European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism

Abstract

The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.

The Closure of Patent Foramen Ovale in Preventing Subsequent Neurological Events: A Bayesian Network Meta-Analysis to Identify the Best Device

“…Our data confirms the literature findings in this regard and as well as demonstrates that currently, any commercially available device is a valid element in preventing the recurrence of a stroke. These findings are in accordance with a recent European position paper [24]. This allows the operator a relative freedom of choice in select- Table (ranking of treatments).…”

“…These data are in agreement with a recent meta-analysis that demonstrated a fourfold increased risk of new onset AF in the PFO closure arm [27]. In the literature, the incidence of these events was lowest with the AMP device [24]. The higher rate of AF in the PFO group may be attributable to several sources such as device triggered arrhythmia and inflammatory mechanisms [28][29][30].…”

“…We further conclude that in our NMA analysis, MT has shown to produce a significant decreased incidence of AF compared to PFO closure (relative risk ratio 400%; absolute risk ratio 4%; NNH 25; 95% Cr.I. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. These data are in agreement with a recent meta-analysis that demonstrated a fourfold increased risk of new onset AF in the PFO closure arm [27].…”

Kriptogeninis jauno amžiaus insultas ir kanapių vartojimas: atvejo pristatymas ir literatūros apžvalga

“…Mû sø pa cien tui ul tra gar si niu ty ri mu, at lik tu ið kar to po su sir gi mo, ko jø ve no se trom bø ne nu sta ty ta, o du bens ve nos ne ver tin tos. Be to, trom bø ne nu sta ty mas ne pa nei gia ve ni nës trom bo em bo li jos ga li my bës [21]. Esant AOA su nuos rû viu ið de ði niø jø ðir dies ert miø á kai ri à sias, ga li ma pa ra dok si në em bo li za ci ja á sme ge nis, ta èiau ið kar to po susir gi mo nu sta ty ta nor ma li D-di me rø kon cen tra ci ja ver èia abe jo ti ðiuo in sul to me cha niz mu.…”

The paradoxical embolism phenomenon in patients with embolic cryptogenic stroke

“…При ТКДГ возможно оценить функциональное значение ПЛ-шунта путем проведения пузырьковой пробы (ПП) -ТКДГ-ПП. Согласно положению по ведению пациентов с ООО Европейской кардиологической ассоциации 2019 г., ТКДГ-ПП обладает большей чувствительностью по сравнению с контрастной ТТЭхоКГ в качестве диагностической методики выбора при определении ПЛ-шунта [15].…”