Patent foramen ovale

Patent foramen ovale is incriminated in patients with cryptogenic stroke; however, concrete evidence that closure of patent foramen ovale using various devices is superior to continued medical therapy is not yet available. Controlled randomized trials are well underway to address this issue.     

C-TCD与TEE在筛选卵圆孔未闭相关性隐源性卒中中的诊断价值

目的探究经颅多普勒发泡实验(C-TCD)和经食道超声心动图(TEE)在筛查卵圆孔未闭(PFO)相关性隐源性卒中(CS)中的诊断价值。方法收集2018年10月至2019年9月于我院神经内科收治的CS患者105例,均行C-TCD与TEE检查。分析两种方式对PFO的检出情况。结果105例CS患者中,经C-TCD平静呼吸时PFO检出率为35%(阳性37例,阴性68例);经TEE的PFO检出率为42%(阳性44例,阴性61例)。两种方法对PFO的检出率比较,差异无统计学意义(P>0.05)。C-TCD行Valsalva动作后的PFO检出率为56%(阳性59例,阴性46例),与TEE的检出率比较,差异具有统计学意义(P<0.05)。结论C-TCD与TEE对PFO均有较高的检出率,Valsalva动作可提高检出率,C-TCD可作为临床工作中筛选PFO的首选方法。     

中青年隐源性DWI阴性急性缺血性脑卒中合并卵圆孔未闭两例

该文报道2例中青年隐源性弥散加权成像(DWI)阴性急性缺血性脑卒中合并卵圆孔未闭男性患者,均为38岁,急性起病,以轻度神经功能缺损症状就诊,既往无脑血管病危险因素,以左侧肢体功能障碍为主要表现,DWI均阴性,经颅多普勒超声发泡检查和经食管心脏彩色多普勒超声检查发现卵圆孔未闭,其后均接受抗血小板、调脂等治疗,好转出院后随访显示2例均接受了卵圆孔未闭封堵治疗,均痊愈。应通过该2例的诊治过程提高对局灶性神经功能缺损合并卵圆孔未闭的认识,当患者出现局灶性神经功能缺损,即使DWI阴性亦不能排除急性缺血性脑卒中,应积极进行危险因素筛查,尤其是在中青年隐源性患者中,应高度重视卵圆孔未闭的检测及治疗,减少卵圆孔未闭所致的脑卒中及卒中复发。     

Clinical manifestation and current management of patent foramen ovale

There is increasing interest in the evaluation and treatment of patent foramen ovale, which has been associated with various pathologic conditions, such as cryptogenic stroke, platypnea–orthodeoxia syndrome and migraine. However, optimal treatment of patients with patent foramen ovale has not been established. This article aims to review the clinical manifestation and current therapeutic options for patent foramen ovale.     

经胸超声心动图在卵圆孔未闭封堵术中的应用

目的 探讨经胸超声心动图（TFE）在卵圆孔未闭（PFO）封堵术中的应用价值。方法回顾性分析43例PFO患者在封堵术前、术中及术后的TTE图像特征。结果 TTE在术前可清晰显示PFO的大小、形态和分流方向,能帮助介入医师选择合适的封堵器;术中可准确地评价PFO患者封堵器的位置、形态及其与周边的临近结构关系;术后可有效地监控PFO患者预后情况。结论 TTE在PFO封堵术前确诊、术中引导、监护及术后随访均具有重要的作用。     

Patent foramen ovale and cryptogenic stroke.

Strokes are the leading cause of long-term, serious disability. A variety of identifiable risk factors exists for the development of a stroke. Individuals who had no definite and clearly identifiable cause for a stroke experience a cryptogenic stroke. The presence of a patent foramen ovale, a flaplike opening of the atrial septum between the septum primum and secundum, contributes to a 40% to 56% incidence of a cryptogenic stroke. This article reviews the pathophysiology of a patent foramen ovale, the diagnostic tests, and nurse's awareness of the potential etiology of a stroke in a younger individual.     

Percutaneous closure of patent foramen ovale: a case series and literature review

Patent foramen ovale (PFO) is an anatomical variant of the interatrial septum with an overall prevalence of 27% in autopsy studies. PFOs have a potential role in causation of stroke, platypneaorthodeoxia, decompression sickness, right to left shunt and migraine headaches. Data regarding percutaneous closure of PFO in low volume tertiary care centers is lacking. Retrospective review of 14 percutaneous PFO closures done in our facility from March 2005 to August 2006 was performed for efficacy of procedure and safety. All patients received clopidogrel for a period of 3 months, and aspirin and subacute bacterial endocarditis prophylaxis for 6 months. Mean age of the study population was 54 years. Fifty percent (7 of 14) of patients experienced an atrial septal aneurysm and 14% (2 patients) exhibited a hypercoagulable state. The indication for closure in 13 patients was transient ischemic attacks or strokes, while one patient had persistent hypoxia due to a severe right to left shunt at PFO. Patients received either a CardioSEAL or Amplatzer device. Deployment rate was 100%. All patients completed a minimum of 6 months of follow-up, with a mean follow-up time of 14.9 +/- 7.6 months. No immediate or late bleeding complication occurred in any patient. One patient developed paroxysmal atrial fibrillation and one patient developed thrombotic complications at 7 months post-procedure secondary to the progression of her anal carcinoma and subsequently died. Pending the results of the four large randomized trials that are enrolling patients, percutaneous closure of PFO for cryptogenic strokes is an attractive alternative to lifelong anticoagulation with relatively few complications, even in low volume centers. There are many challenges in the management of this subset of patients, the foremost being the selection of a target patient population. Role of PFO in migraines is less clear.     

