Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study

Mattioli, Anna Vittoria

doi:10.1053/euhj.2001.2293

Cited by 108 publications

(78 citation statements)

References 23 publications

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“…10 Numerous studies have established that there is an increased prevalence of PFO and ASA in patients who have had a cryptogenic stroke. [11][12][13][14][15][16] A comprehensive meta-analysis of casecontrol studies comparing patients under 55 years of age who had an ischemic stroke to control groups of non-stroke patients reported an increased likelihood of finding a PFO (OR ϭ 3.1; 95% CI, 2.3 to 4.2) or an ASA (OR ϭ 6.1; 95% CI, 2.5 to 15.2) in stroke patients. 17 Moreover, multiple studies have shown an association between degree of shunt or size of PFO and the risk of stroke and stroke recurrence.…”

Section: R E T I R E D R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: [RETIRED]

et al. 2004

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Abstract-Objectives: 1) To evaluate the risk of subsequent stroke or death in patients with a cryptogenic stroke and a patent foramen ovale (PFO), atrial septal aneurysm (ASA), or both. 2) To establish the optimal method of stroke prevention in this population of patients. Methods: MEDLINE, the Cochrane database of systematic reviews, key meeting abstracts from 1997 to 2002, and relevant reference lists were searched to select studies that prospectively collected outcome data in cryptogenic stroke patients with and without interatrial septal abnormalities. Studies were also selected that prospectively compared at least two treatment options. The quality of each study was graded (class I to IV) using a standard classification-of-evidence scheme for each question. Risk analyses were performed and data were pooled when appropriate. Results: The literature search generated 129 articles of which only four fulfilled the inclusion and exclusion criteria. Two studies were graded class I, one study was graded class II, and one study was graded class IV for prognosis. Pooled results of the two class I and one class II studies demonstrated no increased risk of subsequent stroke or death in patients with PFO compared to those without (RR ϭ 0.95, 95% CI 0.62 to 1.44). One class I study found increased risk of recurrent stroke in patients with PFO and ASA (annual rate ϭ 3.8% versus 1.05%, RR ϭ 2.98, 95% CI 1.17 to 7.58) but not increased risk of a composite of stroke and death (annual rate ϭ 3.8% versus 1.8%, RR ϭ 2.10, 95% CI 0.86 to 5.06). Regarding therapy, one study was graded class II, one study class III, and two studies class IV. Among patients with cryptogenic stroke and PFO or ASA, there was no significant difference in stroke or death rate in warfarin-treated patients relative to aspirin-treated patients and the confidence intervals were unable to rule out a benefit of one drug over the other (annual rate ϭ 4.7% versus 8.9%, RR ϭ 0.53, 95% CI 0.18 to 1.58). Minor bleeding rates were higher in the cohort of patients who received warfarin (22.9/100 patient-years versus 8.66/100 patient-years, rate ratio ϭ 2.64, p Ͻ 0.001). No studies compared medical therapy with surgical or endovascular closure. Conclusion: PFO is not associated with increased risk of subsequent stroke or death among medically treated patients with cryptogenic stroke. However, both PFO and ASA possibly increase the risk of subsequent stroke (but not death) in medically treated patients younger than 55 years. In patients with a cryptogenic stroke and an atrial septal abnormality the evidence is insufficient to determine if warfarin or aspirin is superior in preventing recurrent stroke or death, but minor bleeding is more frequent with warfarin. There is insufficient evidence to evaluate the efficacy of surgical or endovascular closure. NEUROLOGY 2004;62:1042-1050 Mission statement. The Quality Standards Subcommittee (QSS) develops evidence based, clinically relevant guidelines to aid in the practice of neurology. This practice parameter assesses the r...

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Section: R E T I R E D R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: [RETIRED]

et al. 2004

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“…The frequency of ASA is higher in patients evaluated with TOE after a cerebral ischaemic event than in the general population. 11 Since ASA is frequently associated with right-to-left interatrial shunting and often associated with large PFOs, it is reported that the mechanism of cardio-embolism is most likely paradoxical embolisation through a coexistent PFO. 12 In our patient two clinical features increased our suspicion of a paradoxical coronary embolus.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical coronary artery embolism causing acute myocardial infarction in a young woman with factor V Leiden thrombophillia

