Percutaneous closure of patent foramen ovale: an underutilized prevention?

Stroke is a devastating event for patients and their families. Paradoxical embolism through a patent foramen ovale (PFO) is a recognized cause of stroke. Percutaneous PFO closure is a simple and safe procedure. The debate on PFO closure is far from settled. This is, in part, due to the fact that the three published randomized controlled trials (RCTs) on PFO closure vs. medical therapy were negative regarding their primary endpoint; however, as-treated and per-protocol analyses as well as several meta-analyses report a benefit of PFO closure. In our opinion, PFO closure is underutilized and the results of the three RCTs are not adequately reflected in the current guidelines.
Source: European Heart Journal - Category: Cardiology Authors: Tags: Clinical update Source Type: research

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The present study aimed to investigate the predictive value of free fatty acid (FFA) in embolic stroke of undetermined source (ESUS) according to the presence of potential embolic sources (PES) after extensive etiologic evaluation. This was a retrospective observational study based on a single-center registry from January 2011 to July 2017. Stroke subtypes were determined through laboratory findings, brain, and angiographic imaging, carotid ultrasonography, transthoracic echocardiography, and 24-hour Holter monitoring. If ESUS was suspected, transesophageal echocardiography was additionally performed. Patients were classi...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
ConclusionsOAC was more effective than APT in reducing the risk of stroke recurrence in patients with PFO and CS, without a significant increase in the risk of major bleedings. Our findings support the need for further randomized data focused on the comparison of antithrombotic strategies in this setting.
Source: Cardiovascular Drugs and Therapy - Category: Cardiology Source Type: research
AbstractPatent foramen ovale (PFO) is a potential conduit for paradoxical embolization to the systemic atrial circulation of a thrombus originating in the venous system. In a selected group of subjects, the prevalence of deep vein thrombosis (DVT) was assessed. Subjects were identified if they underwent magnetic resonance venography (MRV) pelvis and lower extremity doppler (LE-VDU) for assessment of DVT with PFO. The primary outcome measure was to report the number of patients with paradoxical embolization as their suspected etiology of stroke due to the presence of DVT, which then will be considered as determined stroke. ...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Abstract BACKGROUND:  Atrial cardiopathy and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear. METHODS:  Atrial cardiopathy was defined as increased left atrial diameter index (> 23 mm/m2) or left atrial volume index (> 34 mL/m2), or PR prolongation (≥ 200 ms), or presence of supraventricular extrasystoles in the electrocardiograms performed during hospitalization for the index stoke. The presence ...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
Authors: Makhija RR, Palaniswamy C, Aronow WS PMID: 32864016 [PubMed]
Source: Archives of Medical Science - Category: General Medicine Tags: Arch Med Sci Source Type: research
Conclusions: This is the first reported case of intraoperative paradoxical embolism in the setting of RCC with cavoatrial extension and PFO. The presence of PFO may be a risk factor for severe cerebrovascular complications in the surgical management of RCC with venous involvement.
Source: The Neurologist - Category: Neurology Tags: Case Report/Case Series Source Type: research
This study aimed to evaluate the efficacy of saline contrast transthoracic echocardiography (TTE) for identifying high-risk PFO.
Source: Journal of the American Society of Echocardiography - Category: Cardiology Authors: Tags: Brief Research Communication Source Type: research
Abstract Background and Objectives: Transesophageal echocardiography (TEE) guidance is the current gold standard for catheter-based procedures in the treatment of structural heart diseases. Intracardiac echocardiography (ICE), which can be performed under local anesthesia, has been recently introduced and is becoming more widely used. We aimed to compare the efficacy and safety of ICE and TEE in patent foramen ovale (PFO) device closure. Materials and Methods: All 74 patients with a history of cryptogenic stroke undergoing PFO closure for secondary prophylaxis were selected from our registry. Intraprocedural TEE w...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
ACUTE embolic cerebral stroke is a major health setback for any individual, with increased mortality and morbidity. Embolus arising from cardiac chambers constitutes about 20% of ischemic strokes. Atrial fibrillation is the root cause of more than 50% of cardiogenic emboli, whereas congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic heart valves, rheumatic heart valvular disease, dilated cardiomyopathy, and endocarditis are predisposing factors for cardiogenic emboli.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Conference Source Type: research
ACUTE embolic cerebral stroke is a major health setback for any individual, with increased mortality and morbidity. Embolus arising from cardiac chambers constitutes about 20% of ischemic strokes. Atrial fibrillation is the root cause of more than 50% of cardiogenic emboli, whereas congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic heart valves, rheumatic heart valvular disease, dilated cardiomyopathy, and endocarditis are predisposing factors for cardiogenic emboli.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Case Conference Source Type: research
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