When to use femoral vein injection for diagnosis of patent foramen ovale-Effect of a persistent eustachian valve on right atrial flow patterns during contrast transesophageal echocardiography

2017 ◽  
Vol 34 (5) ◽  
pp. 768-772 ◽  
Author(s):  
Tat W. Koh
Keyword(s):  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Femoral Vein ◽  
Flow Patterns ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Eustachian Valve

scholarly journals Variations in right atrial flow patterns in the normal heart a potential contributor to cryptogenic stroke in the setting of patent foramen ovale

2015 ◽  
Vol 17 (Suppl 1) ◽  
pp. P28
Author(s):  
Jehill D Parikh ◽  
Jayant Kakarla ◽  
Kieren G Hollingsworth ◽  
Bernard Keavney ◽  
John J O'Sullivan ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Flow Patterns ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Normal Heart ◽  
Potential Contributor

scholarly journals 4D flow MRI assessment of right atrial flow patterns in the normal heart – influence of caval vein arrangement and implications for the patent foramen ovale

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173046 ◽  
Author(s):  
Jehill D. Parikh ◽  
Jayant Kakarla ◽  
Bernard Keavney ◽  
John J. O’Sullivan ◽  
Gary A. Ford ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Flow Patterns ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Normal Heart ◽  
4D Flow Mri ◽  
4D Flow ◽  
Caval Vein ◽  
Flow Mri

scholarly journals Accuracy and Reproducibility of Assessing Patent Foramen Ovale on Coronary Computed Tomographic Angiography: A Comparison with Transesophageal Echocardiography

2021 ◽  
Author(s):  
Li Xiong ◽  
Yingting Zeng ◽  
Tian Gan ◽  
Feifei Yan ◽  
Jiao Bai ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Predictive Value ◽  
Patent Foramen Ovale ◽  
Computed Tomographic Angiography ◽  
High Accuracy ◽  
Right Atrial ◽  
Foramen Ovale ◽  
Coronary Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Tomographic Angiography

Abstract This study was undertaken to determine if coronary computed tomographic angiography (CCTA) can help to assess patent foramen ovale (PFO) with high accuracy and reproducibility when compared to Transesophageal Echocardiography (TEE). In total, 75 patients (31 men, 44 women; mean age, 45 ± 9 years) with suspected PFO were evaluated using coronary CCTA and TEE. PFO tunnel length (TL) and the opening diameter of the left atrial entrance (ODLAE) and right atrial entrance (ODRAE), as well as contrast shunt (if present due to PFO), were measured by both modalities. PFO was detected in 67 patients with TEE. The sensitivity for the detection of PFO with CCTA was 85.3%; specificity, 71.4%; positive predictive value, 96.7%; and negative predictive value, 33.3%. Both modalities demonstrated good agreement in measuring TL and ODLAE of PFO. However, the ODRAE of TEE was different from that of CCTA (1.14 ± 0.4 mm and 1.45 ± 0.5 mm, respectively, p = 0.04). The intraobserver and interobserver variability and agreement for TL, ODRAE, and ODLAE of PFO were excellent between the two measurements. CCTA provided a method for detection of PFO with high accuracy and reproducibility compared with TEE. Therefore, CCTA is a practical and efficient alternative to TEE for PFO diagnosis.

Modified Technique to Control the Eutachian Valve During Transcatheter Closure of Atrial Septal Defect/Patent Foramen Ovale

2021 ◽  
Vol 23 (Supplement_D) ◽  
Author(s):  
Sahar El Shedoudy ◽  
Fatma Abo Elsoud ◽  
Eman El Dokhlaha ◽  
Reem Rashed ◽  
Mohammad Abdelghani
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Vena Cava ◽  
Right Atrial ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Eustachian Valve ◽  
Jude Medical

