卵圆孔未闭相关非卒中性疾病防治中国专家共识

随着近年来对卵圆孔未闭（PFO）研究的不断深入,PFO相关卒中的循证医学证据充分,其处理策略已得到国内外的一致认可,相继制定了PFO相关共识或指南。目前,临床上除对PFO相关卒中患者进行介入封堵PFO外,PFO合并其他疾病患者接受PFO封堵的数量也快速增长,但PFO相关非卒中性疾病的循证医学证据尚不充分,国内外尚缺乏指导性文件。为了规范PFO介入治疗,结合国内外PFO临床应用和临床研究领域的最新进展,中国人体健康科技促进会结构性心脏病专委会和中国医师协会神经内科分会组织国内相关领域专家,经多次讨论形成了《卵圆孔未闭相关非卒中性疾病防治中国专家共识》。     

卵圆孔未闭超声诊断中国专家共识

随着对卵圆孔未闭（PFO）相关疾病认识的深入及经导管封堵术等治疗的广泛开展，PFO的精准诊断和评估（包括有无PFO、分流量、相关解剖）成为临床迫切需求。《卵圆孔未闭超声诊断中国专家共识》专家组参考国内外相关研究、共识及指南，达成超声技术（包括经胸/经食管超声心动图联合右心声学造影、对比增强经颅多普勒超声、心腔内超声）诊断PFO的临床应用专家共识，以指导临床实践。     

心房颤动左心耳联合卵圆孔未闭封堵：过犹不及？

心房颤动（房颤）患病率高,左心耳封堵预防缺血性卒中近年来有较大进展。成年人卵圆孔未闭（PFO）的发生率较高,PFO与偏头痛及不明原因卒中可能相关,目前指南/专家共识指出,血栓栓塞性脑梗死伴PFO患者,未发现其他卒中发病机制,结合PFO的解剖和分流情况,可考虑PFO封堵术,但对于老年患者并不积极地建议PFO封堵术。对于房...     

卵圆孔未闭处理策略中国专家建议

据估算,约1/4的成人存在卵圆孔未闭（PFO）。长期以来认为PFO不会造成临床后果。近年来,越来越多的研究发现,PFO患者发生脑卒中、偏头痛、外周动脉栓塞、减压病等风险较正常人群呈数倍升高,其致病作用才引起了广大专家和学者的关注。经皮PFO封堵术安全、有效,但PFO人群基数大,为规范PFO封堵术的临床应用,在借鉴国内外最新研究的基础上,结合我国具体情况,国内本领域专家形成了《卵圆孔未闭处理策略中国专家建议》,以供参考。     

卵圆孔封堵术预防脑卒中复发的效果评价

近年来医学界对于卵圆孔未闭(patent foramen ovale,PFO)的认识逐渐深入,现已确定约1/4的成年人存在PFO.在不明原因脑卒中和偏头痛患者中进行的PFO相关筛查促进了经导管卵圆孔封堵术的高速发展.2020年美国学者提出了 PFO相关脑卒中(patent foramen ovale associate...     

经导管卵圆孔未闭介入封堵术预防卒中的研究进展

目前临床研究证实卵圆孔未闭（PFO）与隐源性卒中密切相关。迄今为止国际上已开展了多个大规模临床研究评估经皮卵圆孔介入封堵在预防卒中方面是否有效,与卵圆孔未闭相关隐源性卒中的诊治策略也有了长足进展,但依旧有一些问题亟待解决。本文将回顾近年来国内外经导管卵圆孔未闭介入封堵预防卒中再发的研究历程,以加强临床医生对PFO的认识。     

卵圆孔未闭可能诱发脑卒中相关生化指标的研究进展

卵圆孔未闭（PFO）是一种常见的先天性心脏解剖结构变异，越来越多的研究表明其与脑卒中发作密切相关。经皮PFO封堵术是治疗PFO合并脑卒中的有效方式。发现潜在的相关生化指标对PFO合并脑卒中的诊断、风险评估及术后预后评价至关重要。本文结合近年来相关文献就PFO可能诱发脑卒中相关生化指标的研究进展进行综述。     

