Is Surgical Closure of Patent Foramen Ovale the Gold Standard for Treating Interatrial Shunts? An Echocardiographic Follow-up Study

2005 ◽  
Vol 18 (12) ◽  
pp. 1385-1391 ◽  
Author(s):  
Birke Schneider ◽  
Rudolf Bauer
Keyword(s):  
Gold Standard ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Follow Up Study

Surgical Patent Foramen Ovale Closure for Prevention of Paradoxical Embolism–Related Cerebrovascular Ischemic Events

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Joseph A. Dearani ◽  
Baran S. Ugurlu ◽  
Gordon K. Danielson ◽  
Richard C. Daly ◽  
Christopher G. A. McGregor ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Ischemic Events ◽  
Pfo Closure

Background —The role of surgical closure of patent foramen ovale (PFO) for cerebral infarction (CI) or transient ischemic attack (TIA) resulting from paradoxical embolism is unclear, and its effect on recurrence is unknown. Our objective was to determine the outcome of surgical closure of PFO in patients with a prior ischemic neurological event, define the rate of CI or TIA recurrence after PFO closure, and identify risk factors for these recurrences. Methods and Results —We retrospectively analyzed 91 patients (58 men, 33 women) with ≥1 previous cerebrovascular ischemic events who underwent surgical PFO closure between April 1982 and March 1998. The presence of a PFO with a right-to-left shunt was confirmed with transesophageal echocardiography. Mean age was 44.2±12.2 years. The index event was a CI in 59 and a TIA in 32; a Valsalva-like episode preceded the event in 15 patients. Deep venous thrombosis was documented in 9 patients, and a hypercoagulable state was identified in 10. Surgical closure was performed with extracorporeal circulation by either direct suture (n=82) or patch closure (n=9). Limited incisions were used in 18.7% of patients. There was no operative mortality. Morbidity included transient atrial fibrillation (n=11), pericardial drainage for effusion (n=4), exploration for bleeding (n=3), and superficial wound infection (n=1). Follow-up totaled 176.3 patient-years, and mean follow-up was 2.0 years. No one had a CI, and 8 had a TIA during follow-up, with 1 caused by temporal arteritis. Transesophageal echocardiography demonstrated all closures to be intact in these patients. The overall freedom from TIA recurrence during follow-up was 92.5±3.2% at 1 year and 83.4±6.0% at 4 years. Having multiple neurological events before PFO closure was the only significant risk factor for TIA or CI recurrence after closure by univariate analysis ( P =0.05); the small number of post-PFO closure cerebral ischemic events precluded multivariate analysis. Conclusions —Surgical closure of PFO can be performed with minimal morbidity and mortality. PFO closure may decrease the risk of recurrent stroke or TIA and may avoid lifelong anticoagulation in the young adult if there is no other indication. Recurrent cerebrovascular ischemic events after surgery should prompt further evaluation to identify causes other than paradoxical embolism.

Could genetic analysis be useful in reducing cerebrovascular risk in hypertensive subjects with hyperhomocysteinemia and patent foramen ovale? A 2-year follow-up study

2010 ◽  
Vol 80 (3) ◽  
pp. 545-548 ◽  
Author(s):  
Alberto Mazza ◽  
Domenico Montemurro ◽  
Roberto L'Erario ◽  
Mauro Chinaglia ◽  
Cristian Piergentili ◽  
...  
Keyword(s):  
Genetic Analysis ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Follow Up Study ◽  
Cerebrovascular Risk

scholarly journals Patent foramen ovale in a cohort of young patients with cryptogenic ischemic stroke

2005 ◽  
Vol 63 (2b) ◽  
pp. 427-429 ◽  
Author(s):  
Marcus Tulius T. Silva ◽  
Roíza Rodrigues ◽  
João Tress ◽  
Rosaura Victer ◽  
Francisco Chamiê
Keyword(s):  
Ischemic Stroke ◽  
Patent Foramen Ovale ◽  
Young Patients ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Surgical Closure ◽  
Small Series ◽  
Percutaneous Device ◽  
Ischemic Events

OBJECTIVE: Although its role is a matter of debate, some studies described a higher prevalence of patent foramen ovale (PFO) and atrial septal aneurysm (ASA) in young stroke patients, with higher risk with PFO / ASA association (OR 4.96). The aim of this study was determine the prevalence of PFO and ASA in a cohort of cryptogenic ischemic stroke (IS) patients younger than 55 years and to follow-up after surgical or percutaneous endovascular closure (PEC). METHOD: In 21 months we identified all patients less than 55 years old with IS who were admitted to our hospital. Cryptogenic IS was considered if there is not an identifiably cause to cerebral ischemia. Transesophageal echocardiography (TEE) was performed in all patients. After interatrial septal abnormalities diagnosis, percutaneous device closure was offered to all. Patients were followed monthly and keeped with oral AAS or Clopidogrel. RESULTS: We identified 189 patients with IS and 32 were less than 55 years old (16.9%). In 29 the IS was cryptogenic. TEE was performed in all patients and some form of interatrial septal abnormality was identified in 12 (12/29 - 41.3%); 5 had a PFO and in 7 there was PFO plus ASA. Ten patients were submitted to PEC and 2 were submitted to surgical closure. In mid-term follow-up (28 months) no ischemic events occurred and 2 patients related disappearance of migraine symptoms. CONCLUSION: Our small series description is in accordance with other studies and suggests a possible relation between interatrial septal abnormalities and IS in a cohort of young patient.

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