Paradoxical Embolism

Thompson, Theodore; Evans, William

doi:10.1093/qjmed/os-23.90.135

Cited by 249 publications

(80 citation statements)

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“…Definite confirmation of paradoxical embolism essentially requires the detection of a right atrial thrombus crossing the foramen ovale. 16,17 However, direct observation of this phenomenon during life is rarely possible and remains confined to isolated echocardiographic reports. 18 -21 In clinical practice, the diagnosis of paradoxical embolism is almost always presumptive and relies on (1) the occurrence of an arterial thromboembolic event in the absence of atrial fibrillation, disease of the left side of the heart, or severe atherosclerosis of the thoracic aorta; (2) the detection of right-to-left shunt, usually through a PFO or an atrial septal defect; and (3) the presence of venous thrombosis or pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

et al. 1998

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Background-Right-to-left shunt through a patent foramen ovale is frequently diagnosed by contrast echocardiography and can be particularly prominent in the presence of elevated pressures in the right side of the heart. Its prognostic significance in patients with pulmonary thromboembolism, however, is unknown. Methods and Results-The present prospective study included 139 consecutive patients with major pulmonary embolism diagnosed on the basis of clinical, echocardiographic, and cardiac catheterization criteria. All patients underwent contrast echocardiography at presentation. The end points of the study were overall mortality and complicated clinical course during the hospital stay defined as death, cerebral or peripheral arterial thromboembolism, major bleeding, or need for endotracheal intubation or cardiopulmonary resuscitation. Patent foramen ovale was diagnosed in 48 patients (35%). These patients had a death rate of 33% as opposed to 14% in patients with a negative echo-contrast examination (Pϭ.015). Logistic regression analysis demonstrated that the only independent predictors of mortality in the study population were a patent foramen ovale (odds ratio

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Section: Discussionmentioning

confidence: 99%

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

et al. 1998

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“…40 -50 PFO frequency and size may vary by age. 48,49 Given the high prevalence of PFO in the general population and the variability in PFO size, its size may be an important factor in determining the importance of an individual PFO to act as a conduit for paradoxical embolization.…”

Section: Factors Associated With Paradoxical Embolization Atrial Anatomymentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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“…Atrial septal aneurysm and patent foramen ovale Patent foramen ovale was found in 27 to 35%of autopsy series (58,59). However, using transthoracic or transesophageal contrast echocardiography, patent foramenovale has been reported to be present in only 3.2 to 22% (average: 12%) of normal subjects (18, 20-26).…”

Section: Discussionmentioning

confidence: 99%

Transesophageal Echocardiographic Detection of Cardiac Sources of Embolism in Elderly Patients with Ischemic Stroke.

Okura¹,

Inoue²,

Tomon³

et al. 1999

Intern. Med.

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Objective The aim of this study was to clarify the role of transesophageal echocardiography in detecting cardiac sources of embolism in elderly stroke patients. Methods Weperformed transesophageal echocardiography in 77 patients>70 years old (mean 76.9) with ischemic stroke and investigated embolic sources. Thirty-seven patients were in sinus rhythm (SR) and 40 in atrial fibrillation (Af). Results Left atrial spontaneous echo contrast was detected in 73%of Af and in 14%of SR (p<0.01). Left atrial thrombus was present in 10%ofAf and none of SR (p<0.05). Patent foramen ovale, atrial septal aneurysm, and aortic atherosclerotic plaque>4.0 mmin thickness in the proximal aortic arch were more commonlyfound in patients with SR. Conclusions In elderly ischemic stroke patients, 1) Left atrial spontaneous echo contrast and thrombus are more commonlydetected in patients with Af, reflecting left atrial enlargement and blood stasis, and 2) atrial septal aneurysm, patent foramen ovale and aortic atherosclerotic plaque>4.0 mmin thickness in the proximal aortic arch are important findings in patients with SR. (Internal Medicine 38: 766-772, 1999) Key words: cerebral embolism, embolic source, diagnosis IntroductionRecently, hemorrhagic stroke has remarkably decreased in Japan. However, the prevalence of ischemic stroke has shown a rather gradual decrease. Furthermore, the morbidity and mortality of ischemic stroke is still high and has increased with advancing age (1, 2). Therefore, it is still a major concern for us to determine how to prevent and manage elderly patients with ischemic stroke.For editorial comment, see also p 753.Previous reports suggest that 6-39%of ischemic stroke are caused by cardiogenic emboli (3-8). Left atrial spontaneous echo contrast and thrombus formation associated with atrial fibrillation have been reported as one of the most important cardiac sources of embolism (9-13). Using transesophageal echocardiography, other possible sources of embolismincluding atrial septal aneurysm (14-19), patent foramen ovale (18,(20)(21)(22)(23)(24)(25)(26)(27) and aortic atherosclerotic plaque (28-40) have been reported as independent risk factors of ischemic stroke. However, previous studies have not showncharacteristics of an embolic source in an elderly patient with ischemic stroke. Therefore, we designed this study to characterize the sources of embolism in elderly ischemic stroke patients with both sinus rhythm and atrial fibrillation and to clarify the role of transesophageal echocardiographic examination in elderly patients. Subjects and MethodsBetween June 1995 and September 1997, we recruited patients older than age 70 years with "completed ischemic stroke" referred to the echocardiography laboratory of Kobe Rehabilitation Hospital for a transesophageal echocardiographic examination. The study group consisted of 77 consecutive patients (47 men and 30 women, age ranged 70 to 90 years, mean 76.9±4.4 years). Thirty-seven patients were in sinus rhythm (SR) and 40 in atrial fibrillation (Af).All patients underwe...

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Paradoxical Embolism

Cited by 249 publications

References 0 publications

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

Patent Foramen Ovale Is an Important Predictor of Adverse Outcome in Patients With Major Pulmonary Embolism

Patent Foramen Ovale and Stroke

Transesophageal Echocardiographic Detection of Cardiac Sources of Embolism in Elderly Patients with Ischemic Stroke.

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