Techniques for Identifying a Patent Foramen Ovale
Noninvasive and invasive imaging modalities play important roles for the detection of patent foramen ovale (PFO). Transthoracic echocardiography or transcranial Doppler bubble study can be used for initial noninvasive PFO screening. For diagnostic confirmation, transesophageal echocardiography bubble study can be utilized, a semiinvasive confirmatory test that can directly visualize a PFO. In selective cases when the diagnosis is in doubt, PFO can be accurately diagnosed invasively with right heart catheterization. Understanding the advantages and limitations of each diagnostic option will help clinicians choose the approp...
Source: Cardiology Clinics - February 29, 2024 Category: Cardiology Authors: Sanaullah Mojaddedi, Muhammad O. Zaman, Islam Y. Elgendy, Mohammad K. Mojadidi Source Type: research
Migraine Headache and Patent Foramen Ovale
The pathophysiology of migraine remains poorly understood. Like most migraine preventive therapies, patent foramen ovale (PFO) closure was never intended for the treatment of migraine. After closure of PFO for other reasons, migraine symptom reduction/elimination was noted in some patients. Subsequent small trials failed to prove its benefit. There is significant evidence suggesting a platelet-mediated mechanism linking migraines to PFO. The GORE RELIEF Clinical Study is a randomized, blinded, placebo- and sham-controlled trial, currently enrolling. The study design is meant to optimize patient selection using thienopyridi...
Source: Cardiology Clinics - February 29, 2024 Category: Cardiology Authors: Robert J. Sommer, Barbara T. Robbins Source Type: research
Patent Foramen Ovale and Hypoxemia
This article will discuss these conditions and summarize the related literature. (Source: Cardiology Clinics)
Source: Cardiology Clinics - February 28, 2024 Category: Cardiology Authors: Ashley Nguyen, Elaine Nguyen, Preetham Kumar Source Type: research
Patent Foramen Ovale Embryology, Anatomy, and Physiology
Patent foramen ovale (PFO) is a common finding in the general population but may lead to serious conditions such as stroke from paradoxical embolism and platypnea orthodeoxia. A thorough understanding of the interatrial septal anatomy along with its assessment by different imaging modalities is critical in performing safe transcatheter PFO closure. Investigating the anatomy and right heart to left heart flows using transesophageal echocardiography or intracardiac echocardiography imaging must be done before undertaking closure of a PFO. (Source: Cardiology Clinics)
Source: Cardiology Clinics - February 27, 2024 Category: Cardiology Authors: Adeba Mohammad, HuuTam Truong, Islam Abudayyeh Source Type: research
Patent Foramen Ovale and Acute Mountain Sickness
Acute mountain sickness (AMS) commonly plagues people who travel to high altitude and can be life threatening. Clinically, AMS is defined by a constellation of symptoms as outlined in the Lake Louise Criteria. The underlying etiology is thought to be related to a decrease in partial pressure of oxygen leading to tissue hypoxia. Patent foramen ovale (PFO) has been postulated to play a role in AMS through right-to-left shunt, which can worsen hypoxemia. Recent data demonstrate a higher prevalence of PFO in hikers with AMS. Future studies are needed to further elucidate the relationship between PFO and AMS. (Source: Cardiology Clinics)
Source: Cardiology Clinics - February 27, 2024 Category: Cardiology Authors: Brian West, Jonathan M. Tobis Source Type: research
Patent Foramen Ovale and Decompression Illness
Presence of patent foramen ovale (PFO), particularly if high-grade, increases the risk of decompression illness (DCI) and its severe forms. In unprovoked or recurrent DCI, neurologic, cutaneous, or cardiopulmonary DCI, testing for PFO is indicated with bubble contrast echocardiography or transcranial Doppler using provocative maneuvers. In patients with PFO and history of DCI, evaluation by a cardiologist with expertise in diving medicine is recommended. Consideration should be given to PFO closure if cessation of diving or conservative diving cannot be achieved. Prospective studies evaluating long-term outcomes in patient...
Source: Cardiology Clinics - February 27, 2024 Category: Cardiology Authors: Sanjana Nagraj, Leonidas Palaiodimos Source Type: research
The Current State of Science Surrounding Patent Foramen Ovale
The exploration of patent foramen ovale (PFO) as a pathway for multiple disease states has been one of the more fascinating advances in cardiology over the last 25 years. This compendium of articles describe some of the major issues and clinical states surrounding the study of PFOs. The authors who wrote these articles are some of the leading people in this field. They deserve much credit for helping us understand the sometimes subtle mechanisms associated with PFO. It is our hope that this collection of articles will help educate neurologists and cardiologists who deal with PFO-associated clinical situations, such as stro...
