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NobleStitch PFO Closure for Recurrent Strokes in a Patient on ECMO with COVID-19
Severe hypoxemia secondary to SARS-COV-2 (COVID-19) pneumonia is a significant contributor to morbidity and mortality.1 Patent foramen ovales (PFOs) can exacerbate hypoxemia through an intracardiac shunt, slowing recovery and worsening outcomes.2-4 Cryptogenic stroke is a complication commonly associated with PFOs; however, current guidelines do not address PFO management in COVID-19 patients who experience recurrent paradoxical emboli, especially in the setting of COVID-19 pneumonia, increased right-sided pressures, and a hypercoagulable state.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 18, 2022 Category: Anesthesiology Authors: Perry A. Stout, Nika Samadzadeh Tabrizi, Matt Tribble, Tanya Richvalsky, Cindy Youn, Brion Winston, Alexander D. Shapeton, Sridhar R. Musuku Tags: Case Report Source Type: research

NobleStitch Patent Foramen Ovales Closure for Recurrent Strokes in a Patient with COVID-19 on Extracorporeal Membrane Oxygenation
SEVERE HYPOXEMIA, secondary to the SARS-COV-2 (COVID-19) pneumonia, is a significant contributor to morbidity and mortality.1 Patent foramen ovales (PFOs) can exacerbate hypoxemia through an intracardiac shunt, slowing recovery and worsening outcomes.2-4 Cryptogenic stroke is a complication commonly associated with PFOs; however, current guidelines do not address PFO management in COVID-19 patients who experience recurrent paradoxical emboli, especially in the setting of COVID-19 pneumonia, increased right-sided pressures, and a hypercoagulable state.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 18, 2022 Category: Anesthesiology Authors: Perry A. Stout, Nika Samadzadeh Tabrizi, Matt Tribble, Tanya Richvalsky, Cindy Youn, Brion Winston MD, Alexander D. Shapeton, Sridhar R. Musuku Tags: Case Report Source Type: research

NobleStitch ™ EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and has been increasingly targeted by percutaneous interventional techniques. Both implanted devices and more recently, “deviceless” closure methods (i.e. suturing) have been developed. While device closure methods have historically been the predominant approach, issues related to the implanted devices such as migration, embolization, need for anticoagulation, device related thrombosis (DRT), erosion into adjacen t cardiovascular structures, and endocarditis are well documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

NobleStitch EL PFO Closure Guided by Transesophageal Echocardiography
Paradoxical embolism secondary to a persistent patent foramen ovale (PFO) is a significant source of embolic stroke and increasingly has been targeted by percutaneous interventional techniques. Both implanted devices and, more recently, deviceless closure methods (ie, suturing) have been developed. Although device closure methods historically have been the predominant approach, issues related to the implanted devices, such as migration, embolization, need for anticoagulation, device-related thrombosis, erosion into adjacent cardiovascular structures, and endocarditis are well-documented.
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 5, 2020 Category: Anesthesiology Authors: Sridhar R. Musuku, Adithya Srikanthan, Divya Cherukupalli, Jaqueline Donovan, Alexander D. Shapeton, Brion Winston Tags: Case Report Source Type: research

Left Atrial Myxoma Presenting as Cerebral Infarct
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 - August 5, 2020 Category: Anesthesiology Authors: Hemant Digambar Waikar, Aylliath Gosalakkal Jayakrishnan, Bodiabaduge Senaka Nimalakeerthi Bandusena, Prakash Priyadarshan, Peter Parthepan Kamalaneson, Abhaya Ileperuma, Praveen Kumar Neema, Richa Dhawan, Mark A. Chaney Tags: Case Conference Source Type: research

Left Atrial Myxoma Presenting as Cerebral Embolism
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 - August 5, 2020 Category: Anesthesiology Authors: Hemant Digambar Waikar, Aylliath Gosalakkal Jayakrishnan, Bodiabaduge Senaka Nimalakeerthi Bandusena, Prakash Priyadarshan, Peter Parthepan Kamalaneson, Abhaya Ileperuma, Praveen Kumar Neema, Richa Dhawan, Mark A. Chaney Tags: Case Conference Source Type: research

PFO! Should I Stay, or Should I Go?
IN THIS issue of the Journal of Cardiothoracic and Vascular Anesthesia, Villablanca et al. evaluated whether the presence and diagnosis of a patent foramen ovale (PFO) or atrial septal defect (ASD) preoperatively was associated with an increase in perioperative stroke for patients undergoing noncardiac surgery.1 The authors used “big data” to describe the largest study to date of 19,659,191 hospitalizations retrieved from the Healthcare Cost and Utilization Project's National Readmission Database.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 20, 2020 Category: Anesthesiology Authors: Yvonne Lai, Adam A. Dalia Tags: Editorial Source Type: research

Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale
To evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes.
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 28, 2020 Category: Anesthesiology Authors: Pedro A. Villablanca, Alejandro Lemor, Chak-Yu So, Guson Kang, Tarun Jain, Tanush Gupta, Tomo Ando, Divyanshu Mohananey, Sagar Ranka, Dagmar F. Hernandez-Suarez, Pablo Michel, Tiberio Frisoli, Dee Dee Wang, Marvin Eng, William O'Neill, Harish Ramakrishna Tags: Original Article Source Type: research

A Case-Based Discussion on the Management of Cryptogenic Stroke and Patent Foramen Ovale in the Patient With a Hypercoagulable Disorder
UP TO 40% of all ischemic strokes are considered cryptogenic, implying a stroke without a definitive etiology.1,2 With a dearth of evidence-guided treatment strategies, the literature surrounding cryptogenic stroke is highly variable and not well-standardized. Even though existing guidelines do not specify the exact testing required, the cryptogenic stroke evaluation includes a variety of imaging modalities (eg, echocardiography, angiography, magnetic resonance imaging, carotid ultrasound) and laboratory investigations (eg, genetic testing, hypercoagulable disorder panels, erythrocyte sedimentation rate).
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 27, 2019 Category: Anesthesiology Authors: Neal S. Gerstein, Stacey D. Clegg, Daniel B. Levin, Adam C. Fish, Kirsten Tolstrup, Koki Nakanishi, Yuriko Yoshida, Shunichi Homma Tags: Case Conference Source Type: research

Patent Foramen Ovale and Risk of Cryptogenic Stroke – Analysis of Outcomes and Perioperative Implications
PATENT FORAMEN OVALE (PFO) is the most common congenital defect of the atrial septum, with reported incidences ranging between 27% and 34% in autopsy studies.1 During embryonic life, the PFO is a physiological discontinuity of the septum secundum that allows the oxygenated placental blood to bypass the non-functional lungs of the fetus. There are 2 overlapping components of the developing atrial septum. On the right, the septum secundum stems from an infolding of the atrial walls and contains a posteroinferior oval-shaped opening, the foramen ovale.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 14, 2019 Category: Anesthesiology Authors: Pablo Michel, Pedro A. Villablanca, Sagar Ranka, Alejandro Lemor, Tarun Jain, Harish Ramakrishna Tags: Expert Review Source Type: research