RESUMEN
RATIONALE: Transcatheter interventional closure therapy is the main treatment method for patent foramen ovale (PFO). However, occluder abscission is a serious complication in PFO interventional therapy. Thus, timely and effective management of the occluder detachment is crucial for improving patient prognosis. PATIENT CONCERNS: A 52-year-old female patient was admitted to the Department of Neurology mainly due to "right upper limb weakness for two days, which aggravated for eight hours." The patient had no history of any other diseases. DIAGNOSES: The patient was diagnosed with an atrial septal defect (foramen ovale type) and cerebral infarction. INTERVENTIONS AND OUTCOMES: The occluder abscission was successfully removed after several attempts with the help of the snare device. LESSONS: When the PFO occlusion device is detached, interventional treatment would lead to minimal trauma, fast postoperative recovery, and a definite therapeutic effect. Based on mastering the indications and standardizing the operational process, this is a safe and effective minimally invasive treatment method.
Asunto(s)
Remoción de Dispositivos , Foramen Oval Permeable , Dispositivo Oclusor Septal , Humanos , Femenino , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/terapia , Persona de Mediana Edad , Dispositivo Oclusor Septal/efectos adversos , Remoción de Dispositivos/métodosAsunto(s)
Foramen Oval Permeable , Guías de Práctica Clínica como Asunto , Recurrencia , Prevención Secundaria , Dispositivo Oclusor Septal , Accidente Cerebrovascular , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/terapia , Prevención Secundaria/métodos , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/métodosRESUMEN
A patient presenting with acute ischemic stroke associated with patent foramen ovale (PFO) had concurrent deep vein thrombosis, pulmonary embolism, and new-onset atrial fibrillation. Upon initiation of anticoagulation therapy, the patient developed hemorrhagic transformation of the stroke. The patient's multiple potential sources of embolic stroke were treated with concomitant left atrial appendage occlusion and PFO closure through the PFO, made possible by using the Steerable Amulet Sheath under 3D-intracardiac echocardiography guidance.
Asunto(s)
Apéndice Atrial , Cateterismo Cardíaco , Ecocardiografía Tridimensional , Foramen Oval Permeable , Humanos , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Foramen Oval Permeable/complicaciones , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Resultado del Tratamiento , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Ultrasonografía Intervencional , Masculino , Dispositivo Oclusor Septal , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/terapia , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Anciano , Accidente Cerebrovascular Embólico/etiología , Accidente Cerebrovascular Embólico/prevención & control , Accidente Cerebrovascular Embólico/diagnóstico por imagen , Femenino , Ecocardiografía Transesofágica , Persona de Mediana EdadRESUMEN
Patients with previous interatrial shunt device (IASD) implantation may face greater challenges during future left atrial interventional procedures. Herein, we report the first case of left atrial appendage closure (LAAC) in a patient with previous IASD implantation. The patient successfully underwent LAAC using the LAmbre device without complications.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Cateterismo Cardíaco , Humanos , Apéndice Atrial/fisiopatología , Apéndice Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Resultado del Tratamiento , Cateterismo Cardíaco/instrumentación , Masculino , Femenino , Ecocardiografía Transesofágica , Anciano , Función del Atrio Izquierdo , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/fisiopatología , Foramen Oval Permeable/cirugía , Cierre del Apéndice Auricular IzquierdoRESUMEN
PURPOSE OF REVIEW: Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure. RECENT FINDINGS: PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.