Source: Cardiology Clinics - February 19, 2024 Category: Cardiology Authors: Jonathan M. Tobis Tags: Preface Source Type: research
Advanced Echocardiographic Guidance for Transcatheter Tricuspid Edge-To-Edge Repair
Echocardiography, in all its forms (transthoracic echocardiography [TTE], transesophageal echocardiography [TEE], and intracardiac echocardiography [ICE]), is pivotal for the evaluation, guidance, and follow-up of transcatheter tricuspid edge-to-edge repair (TV-TEER) therapies. Although two-dimensional (2D) echocardiography remains essential, three-dimensional (3D) echo with multiplanar reconstruction (MPR) has revolutionized the field of structural imaging. In addition, the advent of 3D ICE has added an important modality to the imaging toolbox, particularly helpful when intraprocedural TEE images are challenging. In this...
Source: Cardiology Clinics - February 10, 2024 Category: Cardiology Authors: Joseph Kassab, Rhonda L. Miyasaka, Serge C. Harb Source Type: research
Coronary Physiology as Part of a State-of-the-Art Percutaneous Coronary Intervention Strategy
The use of coronary physiology allows for rational decision making at the time of PCI, contributing to better patient outcomes. Yet, coronary physiology is only one aspect of optimal revascularization. State-of-the-art PCI must also consider other important aspects such as intracoronary imaging guidance and specific procedural expertise, as tested in the SYNTAX II study. In this review, we highlight the technical aspects pertaining to the use of physiology as used in that trial and offer a glimpse into the future with emerging physiologic metrics, including functional coronary angiography, which have already established th...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Asad Shabbir, Alejandro Travieso, Hern án Mejía-Rentería, Carolina Espejo-Paeres, Nieves Gonzalo, Adrian P. Banning, Patrick W. Serruys, Javier Escaned Source Type: research
Targeted Therapies for Microvascular Disease
Coronary microvascular dysfunction (CMD) is a common cause of ischemia but no obstructive coronary artery disease that results in an inability of the coronary microvasculature to meet myocardial oxygen demand. CMD is challenging to diagnose and manage due to a lack of mechanistic research and targeted therapy. Recent evidence suggests we can improved patient outcomes by stratifying antianginal therapies according to the diagnosis revealed by invasive assessment of the coronary microcirculation. This review article appraises the evidence for management of CMD, which includes treatment of cardiovascular risk, antianginal the...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Adam Bland, Eunice Chuah, William Meere, Thomas J. Ford Source Type: research
Beyond Coronary Artery Disease
Ischemic heart disease (IHD) affects more than 20 million adults in the United States. Although classically attributed to atherosclerosis of the epicardial coronary arteries, nearly half of patients with stable angina and IHD who undergo invasive coronary angiography do not have obstructive epicardial coronary artery disease. Ischemia with nonobstructive coronary arteries is frequently caused by microvascular angina with underlying coronary microvascular dysfunction (CMD). Greater understanding the pathophysiology, diagnosis, and treatment of CMD holds promise to improve clinical outcomes of patients with ischemic heart di...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Sonal Pruthi, Emaad Siddiqui, Nathaniel R. Smilowitz Source Type: research
Computed Tomography-Derived Physiology Assessment
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Robert D. Safian Source Type: research
Intravascular Imaging-Derived Physiology —Basic Principles and Clinical Application
Intravascular imaging-derived physiology is emerging as a promising tool allowing simultaneous anatomic and functional lesion assessment. Recently, several optical coherence tomography-based and intravascular ultrasound-based fractional flow reserve (FFR) indices have been developed that compute FFR through computational fluid dynamics, fluid dynamics equations, or machine-learning methods. This review aims to provide an overview of the currently available intravascular imaging-based physiologic indices, their diagnostic performance, and clinical application. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Annemieke C. Ziedses des Plantes, Alessandra Scoccia, Frank Gijsen, Gijs van Soest, Joost Daemen Source Type: research
Physiology and Intravascular Imaging Coregistration —Best of all Worlds?
Percutaneous coronary intervention is increasingly guided by coronary physiology and optimized using intravascular imaging. Pressure-based measurements determine the significance of a stenosis using hyperemic or nonhyperemic pressure ratios (eg, the instantaneous wave-free ratio). Intravascular ultrasound and optical coherence tomography provide cross-sectional and longitudinal detail regarding plaque composition and vessel characteristics. These facilitate lesion preparation and optimization of stent sizing and positioning. This review explores the evidence-base and practical aspects of coregistering pressure gradient ass...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Tobin Joseph, Michael Foley, Rasha Al-Lamee Source Type: research
Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization
Coronary physiologic assessment has become a standard of care for patients with coronary atherosclerotic disease. While most attention has focused on pre-interventional physiologic assessment to aid in revascularization decision-making, post-interventional physiologic assessment has not been as widely used, despite evidence supporting its role in assessment and optimization of the revascularization procedure. A thorough understanding of such evidence and ongoing studies would be crucial to incorporate post-interventional physiologic assessment into daily practice. Thus, this review provides a comprehensive overview of curr...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Doosup Shin, Seung Hun Lee, David Hong, Ki Hong Choi, Joo Myung Lee Source Type: research
