Patent Foramen Ovale in Young Stroke Patients

Webster, Mark; Smith, Heidi J.; Sharpe, D. N.; Chancellor, Andrew; Swift, Damon L.; Bass, N. M.; Glasgow, G. L.

doi:10.1016/s0140-6736(88)92944-3

Cited by 754 publications

(440 citation statements)

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“…This proved to be very important, affecting 54% or more of the patients. Other prospective echocardiographic studies by WEBSTER et al [6] (50%) and JEANRENAUD et al [7] (70%) confirmed similar high results.…”

Section: Introductionsupporting

confidence: 67%

Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale

Guffi¹

2003

Rev Bras Cir Cardiovasc

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Introduction: Prevention of recurrent cryptogenic strokes or transient ischemic attacks in adults with patent foramen ovale (PFO) represents a therapeutic challenge. Antithrombotic pharmacological treatment is widely used, but its indication is limited because of its significant complications.Objective: To demonstrate the efficacy of the surgical closure of patent foramen ovale (PFO) as prophylaxis secondary to cryptogenic strokes or transient ischemic attacks of undetermined origin.Method: In this study, 31 men and 16 women with previous ischemic cerebral events underwent direct surgical closure of the PFO. Mean age was 40 years (from 27 to 59 years). No coexisting cause of the stroke was found after extensive investigation, including blood coagulation tests, transesophageal contrast echocardiography (TEE), extracranial and transcranial doppler ultrasonography, 24-hour electrocardiographic monitoring, brain magnetic resonance (BMR) and CT scan. Criteria for operation also included at least two of the following: atrial septal aneurysm, multiple cerebral infarcts, multiple cerebral events and a history of Valsalva strain before stroke. Before operation, only one patient had two shunts (1 PFO and 1 intrapulmonary shunt).Results: No complications occurred during or after the operation, but a few hours after the operation transient arrhythmias developed in four patients without atrial fibrillation, hemodynamic instability nor embolism. All patients survived in class I (NYHA) and during a mean followup of 36 months, no patient had recurrence of the stroke or transient ischemic attacks. All patients prospectively underwent BMR and contrast TEE with simultaneous transcranial doppler ultrasonography. A residual right-toleft shunt, smaller than the preoperative one, was observed in only one patient, whereas no lesion was seen on the BMR.Conclusion: It is concluded that surgical closure of PFO in patients with presumed paradoxical embolism is safe and avoids recurrent stroke.Descriptors: Stoke. Heart septum, surgery. Embolism paradoxical. Cardiovasc 2003; 18(3): 242-252 Rev Bras Cir

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Section: Introductionsupporting

confidence: 67%

Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale

Guffi¹

2003

Rev Bras Cir Cardiovasc

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“…[1][2][3][4] The number of patients in each report, however, was small. In this study, with a significantly larger number of patients, we confirm that PFO is associated with cryptogenic stroke.…”

Section: Discussionmentioning

confidence: 94%

Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale

et al. 2002

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for the PFO in Cryptogenic Stroke Study (PICSS) Investigators* Background-Patent foramen ovale (PFO) is associated with stroke, but there are no randomized studies to evaluate the efficacy of antithrombotic therapies. Methods and Results-The PFO in Cryptogenic Stroke Study was a 42-center study that evaluated transesophageal echocardiographic findings in patients randomly assigned to warfarin or aspirin in the Warfarin-Aspirin Recurrent Stroke Study. In this study, 630 stroke patients were enrolled, of whom 312 (49.5%) were randomized to warfarin and 318 (50.5%) to aspirin. Of these, 265 patients experienced cryptogenic stroke and 365 experienced known stroke subtypes. End points were recurrent ischemic stroke or death. PFO was present in 203 patients (33.8%). There was no significant difference in the time to primary end points between those with and those without PFO in the overall population (Pϭ0.84; hazard ratio 0.96; 95% CI 0.62 to 1.48; 2-year event rates 14.8% versus 15.4%) or in the cryptogenic subset (Pϭ0.65; hazard ratio 1.17; 95% CI 0.60 to 2.37; 2-year event rates 14.3% versus 12.7%). There was no significant difference among those with no, small, or large PFO (Pϭ0.41 for small PFO and Pϭ0.16 for large PFO; 2-year event rates for no, small, and large PFO, 15.4%, 18.5%, and 9.5%, respectively). There was no significant difference between patients with isolated PFO and those with PFO in association with atrial septal aneurysm (Pϭ0.84; 2-year event rates 14.5% versus 15.9%). In patients with PFO, there was no significant difference in the time to primary end points between those treated with warfarin and those treated with aspirin (Pϭ0.49; hazard ratio 1.29; 95% CI 0.63 to 2.64; 2-year event rates 16.5% versus 13.2%). Conclusions-On

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“…Frequent forms of presentation of paradoxical embolism include cryptogenic stroke, [1][2][3][4] peripheral embolism, 3,5 brain abscess, 6 and decompression sickness in underwater divers. 4,7,8 Although the underlying mechanism whereby PFO accounts for this phenomenon is unknown, it is thought to involve the passage of emboli from the right-to the left-sided cardiac chambers through the PFO.…”

mentioning

confidence: 99%

Percutaneous Transcatheter Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism

et al. 2002

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Background-Percutaneous transcatheter closure of patent foramen ovale (PFO) is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical embolism and PFO. Methods and Results-We report the immediate and long-term clinical and echocardiographic outcome of 110 consecutive patients (58 males, mean age 47Ϯ14 years) who underwent transcatheter closure of PFO because of paradoxical embolism between 1995 and 2001. Procedural success, defined as successful deployment of the device and effective occlusion (no, or trivial, shunt after device placement), was achieved in all (100%) patients. There was no in-hospital mortality, 1 device migration requiring surgical intervention (0.9%), and 1 episode of cardiac tamponade (0.9%) requiring pericardiocentesis. A progressive increment in full occlusion was observed (44%, 51%, 66%, and 71% at 1 day, 6 months, and 1 and 2 years, respectively, after device placement). At a mean follow-up of 2.3 years, 2 patients experienced recurrent neurological events (1 fatal stroke and 1 transient ischemic attack), representing an annual risk of recurrence of 0.9%. In addition, 4 (3.6%) of the patients required reintervention for device malalignment or significant shunt. Kaplan-Meier analysis showed a freedom from recurrent embolic events and reintervention of 96% and 90% at 1 and 5 years, respectively. Conclusions-Transcatheter closure of PFO is a safe and effective therapy for patients with paradoxical embolism and PFO. It is associated with a high success rate, low incidence of hospital complications, and low frequency of recurrent systemic embolic events.

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Patent Foramen Ovale in Young Stroke Patients

Cited by 754 publications

References 0 publications

Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale

Surgical prophylaxis secundary to cryptogenic stroke or transient ischemic attack in patients with patent foramen ovale

Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale

Percutaneous Transcatheter Closure of Patent Foramen Ovale in Patients With Paradoxical Embolism

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