Asunto(s)
Foramen Oval Permeable , Dispositivo Oclusor Septal , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/terapia , Humanos , Cateterismo Cardíaco/métodos , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Resultado del Tratamiento , Guías de Práctica Clínica como AsuntoAsunto(s)
Foramen Oval Permeable , Síndrome Hepatopulmonar , Hipoxia , Valor Predictivo de las Pruebas , Humanos , Cateterismo Cardíaco/instrumentación , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/fisiopatología , Foramen Oval Permeable/terapia , Síndrome Hepatopulmonar/fisiopatología , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/etiología , Síndrome Hepatopulmonar/diagnóstico por imagen , Hipoxia/etiología , Hipoxia/fisiopatología , Microburbujas , Circulación PulmonarAsunto(s)
Cateterismo Cardíaco , Anomalía de Ebstein , Foramen Oval Permeable , Dispositivo Oclusor Septal , Adulto , Humanos , Cateterismo Cardíaco/instrumentación , Cateterismo Cardíaco/efectos adversos , Anomalía de Ebstein/cirugía , Anomalía de Ebstein/diagnóstico por imagen , Ecocardiografía Transesofágica , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Dispositivo Oclusor Septal/efectos adversos , Insuficiencia del TratamientoRESUMEN
This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.
Asunto(s)
Fibrilación Atrial , Foramen Oval Permeable , Humanos , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Fibrilación Atrial/terapia , Fibrilación Atrial/diagnóstico , Foramen Oval Permeable/epidemiología , Foramen Oval Permeable/fisiopatología , Foramen Oval Permeable/terapia , Foramen Oval Permeable/complicaciones , Incidencia , Cateterismo Cardíaco/efectos adversos , Factores de Riesgo , Dispositivo Oclusor Septal/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatologíaRESUMEN
BACKGROUND: Migraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates. METHODS: The SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements. CONCLUSION: The SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).
Asunto(s)
Foramen Oval Permeable , Trastornos Migrañosos , Humanos , Estudios Retrospectivos , Estudios Prospectivos , Resultado del Tratamiento , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/prevención & control , Trastornos Migrañosos/etiología , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Foramen Oval Permeable/complicaciones , Cateterismo Cardíaco/efectos adversos , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Foramen Oval Permeable , Accidente Cerebrovascular Isquémico , Femenino , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Accidente Cerebrovascular Isquémico/etiología , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/prevención & control , Factores de Riesgo , Resultado del Tratamiento , AdultoRESUMEN
Paradoxical embolism is a medical condition characterized by the migration of an embolus from a venous source into the systemic circulation. This occurs through a specific cardiac abnormality known as a right-to-left shunt, ultimately resulting in the possibility of arterial embolism. Patent foramen ovale (PFO) is the most common cause of intracardiac shunting. We reported a rare case of a 56-year-old man on hemodialysis with PFO and arteriovenous fistula dysfunction who suffered a paradoxical embolic ischemic stroke after percutaneous transluminal angioplasty. This case emphasized the potential risk of paradoxical embolism in hemodialysis patients with vascular access problems. We aimed to highlight the importance of searching for PFO, as it may serve as a possible source of embolism in these patients.
Asunto(s)
Angioplastia , Embolia Paradójica , Diálisis Renal , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/efectos adversos , Embolia Paradójica/etiología , Embolia Paradójica/diagnóstico , Accidente Cerebrovascular Embólico/etiología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Derivación Arteriovenosa Quirúrgica/efectos adversosRESUMEN
BACKGROUND: The advantages of patent foramen ovale (PFO) closure as protection from a recurrence of stroke remains controversial compared to drug therapy, especially in patients over 60 years. HYPOTHESIS: The aim of the study is to compare recurrence of stroke in patients over 60 years old with PFO closure versus drug therapy alone. METHODS: We included 342 patients over 60 years who suffered a crytopgenic stroke, and were also accepted for a PFO closure. 199 patients refused a PFO closure and were treated with medical therapy alone, whereas 143 patients underwent a PFO closure procedure. RESULTS: The mean follow up time was 5.5 ± 1.5 years. All patients in Group B showed persistent shunt in the follow-up period (n = 199, 100%). In Group A, seven patients were diagnosed with residual shunt during echocardiography examination (5%). A new onset of atrial fibrillation occurred in seven patients in Group A (5%) and six patients in Group B (3%), p = .117. Recurrent stroke occurred in 3 patients in Group A (2%) and 11 patients in Group B (6%), p = .021. One patient died of unknown reason (1%) and two patients were lost due to neurological death (1%) in Group B, whereas no patients in Group A died during the follow-up period. CONCLUSION: Our results show that strict exclusion of patients over 60 years from PFO closure should be reconsidered. As life expectancies are increasing, patients should be considered for same treatment as younger patients, since the outcomes are improved compared to patients treated with medical therapy alone.