Croft

Khan²,

Chittari³

et al. 2012

J R Coll Physicians Edinb

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Paradoxical coronary artery embolism is a rare but under-diagnosed cause of acute myocardial infarction (AMI) and requires a high level of clinical suspicion to make an early diagnosis. We describe the case of a young woman who presented with a severe cough and chest pain who was subsequently found to have a paradoxical embolus in the right coronary artery. Echocardiography showed a patent foramen ovale (PFO) and an atrial septal aneurysm (ASA). The patient was found to be a heterozygous carrier of the factor V Leiden mutation that increases the risk for venous-thromboembolism. The association between a PFO and an ASA is a risk factor for systemic embolisation. This is the first reported case of paradoxical coronary artery embolus causing AMI in a non-pregnant patient with factor Leiden thrombophilia. Identification of this clinical phenotype is vital as the risk of future embolic events can be reduced by anticoagulation and closure of anatomical cardiac defects. KeywoRdS CASe HiSToRyA 44-year old non-smoking patient (Caucasian female; 72 kilograms [kg]; body mass index [BMI] 28) presented to hospital with a three-week history of increasing breathlessness and severe dry cough. She was treated with three consecutive courses of oral antibiotics (amoxicillin 500 milligrams [mg] three times daily for five days, doxycycline 100 mg once daily and erythromycin 500 mg four times daily for two days which were stopped due to gastrointestinal side-effects) and a fiveday course of oral prednisolone with minimal symptomatic improvement. On closer questioning the patient described severe central chest tightness radiating to the back. She had no haemoptysis or known risk factors for venous thromboembolism. On admission she was taking no regular medications or oral contraceptive pill. Her only past medical history of note was a previous episode of acute onset vertigo with ataxia that was diagnosed as a probable transient ischaemic attack (TIA) in 1995. She had also been investigated seven years previously for persistent breathlessness and had normal computed tomography (CT) pulmonary angiogram and cardiac catheterisation studies.Her general and cardiac examination was unremarkable. Blood pressure was 109/63 millimetres of mercury (mm Hg) and radial pulse was regular at a rate of 92 beats per minute with a respiratory rate of 20 breaths per minute and oxygen saturations on pulse oximetry of 95% on room air. She was afebrile on admission. Initial laboratory investigations of full blood count and biochemistry were within normal limits, apart from mildly elevated C-reactive protein levels at 30 milligrams per litre (mg/L). Arterial blood gas analysis on air was unremarkable, with no evidence of hypoxia. Serum cardiac troponin T levels were markedly raised at 2.47 micrograms per litre (µg/L) (normal range <0.01 µg/L). The plain chest radiograph was normal. The 12-lead electrocardiogram showed sinus bradycardia (49 beats per minute) with incomplete right bundle-branch block, Q wave in lead III and T-wave inversion in inferi...

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“…Практически у всех больных наблюдается поражение крупных сосудов и сердца. Особое диагностическое значение имеет расшире-ние или аневризма аорты [63]. Типичны нарушения органов зрения: миопия высокой степени, подвы-вих, сферичность, уменьшение размеров хрустали-ка, отслойка сетчатки.…”

Section: синдром марфанаunclassified

Multifactorial and hereditary connective tissue disorders in children. diagnostic algorithms. management tactics. russian guidelines

et al. 2016

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Monogenic forms of inherited disorders of connective tissue and multifactorial connective tissue dysplasia are quite common in the population. Despite the high level of modern molecular techniques, clarification of their nosology of today, still remains a distant prospect. These difficulties are due to a large variety of mutations expressed their phenotypic polymorphism clinical manifestations, the considerable size of the genes encoding the proteins of the connective tissue, a rarity major mutations and low availability of molecular genetic research methods to verify the diagnosis. Clarification of the incidence of connective tissue displasia hindered by the lack of common terminology, standardized diagnostic criteria, as well as the practical inaccessibility of modern molecular genetic techniques to identify this heterogeneous pathology. The first part is devoted to the recommendations of the pediatric aspects of diagnosis of hereditary disorders of connective tissue with agreed international diagnostic criteria, and connective tissue displasia. Details covered principles of tactics and treatment of patients with this pathology. The attention of researchers aimed at studying the problems of the modifying effect of this disease on the nature of the flow of almost all diseases. This proves the feasibility of making additions to the standards of inspection and management of these patients with the mandatory inclusion of a comprehensive treatment of the underlying disease additional treatment and rehabilitation, correcting disorders caused by comorbidities.

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Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study

Cited by 108 publications

References 23 publications

Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: [RETIRED]

Practice Parameter: Recurrent stroke with patent foramen ovale and atrial septal aneurysm: [RETIRED]

Paradoxical coronary artery embolism causing acute myocardial infarction in a young woman with factor V Leiden thrombophillia

Multifactorial and hereditary connective tissue disorders in children. diagnostic algorithms. management tactics. russian guidelines

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