Patent foramen ovale

Unless contraindicated, patients should be anticoagulated to reduce risk of pulmonary fhromboembolism or systemic embolism through a patent foramen ovale... 

A variety of Amplatzer devices are applicable for LAA occlusion including the atrial and ventricular septal defect devices, the patent foramen ovale devices, the patent ductus arteriosus devices, and other arteriovenous fistulae devices. A special fabric-free LAA plug is currently under investigation (Rg. 2). 

Persistence of patent foramen ovale (PFO) into adulthood carries a risk of paradoxical embolization. This risk is accentuated... 

Mas JL, Arquizan C, Lamy C. Patent Foramen Ovale and Atrial Septal Aneurysm Study Group recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm or both. N Eng J Med 2001 345 1740-1746. 

Khairy B O Donnell CP Landzberg MJ. Transcatheter closure versus medical therapy of patent foramen ovale and presumed paradoxical thromboemboli a systematic review. Ann Intern Med 2003 139(9)753-760. 

Schwerzmann M, Wiher S, Nedeltchev K, et al. Percutaneous closure of patent foramen ovale reduces the frequency of migraine attacks. Neurology 2004 62(8) 1399-1401. 

In Caucasians, the vast majority of MCA occlusions are of embolic origin with emboli arising from a carotid stenosis, the aortic arch or the heart (Heinsius et al. 1998) or from the venous side in case of a patent foramen ovale. In black or Asian patients a higher prevalence of intracranial occlusive disease is found with subsequent thrombotic arterial occlusion or stenosis (Feldmann et al. 1990). 

Paradoxical embolism can occur in a patent foramen ovale with a right to left shunt. Embolic material arising from the pelvic or leg veins or elsewhere in the venous system may bypass the pulmonary system and reach the cerebral arteries (Braun et al. 2004). 

Brandt T, Steinke W, Thie A et al (2000) Posterior cerebral artery territory infarcts clinical features, infarct topography, causes and outcome 1. Cerebrovasc Dis 10 170-182 Braun M, Chech V, Boscheri A et al (2004) Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems. Eur Heart J 25 424-430... 

Apart from atrial fibrillation, there are many other causes of cardioembolic stroke including prosthetic heart valves and patent foramen ovale (see Ch. 6). 

Blunt chest injury Mechanical artificial heart Atrial septal defect Ventricular septal defect Patent foramen ovale Pulmonary arteriovenous fistula Particularly with right to left shunt Catheterization, angioplasty Primary oxalosis, hydatid cyst... 

Autopsy examples have established that paradoxical embolism can occur from venous thrombi through the right to the left side of the heart. Emboli may pass through a patent foramen ovale, which is found in approximately one-quarter of healthy people, an atrial septal defect or a ventriculoseptal defect (Gautier et al. 1991 Jeanrenaud and Kappenberger 1991 Cabanes et al. 1993). There is an increased incidence of patent foramen ovale in... 

Diener HC, Weimar C, Katsarava Z (2005). Patent foramen ovale paradoxical connection to migraine and stroke. Current Opinion in Neurology 18 299-304... 

Gan R, Sacco RL, Kargman DE et al. (1997). Testing the vaUdity of the lacunar hypothesis the Northern Manhattan Stroke Study experience. Neurology 48 1204-1211 Gautier )G, Durr A, Koussa S et al. (1991). Paradoxical cerebral embohsm with a patent foramen ovale. A report of 29 patients. Cerebrovascular Diseases 1 193-202... 

Jeanrenaud X, Kappenberger L (1991). Patent foramen ovale and stroke of unknown origin. Cerebrovascular Diseases 1 184-192... 

Kizer JR, Devereux RB (2005). Clinical practice. Patent foramen ovale in young adults with unexplained stroke. New England Journal of Medicine 353 2361-2372 Koennecke H, Mast H, Trocio SH et al (1998). Frequency and determinants of microembolic signals on transcranial Doppler in unselected patients with acute carotid territory ischemia. A prospective study. Cerebrovascular Diseases 8 107-112... 

Lamy C, Giarmesini C, Zuber M et al. (2002). Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale the PFO-ASA Study (Atrial Septal Aneurysm). Stroke 33 706-711 Leung SY, Ng THK, Yuen ST et al. (1993). Pattern of cerebral atherosclerosis in Hong Kong Chinese severity in intracranial and extracranial vessels. Stroke 24 779-786 Leys D, Moulin Th, Stojkovic T et al. (1995). Follow-up of patients with history of cervical artery dissection. Cerebrovascular Diseases 5 43-49... 

Advances in Neurology 92 197-202 Mas JL, Arquizan C, Lamy C et al. (2001). Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. Recurrent cerebrovascular events associated with patent foramen ovale atrial septal aneurysm or both. New England Journal of Medicine 345 1740-1746 Masuda J, Yutani C, Wald R et al. (1992). Histopathological analysis of the mechanisms of intracranial haemorrhage complicating infective endocarditis. Stroke 23 843-850 Matijevic N, Wu K (2006). Hypercoagulable states and strokes. Current Atherosclerosis Reports 8 324-329... 

Wahl A, Meier B, Haxel B et al. (2001). Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism. Neurology 57 1330-1332 Wallis WE, Donaldson I, Scott RS et al. 

Atrial septal aneurysm Patent foramen ovale ... 

A less-invasive alternative is to inject air bubbles or other echocontrast material intravenously if there is a patent foramen ovale, they can be detected by transcranial Doppler sonography of the middle cerebral artery, particularly with a provocative Valsalva maneuver. There is considerable variation in the methods used to detect patent foramen ovale and this influences the diagnostic sensitivity and specificity. It is also uncertain what size of shunt is "clinically relevant" and some bubbles may pass to the brain through pulmonary rather than cardiac shunts (Droste ef al. 1999, 2002 Schwarze ef al. 1999),... 

A transthoracic echocardiogram (TTE) will determine whether valve abnormalities or wall motion abnormalities are sources of emboli to the brain. A "bubble test" can be done to look for an intraatrial shunt indicating an atrial septal defect or a patent foramen ovale. 

Cardioembolic stroke—An ischemic stroke thought to be caused by an embolism arising from the heart. Cardioembolic stroke can be assumed in patients with significant cardiovascular disease including atrial fibrillation, dilated cardiomyopathy, prosthetic valves, recent MI and patent foramen ovale. 

Mas JL, Zuber M Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack, french study group on patent foramen ovale and atrial septal aneurysm. Am Heart J 1995 130 pp. 1083-1088. 

Homma S, Sacco RL, Di TuUio MR, Sciacca RR, Mohr JP Effect of medical treatment in stroke patients with patent foramen ovale patent foramen ovale in cryptogenic stroke study. Circulation 2002 105 pp. 2625-2631. 

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