High prevalence of patent foramen ovale in migraine with aura

In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour–coded sonography (c–TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c–TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c–TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.     

超声心动图在卵圆孔未闭封堵中的应用及卵圆孔未闭分流方向的探讨

目的探讨超声心动图在卵圆孔未闭(PFO)治疗中的应用价值.方法 7例封堵治疗PFO患者,术前经胸(TTE)或经食管超声心动图(TEE)明确PFO诊断,术中TTE和X线引导监护,术后TTE随访;并对157例PFO分流方向进行统计分析.结果 7例PFO封堵患者右向左分流的确诊方法:TTE 1例,TEE 4例,TTE或TEE 右心声学造影各1例.术后TTE随访PFO分流消失.157例TTE诊断的PFO以左向右分流表现为主,少数右向左分流和双向分流者多伴其他心脏结构和功能改变.结论超声心动图在PFO封堵术中具有多方面重要作用.TEE及声学造影诊断PFO右向左分流的敏感性高于单纯TTE.常规TTE检查PFO多表现为左向右分流,而非理论定义的右向左分流.     

Valsalva maneuver as migraine inducer: a case report of a woman with patent foramen ovale and an ischemic stroke

The association between patent foramen ovale, ischemic stroke, and migraine with aura is well known. It is, however, complicated and generates a considerable debate about the features and clinical consequences of the phenomenon. We report a case of a woman for whom patent foramen ovale has possibly acted as an inducer of both migraine attacks and ischemic stroke.     

偏头痛与卵圆孔未闭关系的研究

目的：探讨先兆性偏头痛、无先兆性偏头痛患者和正常人卵圆孔未闭（ PFO）发生率的差异。方法采用经颅多普勒超声（TCD）检测先兆性偏头痛组（29例）、无先兆偏头痛组（31例）和正常对照组（26名） PFO的发生率,比较各组差异。记录治疗前偏头痛患者的头痛频率、头痛发作日数和头痛程度等,并分析其与PFD分流量大小的相关性。结果先兆性偏头痛组、无先兆偏头痛组和正常对照组PFO发生率分别为72％、45％和31％,先兆偏头痛组PFO发生率较正常对照组高（ P＝0.008）,无先兆偏头痛组较正常对照组高,但比较差异尚无统计学意义（ P＝0.491）;PFO大小与头痛频率、头痛发作日数呈正相关（P均＜0.05）。结论先兆偏头痛患者的PFO发生率较高,提示此两种疾病可能有共同的病理学发病机制。     

To close or not to close: contemporary indications for patent foramen ovale closure

Introduction: Patent foramen ovale (PFO) is a common congenital cardiac abnormality and that has been associated with several disease processes including transient ischemic attacks (TIA), stroke, migraine headaches with aura, decompression sickness, platypnea-orthodeoxia syndrome, and shunt induced cyanosis. Controversy exists regarding closure of PFO as a therapeutic treatment modality for these disease processes. This review addresses the contemporary clinical indications for PFO closure.

Areas covered: We conducted a comprehensive literature search of contemporary research studies focusing on randomized trials and meta-analyses comparing medical therapy and device closure of PFOs for the treatment of PFO associated clinical syndromes. We synthesized this literature into a review addressing indications for PFO closure in stroke, TIA, migraine headaches with aura, decompression sickness, platypnea-orthodeoxia syndrome, and shunt induced cyanosis.

Expert commentary: Because in many PFO associated conditions it can be difficult to determine the degree to which the PFO is a causative factor in the disease process, we recommend a comprehensive diagnostic evaluation to exclude other obvious etiologies of PFO associated conditions before implicating the PFO and proceeding with closure. However in the properly selected patient population there is growing clinical experience and experimental evidence suggesting that closure of PFO is a safe and effective treatment modality.     