Asunto(s)
Fibrilación Atrial , Foramen Oval Permeable , Accidente Cerebrovascular , Humanos , Persona de Mediana Edad , Estudios de Seguimiento , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Infarto Cerebral , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlRESUMEN
Atrial septal abnormalities are common congenital lesions that remain asymptomatic in many patients until adulthood. Adults with atrial septal defects (ASD) most commonly have ostium secundum ASD. Transcatheter closure has become increasingly popular in recent years as a successful alternative method to surgery for treating ASD and patent foramen ovale (PFO). The overall rate of ASD transcatheter closure device embolization has been reported to be less than 1%; however, retrieving the device via surgery or by trans-catheter route can be necessary. The current manuscript describes a systematic review of the techniques used to retrieve ASD closure devices, as well as their success rates, complications, and limitations. A comprehensive search was performed covering various databases including PubMed, MEDLINE, SCOPUS, Google Scholar, and Cochrane Library from inception until April 2022 for English-published case reports, case series, and experimental studies investigating the indications, safety, and limitations of ASD closure and ASD device retrieval by trans-catheter approaches. Finally, 20 studies were included in our review. Our findings showed that most of the studies used a single snare technique; of these, all but one reported 100% success. Double tool retrieval methods (snare plus snare, snare plus bioptome, or snare plus forceps) and the gooseneck snare technique yielded 100% success. One study that used the lasso technique reported unsuccessful retrieval and the need for surgical intervention. More recently, the novel "coronary wire trap technique" was introduced, which provides a simpler method for embolized device removal by trapping the device for retrieval using coronary wire.
Asunto(s)
Cateterismo Cardíaco , Remoción de Dispositivos , Foramen Oval Permeable , Defectos del Tabique Interatrial , Dispositivo Oclusor Septal , Humanos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/diagnóstico , Cateterismo Cardíaco/métodos , Foramen Oval Permeable/cirugía , Foramen Oval Permeable/terapia , Remoción de Dispositivos/métodosRESUMEN
BACKGROUND: Patent foramen ovale (PFO) is a known cause of ischemic stroke in young adults and combined oral contraceptives (COCs) are widely used by women of reproductive age. If young women with PFO are taking COCs, they may be subjected to a synergistic increase in the occurrence of stroke, though reports of ischemic stroke in this population are rare. We report a woman of reproductive age who was taking COC suffered repetitive ischemic strokes before a patent foramen ovale (PFO) was detected and closed, which may raise concerns in this field. CASE PRESENTATION: A 31-year-old woman presented to the emergency department with sudden-onset right upper- and lower-limb weakness and dysarthria for 1 hour, whose only risk factor of stroke was oral contraceptive use. On admission, she was alert with left gaze deviation, dysarthria, and right-sided hemiplegia. Her symptoms improved after receiving the revascularization therapy. About 24 hours later, her left eye experienced sudden painless vision loss. Then the PFO with a substantial right-to-left shunt was detected and then she received a trans-catheter closure of the defect. Over 3 months of follow-up, there were no signs of stroke, but visual loss persisted. CONCLUSION: This case of disabling stroke raises concerns regarding optimal management in primary and secondary prevention of stroke in young women on COCs with additional risk factors of stroke.
