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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

RoPES, Strokes and Closures
We read with great interest the review article by Dalen and Alpert regarding “Which Patent Foramen Ovales Need Closure to Prevent Cryptogenic Strokes?”1 The authors have provided a succinct contemporary review and have also distinctively tabulated the results of the path-defining trials in this somewhat contentious field. The main message provided by the authors is that in patients with cryptogenic stroke, a patent foramen ovale associated with an atrial septal aneurysm should be closed and that closure is not indicated when an atrial septal aneurysm is absent.
Source: The American Journal of Medicine - October 27, 2018 Category: General Medicine Authors: Adil S. Wani, Suhail Q. Allaqaband, M. Fuad Jan Tags: Letter 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

To Reduce Stroke with PFO Closure, Respect the Shunt
We read with interest the very timely updated meta-analysis regarding closure of patent foramen ovale for cryptogenic stroke by Vaduganathan et  al.1 They suggest a marked benefit in stroke prevention with an increase in the incidence of atrial fibrillation. However, we would like to draw your attention to a few caveats that are important for clinicians dealing with this situation and expand on the pooled analysis using the same 5 trials i ncluded in the current paper.2-6
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Arka Chatterjee, Mark A. Law Tags: Letter Source Type: research

Patent Foramen Ovale Closure Versus Medical Therapy After Cryptogenic Stroke
We read with great interest the recent updated meta-analysis by Vaduganathan et  al evaluating patent foramen ovale closure for prevention of cryptogenic stroke.1 Although we congratulate and applaud their excellent work, we would like to comment on several important issues in the study.
Source: The American Journal of Medicine - May 19, 2018 Category: General Medicine Authors: Hong-Tao Tie, Rui Shi Tags: Letter Source Type: research

Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials
• In patients with recent cryptogenic stroke, percutaneous closure of patent foramen ovale reduced recurrent stroke/transient ischemic attack compared with medical therapy, but was associated with higher risk of new-onset atrial fibrillation/flutter.• Select, young patients (≤60 years) present ing with recent cryptogenic stroke may benefit from percutaneous closure of patent foramen ovale at relatively low procedural risk.
Source: The American Journal of Medicine - December 8, 2017 Category: General Medicine Authors: Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B. Golwala, Ambarish Pandey, Deepak L. Bhatt Tags: Brief Observation 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

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

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