Lower patent foramen ovale detection with transthoracic echocardiography in atrial fibrillation

Background Patent foramina ovale (PFO) are small defects within the atrial septum that may play a role in paradoxical embolism, stroke and migraines. The relationship between PFO and atrial fibrillation (AF) has not been formally studied. We prospectively studied patients with a history of AF, versus those without (controls), in order to compare PFO prevalence among them. Methods Sixty-one patients with AF and forty-one controls completed the study, all undergoing transthoracic echocardiography using agitated saline microbubbles and a Valsalva maneuver. Results In the control group, 12/41 participants (29.2%) had PFOs compared to 5/61 (8.2%) in the AF group (P < 0.01). PFO positive patients within the entire study population demonstrated greater leftward inter-atrial septal shifting (82% vs 49%, P < 0.05). There was also reduced leftward inter-atrial septal shift observed within the AF group compared to controls (32/61 (52%) vs 31/41 (76%), P < 0.05). Conclusion This study is the first to demonstrate an apparent lower rate of PFO in patients with AF, using bubble contrast echocardiography.     

卵圆孔未闭介入封堵预防隐源性脑卒中复发

目的 探究卵圆孔未闭(PFO)封堵治疗的安全性、有效性,进一步讨论介入封堵治疗PFO的临床意义。方法 选取2019年1-7月我院行PFO介入封堵术的PFO患者90例,术前所有患者均行经胸超声心动图右心声学造影（cTTE）及经食道超声心动图（TEE）证实为卵圆孔未闭并存在右向左分流。封堵成功即刻予床旁经胸超声心动图（TTE）,观察封堵器及分流情况。术后3个月,行cTTE及颅脑CT。结果 所有患者均成功置入封堵器,即刻经胸超声心动图证实封堵器位置正常,二、三尖瓣功能正常,未见残余分流,均未出现术中、术后并发症。术后随访3个月,58.9%患者头痛症状完全消失,34.4%患者头痛症状明显改善,发作频率较前明显减少,总的有效率为93.3%。术前27例一侧肢体麻木乏力患者中19例术后肢体麻木乏力症状完全消失,8例肢体麻木乏力症状虽未完全消失但较前不同程度缓解;术前8例恶心呕吐患者,术后症状完全消失。术后3个月复查经胸壁超声心动图右心声学造影示阳性率为5.6%（5/90）。术后3个月复查颅脑CT,提示本研究中90例患者均未发现新发梗死灶,再发脑卒中发生率为0%。结论 介入封堵治疗PFO可明显缓解患者临床症状,解除患者痛苦,减少分流量,降低脑卒中的再发风险,是一种安全、有效的治疗方法,对PFO的治疗具有指导意义。     

超声心动图联合右心声学造影在卵圆孔未闭诊断中的价值探讨

目的:探讨经食道超声心动图(transesophageal echocardiography,TEE)、右心声学造影(contrast transthoracic echocardiography,cTTE)在卵圆孔未闭(patent foramen ovale,PFO)诊断中的应用价值.方法:本研究选取2019年8月...     

心腔内超声在卵圆孔未闭封堵术中的应用

目的探讨心腔内超声(ICE)在经导管卵圆孔未闭(PFO)封堵术中的应用价值。方法应用ICE观察86例PFO的解剖形态及周围结构，测量PFO通道的直径和长度，监测与引导封堵过程、伞释放后位置，并通过彩色血流显像和超声造影判断有无残余分流。结果ICE清晰地观察到各种形态的PFO，86例中有85例封堵成功，1例失败。结论ICE指导经导管封堵PFO是一种安全、有效、简便和创伤小的方法。     

Patent foramen ovale closure: past,present and future

Patent foramen ovale (PFO) is a common congenital abnormality that has been implicated in a number of disease processes, including cryptogenic stroke and migraine headaches. Medical treatment for these processes is often considered inadequate and mechanical closure of the PFO is an attractive, albeit controversial, alternative. PFO closure has become common practice in many centers, although recent guidelines limit its indication to certain subsets of patients. This review first focuses on the anatomy, physiology and pathophysiology of PFO, and then reviews the currently available and experimental devices for PFO closure, as well as the present clinical data pertaining to them. Finally, we present our perspective of the PFO closure, with regard to its current use and future directions.     

Cryptogenic stroke: time to determine aetiology

Summary.  Strokes that remain without a definite cause even after extensive work-up are classified as cryptogenic. These constitute about 30–40% of all strokes. Stroke aetiology may remain undetermined for the following reasons: (i) the cause of stroke is transitory or reversible and the diagnostic work-out is not therefore performed at the appropriate time; (ii) all known causes of stroke are not fully investigated; (iii) some causes of stroke remain unknown. Recent studies have challenged the previous view that cryptogenic stroke is a relatively benign cerebrovascular event, and have shown that cryptogenic stroke is associated with a higher rate of recurrence and adverse outcome at long-term follow-up. The determination of stroke aetiology is a valuable procedure to avoid the risk of stroke recurrence, especially in young patients. In this review, we discuss new evidence on the aetiology of cryptogenic stroke, specifically focusing on patients with patent foramen ovale and atheroma of the aortic arch.