Patent foramen ovale

Alakbarzade, Vafa; Keteepe-Arachi, Tracey; Karsan, Nazia; Ray, Robin; Pereira, Anthony

doi:10.1136/practneurol-2019-002450

Cited by 19 publications

(19 citation statements)

References 73 publications

(110 reference statements)

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“…Contrast‐enhanced Transcranial Doppler Ultrasonography (cTCD) with the agitated saline test was performed and showed a high degree of RLS (grade IV) with uncountable microembolic signals (the “curtain effect”). The shunt was classified as permanent because it was present under basal conditions without using the Valsalva maneuvre (Alakbarzade et al, 2020) (Figure 1a,b).…”

Section: Methodsmentioning

confidence: 99%

“…It is the most common anatomical cause of an interatrial right‐to‐left shunt (RLS). Patients with this congenital heart abnormality are usually asymptomatic because the defect is flap‐like and does not permit significant left‐to‐right shunting (Alakbarzade et al, 2020). However, some PFOs may open widely and provide a conduit for material such as thrombi, air or vasoactive peptides to travel from the venous to arterial circulation causing a paradoxical embolism.…”

Section: Introductionmentioning

confidence: 99%

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When orofacial pain needs a heart repair

Adamo

Calabria

Coppola

et al. 2020

Clinical & Exp Dental Res

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Objectives The association of chronic orofacial pain (COFP) and congenital heart disease has never previously been reported. We report the first case of COFP secondary to a right‐to‐left shunt (RLS) due to asymptomatic patent foramen ovale (PFO) in a patient with prothrombotic states. Materials and methods A 48‐year‐old female patient presented with a 10‐month history of left‐sided facial pain who was initially diagnosed with persistent idiopathic facial pain (PIFP) on account of its similar characteristics. Magnetic resonance imaging (MRI) of the brain revealed gliosis and carotid siphon tortuosity; in addition, hyperhomocysteinaemia due to the homozygosis mutation for 5,10 MethyleneTetraHydroFolate Reductase was identified. Transcranial doppler ultrasonography was requested from a neurology consultant which revealed a high degree of RLS. Subsequently, a cardiological evaluation was performed; the specialist requested a transesophageal echocardiography that detected an interatrial septum aneurysm with PFO. Results Based on the analysis of the patient's high degree of RLS, prothrombotic state and gliosis in relation to age, the cardiological consultant chose to perform a percutaneous closure of the PFO to avoid the risk of a cryptogenic stroke. After PFO closure, a complete remission of the pain was obtained. Conclusions The disappearance of the pain supports the possible association between RLS and COFP. PFO with RLS has been suggested as a risk factor for cryptogenic stroke, especially in association with other thromboembolic risk factors. Therefore, the early detection, in this case, could be considered a possible lifesaver. Communication between different care providers is essential when the patient presents symptoms of facial pain which are of an atypical nature.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

When orofacial pain needs a heart repair

Adamo

Calabria

Coppola

et al. 2020

Clinical & Exp Dental Res

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“…The patient’s activity at symptom onset may provide an insight to stroke mechanism, for example, neck manipulation or trauma (cervical artery dissection), or Valsalva (paradoxical embolism via a patent foramen ovale). As these are relatively common causes of ischaemic stroke, particularly in the context of risk factors for venous thromboembolism in people with patent foramen ovale,7 we do not discuss them further here.…”

Section: Historymentioning

confidence: 99%

“…6 In this article we outline a practical approach to diagnosing uncommon causes of ischaemic stroke by highlighting 'red flags' in the history, examination and initial investigations; for the patients so identified, we also propose a structured approach to investigations beyond the 'standard' ischaemic stroke work-up. We focus on conditions that have a direct and proven mechanistic association with ischaemic stroke, but will not dwell on patent foramen ovale 7 and cerebral venous sinus thrombosis (CVST; including both cerebral venous sinus thrombosis and cortical vein thrombosis), which have both recently been reviewed in Practical Neurology. 8 Furthermore, monogenic causes of ischaemic stroke will be addressed in a forthcoming article in this series so will not be covered in detail.…”

Section: Introductionmentioning

confidence: 99%

Uncommon causes of ischaemic stroke: how to approach the diagnosis

et al. 2022

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Stroke is a common neurological emergency and although most cases are associated with traditional vascular risk factors leading to cerebral ischaemia by well-recognised pathophysiological mechanisms, around 4% of ischaemic strokes are due to rare conditions. These are important to recognise due to their different management, which is often specific and effective, and due to their different prognosis from otherwise cryptogenic ischaemic strokes. We outline a practical approach to identifying uncommon causes of ischaemic stroke by highlighting diagnostic ‘red flags’ and propose a structured approach to investigating them.

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“…So far, its etiology and exact pathophysiology remain obscure (2,4). Growing body of evidence reveals an association between mid to large RLS through the PFO and migraine (5)(6)(7). The foramen ovale is a flap-like communication in the atria septum secundum after birth, which is present in ∼25% of adults (8).…”

Section: Introductionmentioning

confidence: 99%

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

2020

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Objective: This study aimed to develop and validate a nomogram to predict cessation of patent foramen ovale (PFO) patients with migraine headache after percutaneous closure. Methods: A total of 247 eligible patients with PFO and migraine after percutaneous closure between May, 2016 and May, 2018 were divided into a development cohort (n = 149) and a validation cohort (n = 98). The primary end point was cessation of migraine at follow-up of 1 year after the procedure measured by the Migraine Disability Assessment Score (MIDAS). In the development cohort, the LASSO regression was used data dimension reduction. A multivariable logistic regression analysis was used to develop the predicting nomogram. The performance of the nomogram was assessed by concordance index (C-index), calibration and clinical usefulness. The results were validated in the validation cohort. Results: Migraine with aura, history of antiplatelet, and the right-to-left shunt (RLS) at rest were identified as significant predictors based on the analysis of multivariate logistic regression. The nomogram incorporating these variables showed good calibration and discrimination in the development cohort with C-index of 0.906 (95% CI: 0.847-0.965), which was confirmed using the validation cohort with C-index of 0.827 (95% CI: 0.751-0.903). The nomogram showed good agreement between prediction by nomogram and actual observation. Furthermore, the decision curve indicated that the novel nomogram was clinically useful. Conclusion: The novel nomogram showed favorable predictive accuracy for cessation of migraine among patients with PFO after percutaneous closure and might provide constructive guidance in clinical decision making.

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Patent foramen ovale

Cited by 19 publications

References 73 publications

When orofacial pain needs a heart repair

When orofacial pain needs a heart repair

Uncommon causes of ischaemic stroke: how to approach the diagnosis

A Nomogram for the Prediction of Cessation of Migraine Among Patients With Patent Foramen Ovale After Percutaneous Closure

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