Asunto(s)
Foramen Oval Permeable , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Adulto Joven , Humanos , Femenino , Adulto , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Disartria/complicaciones , Accidente Cerebrovascular/etiología , Factores de Riesgo , Accidente Cerebrovascular Isquémico/complicaciones , Recurrencia , Resultado del TratamientoRESUMEN
INTRODUCTION: Atrial arrhythmia is the most common complication of patent foramen ovale (PFO) closure. The real incidence of post-PFO closure atrial arrhytmia and whether this complication can be prevented is unknown. METHODS/DESIGN: The Assessment of Flecainide to Lower the PFO closure risk of Atrial fibrillation or Tachycardia (AFLOAT) trial is a prospective, national, multicentre, randomized, open-label, superiority trial with a blind evaluation of all the endpoints (PROBE design). A total of 186 patients are randomized in a 1:1:1 ratio immediately after PFO closure to receive Flecainide (150 mg per day in a single sustained-release (SR) dose) for 6 months (Group 1), Flecainide (150 mg per day in a single SR dose) for 3 months (Group 2), or no additional treatment (standard of care) for 6 months (Group 3). The primary endpoint is the percentage of patients with at least one episode of symptomatic or asymptomatic atrial arrhythmia episode (≥30 s) recorded within 3 months after PFO closure on long-term monitoring with an insertable cardiac monitor. Whether 3 months of treatment is sufficient compared to 6 months will be analysed as a secondary objective of the study. CONCLUSION: AFLOAT is the first trial to test the hypothesis that a short treatment with oral Flecainide can prevent the new-onset of atrial arrhythmia after PFO closure. CLINICAL TRIAL REGISTRATION: NCT05213104 (clinicaltrials.gov).
Asunto(s)
Antiarrítmicos , Fibrilación Atrial , Flecainida , Foramen Oval Permeable , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antiarrítmicos/uso terapéutico , Antiarrítmicos/efectos adversos , Antiarrítmicos/administración & dosificación , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/prevención & control , Flecainida/efectos adversos , Flecainida/administración & dosificación , Flecainida/uso terapéutico , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/terapia , Frecuencia Cardíaca/efectos de los fármacos , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: Several clinical trials have provided evidence supporting the transcatheter closure of patent foramen ovale (PFO) in selected patients following a cryptogenic stroke. However, it remains unknown to what extent these guidelines have been implemented in everyday clinical practice and the familiarity of physicians from different specialties with PFO closure. The aim of our nationwide survey is to explore the implementation of transcatheter PFO occlusion in Greek clinical practice. MATERIALS AND METHODS: Attending level cardiologists, internal medicine physicians and neurologists involved in the management of PFO-related strokes working in Greece were invited to complete an online questionnaire. The questionnaire consisted of 19 questions and was designed to obtain comprehensive data on provider demographics, PFO characteristics, and specific clinical scenarios. RESULTS: A total of 51 physicians (56.9 % cardiologists, 25.5 % neurologists and 17.6 % internal medicine physicians) completed the survey, resulting in a response rate of 53 %. Cardiologists, internal medicine physicians and neurologists agree on several issues regarding PFO closure, such as PFO closure as first line treatment, management of patients with DVT or prior decompression sickness, and post-closure antithrombotic treatment, but different approaches were reported regarding closure in patients with thrombophilia treated with oral anticoagulation (p=0.012) and implantable loop recorder placement for atrial fibrillation exclusion (p=0.029 and p=0.020). CONCLUSIONS: Our findings show that cardiologists, internal medicine physicians and neurologists agree in numerous issues, but share different views in the management of patients with thrombophilia and rhythm monitoring duration. These results highlight the significance of collaboration among physicians from different medical specialties for achieving optimal results.
Asunto(s)
Foramen Oval Permeable , Accidente Cerebrovascular , Trombofilia , Humanos , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/terapia , Prevención Secundaria/métodos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Factores de Riesgo , Resultado del Tratamiento , RecurrenciaRESUMEN
Impending paradoxical embolism (IPDE) is a right heart thrombus (RHT), in times of elevated pulmonary arterial pressure, that is trapped in a patent foramen ovale (PFO) Myers et al. (2010) (3). We present a case that highlights our multidisciplinary approach in a patient with IPDE with cardiogenic shock from pulmonary embolism (PE).