Patent foramen ovale

Homma, Shunichi; Messé, Steven R.; Rundek, Tatjana; Sun, Yee Ping; Franke, Jennifer; Davidson, Karina W.; Sievert, Horst; Sacco, Ralph L.; Tullio, Marco R. Di

doi:10.1038/nrdp.2015.86

Cited by 123 publications

(126 citation statements)

References 152 publications

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“…Although many authors have confirmed the statistical association between PFO and unexplained neurological events especially in young patients, the causality has not been conclusively established. This is an area of clinical uncertainty and ongoing debate [58].…”

Section: Patent Foramen Ovalementioning

confidence: 99%

Role of echocardiography in patients with stroke

Nakanishi

Homma

2016

Journal of Cardiology

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Investigation of potential embolic source is an important diagnostic step in treating patients with ischemic stroke and transient ischemic attack. Cardiogenic embolism has been estimated to be the causative factor in 15-30% of all cases of ischemic stroke. Cardioembolic strokes are generally severe and recurrence and mortality rate high. Various cardiac disorders including atrial fibrillation, ventricular thrombus, valvular heart disease, cardiac tumors, and structural heart defects can cause cardioembolic stroke. Although the aortic arch is not a cardiac structure, it is usually considered under source of cardiac embolism (cardioaortic source) and is reviewed in this article. Echocardiography (both transthoracic and transesophageal) is a widely used and versatile technique that can provide comprehensive information of thromboembolic risk in patients with stroke. This article reviews potential cardiac sources of stroke and discusses the role of echocardiography in clinical practice.

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Section: Patent Foramen Ovalementioning

confidence: 99%

Role of echocardiography in patients with stroke

Nakanishi

Homma

2016

Journal of Cardiology

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“…() and Homma et al . (). In brief, shunts in the mammalian foetus (and, with a few small differences, in the avian embryo) occur through both intracardiac and external vascular mechanisms and structures.…”

Section: Cardiovascular Shunts In Ectothermic Vertebrates: Theories mentioning

confidence: 99%

“…The role of central vascular shunts in developing mammals has been considered in great detail, not only with regard to the basic biology of shunting in endotherms, but also because of their importance in human development and the management of pathologies during foetal development. It is not our intention to review here this material, largely of a clinical nature -we instead refer the reader to reviews in Achiron & Kivilevitch (2016), Anilkumar (2013), Araujo Junior et al (2016, Dzialowski et al (2011) andHomma et al (2016). In brief, shunts in the mammalian foetus (and, with a few small differences, in the avian embryo) occur through both intracardiac and external vascular mechanisms and structures.…”

Section: (7) Developmental Context (A) Endothermsmentioning

confidence: 99%

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

2019

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This review explores the long‐standing question: ‘Why do cardiovascular shunts occur?’ An historical perspective is provided on previous research into cardiac shunts in vertebrates that continues to shape current views. Cardiac shunts and when they occur is then described for vertebrates. Nearly 20 different functional reasons have been proposed as specific causes of shunts, ranging from energy conservation to improved gas exchange, and including a plethora of functions related to thermoregulation, digestion and haemodynamics. It has even been suggested that shunts are merely an evolutionary or developmental relic. Having considered the various hypotheses involving cardiovascular shunting in vertebrates, this review then takes a non‐traditional approach. Rather than attempting to identify the single ‘correct’ reason for the occurrence of shunts, we advance a more holistic, integrative approach that embraces multiple, non‐exclusive suites of proposed causes for shunts, and indicates how these varied functions might at least co‐exist, if not actually support each other as shunts serve multiple, concurrent physiological functions. It is argued that deposing the ‘monolithic’ view of shunting leads to a more nuanced view of vertebrate cardiovascular systems. This review concludes by suggesting new paradigms for testing the function(s) of shunts, including experimentally placing organ systems into conflict in terms of their perfusion needs, reducing sources of variation in physiological experiments, measuring possible compensatory responses to shunt ablation, moving experiments from the laboratory to the field, and using cladistics‐related approaches in the choice of experimental animals.

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“…1). In the course of a venous-arterial shunt, paradoxical embolism may occur, where venous emboli or thrombi may pass from venous to arterial circulation causing ischaemic strokes [3,4,5,6]. While diving, the PFO may be the route for gas bubbles that appear during normal decompression or in the course of the decompression sickness, which may then penetrate arterial vessels.…”

Section: Introductionmentioning

confidence: 99%

Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

Dziewiatowski¹,

Siermontowski

2019

Polish Hyperbaric Research

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Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

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Patent foramen ovale

Cited by 123 publications

References 152 publications

Role of echocardiography in patients with stroke

Role of echocardiography in patients with stroke

Cardiovascular shunting in vertebrates: a practical integration of competing hypotheses

Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

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