Abstract Objective to describe an approach to perform safe transcatheter closure of Atrial Septal Defect (ASD)/Patent Foramen Ovale (PFO) associated with large redundant Eustachian Valve. Background Transcatheter device closure of ASD/PFO is feasible in a great majority of patients. However, the presence of a huge mobile Eustachian Valve can compromise device placement. Patients and Methods Six patients (3 PFO and 3 ASD patients) with a huge redundant Eustachian valve were included. Two patients had PFO with long tunnel and were closed with Occlutech FigullaFlex II PFO occluders sized 23/25 and 27/30 respectively. The other PFO patient had an associated atrial septal aneurysm (ASA) and was closed with a 25 mm Amplatzer Multi-Fenestrated Septal Occluder “cribriform” device (St. Jude Medical – Abbott Vascular). The three ASDs were closed by regular ASD occluders (2 Flex II ASD Occluders sized 30 and 33 mm and 1 Amplatzer ASD Occluder sized 24 mm). Eustachian valve was successfully held with a steerable ablation catheter to deflect it against the lateral right atrial wall, keeping it away from the inter-atrial septum to prevent its entrapment or interference with the cable, the sheath or the device. Results All ASDs/PFOs have been successfully closed with no complications with free inferior vena cava (IVC) flow, with no residual inter-atrial shunt and the eustachian valve is not interfering with the device. Conclusions Safe percutaneous ASD/PFO closure can be achieved with proper control of a large redundant Eustachian valve.

scholarly journals Flow-driven right-to-left cardiac shunting in a patient with carcinoid heart disease and patent foramen ovale without elevated right atrial pressure: a case report and literature review

2020 ◽  
Author(s):  
Parinita Dherange ◽  
Nelson Telles ◽  
Kalgi Modi
Keyword(s):  
Heart Disease ◽  
Patent Foramen Ovale ◽  
Atrial Septum ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Heart Catheterization ◽  
Carcinoid Heart Disease ◽  
Foramen Ovale ◽  
Arterial Blood

Abstract Background Carcinoid heart disease is present in approximately 20% of the patients with carcinoid syndrome and is associated with poor prognosis. It usually manifests with right-sided valvular involvement including tricuspid insufficiency and pulmonary stenosis. Patent foramen ovale (PFO) is present in approximately 50% of the patients with carcinoid heart disease which is twice higher than the general population. Right-to-left shunting through a PFO can occur either due to higher right atrial pressure than left (pressure-driven) or when the venous flow is directed towards the PFO (flow-driven) in the setting of normal intracardiac pressures. We report a rare case of flow-driven right-to-left atrial shunting via PFO in a patient with carcinoid heart disease. Case summary A 54-year-old male with a metastatic neuroendocrine tumour to liver presented with progressive shortness of breath for 5 months. Patient was found to be hypoxic with oxygen saturation of 78% and examination revealed a holosystolic murmur. Arterial blood gas showed oxygen tension of 43 mmHg. A transthoracic and transoesophageal echocardiogram showed aneurysmal inter-atrial septum with a PFO, severe tricuspid regurgitation directed anteriorly towards the inter-atrial septum leading to a marked right-to-left shunt. Right heart catheterization showed right atrial pressure of 8 mmHg, mean pulmonary artery pressure of 12 mmHg, and normal oxygen saturations in the right atrium, right ventricle, and pulmonary arteries. The patient then underwent closure of the PFO along with tricuspid valve and pulmonary valve replacement at an experienced cardiovascular surgical centre and has been asymptomatic since. Conclusion Right-to-left shunting through a PFO in patients with normal right atrial pressure can be successfully treated with closure of the PFO. Thus, understanding the mechanism of intracardiac shunts is important to accurately diagnose and treat this rare and fatal condition.

scholarly journals Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis

2017 ◽  
Vol 9 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Seung-Jae Lee
Keyword(s):  
Ischemic Stroke ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Holter Monitoring ◽  
Precentral Gyrus ◽  
Foramen Ovale ◽  
Rare Presentation ◽  
Laboratory Findings ◽  
Abnormal Finding ◽  
Hand Motor Area

Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

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