomized controlled trials and reports of single-center experience have indicated that transcatheter PFO closure is a potential option for patients with PFO and thromboembolic phenomena, in that it avoids the morbidity associated with surgical closure or lifelong anticoagulation therapy. 4,7-10 Despite the good short-term results of transcatheter PFO closure in these patients, however, the long-term data are limited, especially in Chinese patients. The aim of the present study was therefore to assess the long-term clinical outcome in PFO patients with paradoxical embolism who underwent transcatheter PFO closure in a single center. Methods PatientsBetween January 2005 and May 2010, 192 patients who were referred for transcatheter closure of a PFO following 1 or more presumed paradoxical systemic events were included in the present study. A TE was considered to be due to a paradoxical embolism when the following criteria were met: presence of PFO with spontaneous or provocable right-to-left shunt during transthoracic echocardiography (TTE)/trans-

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Echocardiography Definitionsmentioning

confidence: 99%

Transcatheter Closure of Patent Foramen Ovale in Chinese Patients With Paradoxical Embolism - Immediate Results and Long-Term Follow-up -

Zhang

Huang

et al. 2011

Circ J

View full text Add to dashboard Cite

show abstract

“…The potential opening diameter of the PFO ranges o1-19 mm [4]. Since the number of bubbles passing through is only a rough estimate of the diameter during balloon sizing, and no catheterisation was performed, the exact maximum opening diameter is not known [28]. The interatrial pressure relationship will depend on the degree of right-heart loading during obstructive apnoea but also on concomitant left-heart condition [23].…”

Section: Discussionmentioning

confidence: 99%

The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

Johansson¹,

Eriksson²,

Peker³

et al. 2006

Eur Respir J

View full text Add to dashboard Cite

Obstructive sleep apnoea (OSA) is associated with oxygen desaturation to a varying degree. A patent foramen ovale (PFO) may allow interatrial right-to-left shunting. The hypothesis of the current study was that oxygen desaturation will occur more often, in proportion to the frequency of respiratory disturbances, in OSA subjects with PFO than in those without.In a group of 209 subjects diagnosed with OSA, the proportion of desaturation to respiratory events was calculated as the ratio of oxygen desaturation index (ODI)/apnoea-hypopnoea index (AHI). A total of 15 cases with high proportional desaturation (ODI/AHI o0.66) were individually matched with 15 controls with low proportional desaturation (ODI/AHI f0.33), all without pulmonary disease. PFO was assessed with contrast transoesophageal echocardiography and considered large when o20 bubbles passed over from the right to the left atrium after a single injection.The prevalence of large PFO was nine out of 15 (60%) in the high proportional desaturation group versus two out of 15 (13%) in the low proportional desaturation group. The median number of passing bubbles was positively correlated to minimum oxygen saturation among those with PFO.In conclusion, oxygen desaturation occurs more often, in proportion to the frequency of respiratory disturbances, in obstructive sleep apnoea subjects with a patent foramen ovale than in those without.

show abstract

“…There is a correlation between the size of the interatrial shunt and the risk of ischemic stroke, 19,20 but whether the size of the foramen ovale or the degree of shunting is the more important predictor of stroke is not yet clarified. In the present case there was a small shunt and so we consider that this large thrombus grew within the right atrium.…”

Section: Discussionmentioning

confidence: 99%

Impending Paradoxical Cerebral Embolism in a Patient With Atrial Septal Aneurysm

Miyazaki

Hirai

Hosokawa

et al. 2005

Circ J

View full text Add to dashboard Cite

atent foramen ovale (PFO) and atrial septal aneurysm (ASA) have been identified as potential risk factors for stroke; 1-5 when transesophageal echocardiography (TEE) is used, the prevalence of PFO in the normal population is as high as 22-38%. 6 However, it is often difficult to prove that the mechanism of systemic embolism was paradoxical embolism in stroke patients with PFO. 1 We present a case of impending paradoxical cerebral embolism diagnosed by TEE and contrast echocardiography. Case ReportAn 89-year-old man was admitted to the Hokushin General Hospital with hemiparesis of the left limbs and impaired consciousness. On physical examination, he had normal heart sounds, left hemiparesis, and no swelling of the lower limbs. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain showed cerebral infarction in the area of the right middle cerebral artery (Fig 1). Magnetic resonance angiography (MRA) showed no atherosclerotic changes in the large cerebro-vascular walls. Electrocardiogram showed sinus rhythm and he had an episode of chronic atrial fibrillation before admission. The chest X-ray and laboratory data presented no abnormalities.Because there was no definite evidence of artery to artery stroke, we performed transthoracic echocardiography (TTE) to rule out a cardiac source of the emboli. TTE showed a slightly enlarged right ventricle, mild tricuspid regurgitation (max pressure gradient =34 mmHg), atrial septal aneurysm, and a floating mass in the left atrium (Fig 2A). To further examine that mass, we performed TEE, which showed a large string-like mass transiting from the right atrium (RA) to the left atrium (LA) through the atrial septum (Fig 2B), and the absence of any thrombus on the left atrial appendage (Fig 2C).We diagnosed paradoxical cerebral embolism caused by intra-atrial thrombus. Peripheral Doppler echocardiography of the lower extremities revealed normal flow velocities and no existence of deep vein thrombosis. A hypercoagulability profile for intravascular blood stasis was also negative.We chose anticoagulation therapy rather than surgical embolectomy because of the patient's age and poor general condition. After 4 weeks of warfarin therapy, the atrial mass had completely disappeared from the TEE images. Right-to-left shunt flow was not identified with color flow Doppler, although it was proved with a contrast study under the provocative maneuver (Fig 3). We used a microbubble contrast agent (Levovist R , Shering Co Ltd) instead of hand-agitated saline to avoid possible systemic air Circ J 2005; 69: 246 -248 (Received September 10, 2003; revised manuscript received January 19, 2004; accepted February 18, 2004) Departments of Cardiology and *Neurology, Hokushin General Hospital, Nagano, Japan Mailing address: Toshihiko Takamoto, MD, FACC, Department of Cardiology, Hokushin General Hospital, 1-5-63 Nishi, Nakano, Nagano 383-8505, Japan. E-mail: ttakamoto-circ@umin.ac.jp Impending Paradoxical Cerebral Embolism in a PatientWith Atrial Septal Aneurysm

show abstract

Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events

Cited by 95 publications

References 37 publications

Transcatheter Closure of Patent Foramen Ovale in Chinese Patients With Paradoxical Embolism - Immediate Results and Long-Term Follow-up -

Transcatheter Closure of Patent Foramen Ovale in Chinese Patients With Paradoxical Embolism - Immediate Results and Long-Term Follow-up -

The influence of patent foramen ovale on oxygen desaturation in obstructive sleep apnoea

Impending Paradoxical Cerebral Embolism in a Patient With Atrial Septal Aneurysm

Contact Info

Product

Resources

About