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Persistent pathology of the patent foramen ovale: a review of the literature
Med J Aust. 2021 Jul 4. doi: 10.5694/mja2.51141. Online ahead of print.ABSTRACTA patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20-34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea-orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identi...
Source: Medical Journal of Australia - July 4, 2021 Category: General Medicine Authors: Kenneth K Cho Shaun Khanna Phillip Lo Daniel Cheng David Roy Source Type: research

Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale —Reply
In Reply We agree with Drs Rigatelli and Zuin that the PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System used in our study does not include every attribute of potential relevance to the causal relatedness of a discovered PFO to an index stroke, such as Eustachian valve prominence or tunnel length. We would add to their list of PASCAL-omitted variables with a putative association with paradoxical embolism: Valsalva at stroke onset, recent history of prolonged immobility, history of sleep apnea, and presence of venous thrombophilia, to mention only a few.
Source: JAMA - April 12, 2022 Category: General Medicine Source Type: research

Decompressive craniectomy for malignant middle cerebral artery infarction in a 16-year old boy: a case report
ConclusionsThis case highlights the preponderance of cryptogenic stroke in younger patients and its etiological elusiveness. It further demonstrates that age is predictive in terms of survival and functional outcome in the context of malignant middle cerebral artery infarction.
Source: Journal of Medical Case Reports - December 19, 2016 Category: Journals (General) Source Type: research

How often is patent foramen ovale an innocent bystander?
Key Clinical Message Patent foramen ovale (PFO) is a risk factor for cryptogenetic stroke; its closure should be considered in selected patients. It is not always clear whether symptoms (presyncope, paresthesia) apparently due to paradoxical embolism are related with other cardiovascular disorders such as arrhythmias. Flecainide administration for post‐PFO‐closure supraventricular arrhythmias can unmask a latent undiagnosed Brugada syndrome. Patent foramen ovale (PFO) is a risk factor for cryptogenetic stroke; its closure should be considered in selected patients. It is not always clear whether symptoms (presyncope, ...
Source: Clinical Case Reports - October 1, 2017 Category: General Medicine Authors: Francesco Versaci, Giampiero Vizzari, Domenico Sergi, Giuseppe And ò, Antonio Trivisonno, Francesco Romeo Tags: Case Report Source Type: research

The Reply
When preparing our review of patent foramen ovale closures,1 we were not aware of the 2013 report by Kent et al.,2 cited by Wani and colleagues in their comments. We would certainly agree that a cryptogenic stroke in a young patient without risk factors for cerebrovascular disease is more likely to be due to paradoxical embolism than a cryptogenic stroke in an elderly patient with risk factors for cerebrovascular disease.
Source: The American Journal of Medicine - October 27, 2018 Category: General Medicine Authors: James E Dalen Tags: Letter Source Type: research

Heterogeneity of Treatment Effect
This Guide to Statistics and Methods discusses the various approaches to estimating variability in treatment effects, including heterogeneity of treatment effect, which was used to assess the association between surgery to close patent foramen ovale and risk of recurrent stroke in patients who presented with a stroke in a related JAMA article.
Source: JAMA - December 14, 2021 Category: General Medicine Source Type: research

Data Plotted Incorrectly in Figure 2
This article was corrected online.
Source: JAMA - January 25, 2022 Category: General Medicine Source Type: research

Patent foramen ovale and the risk of cryptogenic stroke
Source: Cleveland Clinic Journal of Medicine - July 1, 2014 Category: Journals (General) Authors: TOBIS, J. Tags: Commentary Source Type: research

Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report
Conclusions Our case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.
Source: Journal of Medical Case Reports - June 12, 2015 Category: Journals (General) Source Type: research

A very rare association between giant right atrial myxoma and patent foramen ovale. Extracellular matrix and morphological aspects: a case report.
We report a case of sporadic giant cardiac myxoma with a rare localization in the right atrium, operated in our Service, in a 73-year-old female patient who also presented a patent foramen ovale and a history of ischemic stroke in the year prior to current admission. Intra-operatively, the tumor had a very friable, gelatinous aspect, with a high potential for embolization due to its reduced consistency. The present paper refers to clinical, histochemical and immunohistochemical particularities, as well as to macroscopic and microscopic characteristics of the cardiac myxoma, emphasizing the extracellular matrix aspects, and...
Source: Romanian Journal of Morphology and Embryology - August 17, 2016 Category: Journals (General) Tags: Rom J Morphol Embryol Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What ’s The Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic; that is their cause is not determined after an appropriate evaluation.In 1988 it was reported that the incidence of a patent foramen ovale (PFO) was 30 to 40% in young patients with a cryptogenic stroke compared to 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism; that is a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic, that is, their cause is not determined after an appropriate evaluation. In 1988, it was reported that the incidence of a patent foramen ovale was 30 to 40% in young patients with a cryptogenic stroke compared with 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

Reducing Recurrent Strokes
Adevice that reduces the risk of a second stroke in patients whose first may have resulted from a blood clot traveling through a patent foramen ovale (PFO) and on to the brain has received FDA approval.
Source: JAMA - January 3, 2017 Category: Journals (General) Source Type: research

Cerebral Air Embolism Following Central Venous Catheter Removal
Air embolism is a rare but potentially fatal complication of central venous catheterization1. Venous air emboli can paradoxically enter the arterial circulation through a patent foramen ovale. Paradoxical shunting of air emboli through a patent foramen ovale can lead to cerebral air embolism and cause neurological compromise2. An atrial septal aneurysm is redundant atrial tissue that protrudes towards either or both atria during the cardiac cycle. It significantly increases the risk of embolic stroke when associated with a patent foramen ovale3.
Source: The American Journal of Medicine - August 10, 2017 Category: General Medicine Authors: Liane A. Arcinas, Shuangbo Liu, G. Isanne Schacter, Malek Kass Tags: Clinical Communication to the Editor Source Type: research

The Reply
We recently reported an updated meta-analysis of 5 randomized clinical trials demonstrating that transcatheter closure of patent foramen ovale reduces the risk of recurrent neurologic events compared with medical therapy after cryptogenic stroke.1 Key trials have collectively studied more than 10 different patent foramen ovale closure devices, including the US Food and Drug Administration –approved AMPLATZER PFO Occluder (Abbott Vascular, Santa Clara, Calif). These devices vary considerably in material, size, and profile and differ with respect to procedural deployment.
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B. Golwala, Ambarish Pandey, Deepak L. Bhatt Tags: Letter Source Type: research

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