房间隔缺损或卵圆孔未闭患者封堵术后封堵器血栓形成的发生率和临床过程

自开展经导管房间隔缺损(ASD)及卵圆孔 未闭(PFO)封堵术以来,先后有多种类型的封堵 器应用于临床。封堵器的血栓形成及其临床过程的有关研究尚不多。该研究观察并分析了1000例 ASD或PFO封堵术后封堵器血栓形成     

卵圆孔未闭与偏头痛的研究进展

卵圆孔未闭(PFO)是一种常见的先天结构异常。近期研究发现PFO可能与偏头痛有关。本文对PFO与偏头痛的相关性及经皮PFO封堵术的疗效作一综述。     

卵圆孔未闭与隐源性卒中

隐源性卒中占所有缺血性卒中的25％~40％,其病因诊断和治疗一直是临床研究者们努力的方向。其中,卵圆孔未闭（patent foramen ovale, PFO）与隐源性卒中的关系广受争议,一直是研究的热点。病例对照研究表明,与普通人群相比,隐源性卒中患者中PFO患病率显著增高。不过,前瞻性研究显示,单纯PFO并不会增高隐源性卒中发生率,只有在PFO与其他一些高危因素共存时才会显著增高缺血性卒中风险。 PFO的治疗选择包括抗血小板药、抗凝药、经皮介入封堵术和开胸封堵术。近年来,3项比较PFO封堵术与药物预防隐源性卒中复发的大样本临床试验结果已发表,使得卒中二级预防指南得以更新。文章就PFO与隐源性卒中的联系、PFO相关隐源性卒中的高危特征以及二级预防治疗方面的研究进展进行了综述。     

New aspects of paradoxical embolism

Paradoxical emboli have their origin in the low-pressure venous system and can cause ischemic stroke or peripheral arterial embolism through a cardiac or pulmonary shunt. In most cases, a patent foramen ovale (PFO) is found. About 20 % of the population has a patent foramen ovale. This review gives insight into publications concerning the association between the presence of a patent foramen ovale and cryptogenic stroke; the association of PFO, coagulation disorders and stroke; and recurrence rates of stroke in patients with PFO. Diagnostic features are discussed, as are the different therapy modalities, taking existing national and international guidelines into account. Also, our own recommendations are given. In addition some new information on the potential improvement of migraine after PFO closure is discussed. It is widely accepted that the optimal therapy for the prevention of recurrent stroke in patients with PFO and cryptogenic stroke has not yet been found. Randomized, controlled clinical studies are ongoing in the United States and will give even more insight and answer open questions in the future.     

Successful percutaneous closure of patent foramen ovale seven years after surgical closure

Through advancements in transcatheter technology, a patent foramen ovale (PFO) can now be closed by either a percutaneous or surgical procedure. This report presents a patient who suffered an embolic stroke secondary to a PFO. The PFO was successfully closed surgically, but 7 years later the foramen ovale was found to be widely patent. The patient underwent successful percutaneous PFO closure and the foramen ovale remains closed. This case demonstrates that percutaneous PFO closure may be viable in patients in whom surgical closure has not provided long-term closure.     

Patent foramen ovale in cryptogenic stroke: current understanding and management options

There is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalva-inducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.     

Ischemic Attacks and Patent Foramen Ovale: Transcatheter Closure of Patent Foramen Ovale in Adults with Cryptogenic Systemic Embolism

In the presence of a patent foramen ovale with otherwise unexplained (cryptogenic) cerebral embolism, the usual therapy is oral anticoagulation or antiplatelet therapy. Surgery is considered only in cases of recurrence. Percutaneous transcatheter occlusion of the patent foramen ovale (PFO) is a new valuable alternative. This article presents the current knowledge and our data concerning nonsurgical closure of patent foramen ovale to prevent paradoxical arterial embolism. Transcatheter PFO closure represents an elegant therapeutic approach in patients with suspected paradoxical embolism because it avoids open heart surgery and is minimally invasive. Even if the recurrence rate of embolism were identical, transcatheter closure would be preferable to anticoagulation because the annual risk of bleeding complications of 2%-3% and the long-term costs of anticoagulation can be avoided. Randomized studies are needed to compare transcatheter closure of patent foramen ovale with anticoagulation, platelet inhibitors, or surgery.     

