Patent foramen ovale (PFO) is common, with a probe-patent PFO present in 15-35% of the general population. Patent foramen ovale has been implicated in the aetiology of a number of different pathologies, including cryptogenic stroke, decompression sickness in divers, platypnea orthodeoxia, and migraine with aura. Cardiac ultrasound has a major role not only in the diagnosis of PFO but also in monitoring subsequent therapeutic intervention and in the post-procedural assessment of patients following percutaneous closure. The aim of this review was to outline the data regarding the role of echocardiography in diagnosis, during monitoring and post-procedural assessment so as to provide practical advice to minimize error and optimize patient outcomes. The review will seek to outline the limitations of the available techniques and factors that should be taken into account during percutaneous device closure.
Two patients with a long history of paroxysmal supraventricular tachycardia are presented. The episodes of arrhythmia had been refractory to a wide variety of suppressive drugs and a significant deterioration in life style had resulted. Cardiac conduction studies demonstrated a re-entry mechanism, and it was possible to induce and terminate the tachycardia by appropriately timed electrical stimuli. The application of this principle to long-term control using inductive right atrial pacing is discussed. Both patients have repeatedly abolished episodes of tachycardia using this technique.
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