Stroke due to late device thrombosis following successful percutaneous patent foramen ovale closure

We report a case of stroke due to device thrombosis occurring three years following percutaneous patent foramen ovale (patent foramen ovale) closure with an Amplatzer atrial septal occluder device. We discuss risk factors that may have contributed to device thrombosis and raise concerns regarding the lack of a dedicated PFO closure device for clinical use in the United States.     

Role of real-time three-dimensional transoesophageal echocardiography for guiding transcatheter patent foramen ovale closure

Patent foramen ovale (PFO) is a relatively common congenitalcondition which has been implicated in cryptogenic stroke asa result of paradoxical thromboembolism by right-to-left shunting.Many studies have demonstrated that transcatheter PFO closuresignificantly reduced the incidence of recurrent strokes ina small group of high-risk patients with PFO and atrial septalaneurysm compared with antithrombotic drugs. Two-dimensionaltransoesophageal echocardiography (2D TEE) has become the electiontechnique for guiding patent foramen ovale closure. Real-timeThree-dimensional transoesophageal echocardiography (3D TEE)may be potentially superior to 2D TEE in the accurate assessmentof the morphology and efficacy of transcatheter closure devicesbecause of a better spacial orientation.     

Patent Foramen Ovale: When Is Intervention Warranted?

In our desire to bring harmony to understanding of unexplained pathologies, we tend to relate commonly occurring entities and attempt to demonstrate meaningful association or causality. The foramen ovale is a universally present structure in utero, remaining patent in a substantial proportion of live births and through adulthood. In its commonness, it has been associated with many disease states and claims of causal inference. As we review the current state of best practice concerning patent foramen ovale (PFO) based on recent randomized controlled trials and practice guidelines, we are reminded that the human body, despite its medical frailties, remains an incredibly efficient machine; a decision to permanently alter its workings should demand knowledge gleaned from substantiated experience and validated data. Presently, no indications exist for PFO closure, whether via a transcatheter or surgical approach, within existing medical care guidelines. Recent randomized controlled trials examining reduction of risk for secondary prevention of stroke and/or transient ischemic attack and for elimination of migraine have underscored the message to restrain the temptation to intervene on a PFO; adversity appears to increase without accrued benefit from such an intervention.     

Eustachian valve interfering with transcatheter closure of patent foramen ovale

A prominent Eustachian valve (EV) is a common finding in patientswith a patent foramen ovale (PFO). Its presence might compromisetranscatheter closure of the PFO.     

A tale of two toes

Percutaneous closure of a patent foramen ovale (PFO) is increasingly being performed for patients with suspected paradoxical embolus. We report a rare case of a PFO occluder device related infective endocarditis.     

Platypnea-orthodeoxia of a 69-year old woman with a patent foramen ovale

Platypnea-orthodeoxia is a rare syndrome that is often associated with interatrial shunting through a patent foramen ovale (PFO) or atrial septal defect. We describe the case of a 69-year-old woman with progressive dyspnea and hypoxia when standing, which was relieved by assuming the recumbent position. After detection of a PFO by transesophageal echocardiography the diagnosis was confirmed by transthoracic echocardiography using saline contrast injection while lying supine and standing upright. This maneuver demonstrated a large right-to-left shunt through a patent foramen ovale while the patient was in a upright position and no significant shunt while being in a recumbent position. The patient showed a rapid improvement after closure of the PFO. This case demonstrates that platypnea-orthodeoxia caused by a patent foramen ovale can be easily demonstrated by the technique of contrast transthoracic echocardiography and a simple positioning maneuver.